session 7 The hospital child and child pain assessment Flashcards
what is family centred care and why is it used?
It requries involving the family in the process to reduce anxiety and stress, give feelings of control, promote feelings of trust, promotes feelings of value, worth and competence to care for their child, prepares family for care required at home- education
how does the nurse support coping in the child and parent?
talk at childs/ parents level of understanding- children need simple clear explanations
lots of reassurance
keep the parent or caregiver present
no painful procedures in their play area - this is done in the treatment room only
use play (bubbles, games, clowns,songs, therapuetic music)
older children can do school work on the ward
offer coping mechanisms to the parents and caregivers - anxiety transfers to the child
how would you explain an iv insertion/ needle to a child?
use a teddy to explain and demonstrate
explain that when the cannula is removed there is no needle left in the arm and that what is left is giving the vein “ a little drink”
If a child is going into theatre - saying that it is spidermans web shooter (propofol is white) can work if they are a little boy.
calming medication can be given for children who are needle phobic
In general, can giving opioids to children make them more prone to substance addiction - True or False
false
True or False - “children dont remember pain anyway”
False - studies have found neonates HR and vital signs increase when they smell alcohol - the same as IV solution and have associated this to pain.
What does pain indicate?
a neurological response to tissue injury and that there is something wrong
will all children display the signs of pain?
No itis individual - a child can state they are a 7/10 and be jumping on a bed and playing, intermittently guarding his abdoment with his hands, not wanting any medication for pain control and when taken to surgery had a perforated appendix
Why do children refuse pain medication?
They don’t like the taste
some see it as a worse alternative to the pain they are in
they can’t swallow a tablet and don’t realise there is a liquid alternative
What is the definition of pain
An unpleasant sensory and emotional experience with actual or potential tissue damage. Pain is subjective and learnt through the persons experiences
***What are the physchological consequences of unrelieved pain in children?
Respiratory - rapid breathing - alkalosis
- inadequate cough - atelectasis, pnuemonia
- inadequate lung expansion - decreased O2
Neurologic - SNS activity - tachycardia, ^BP, ^ICP, change
sleep and irritability
Metabolic - increased metabolic rate with stress
response - fluid and electrolyte losses
- ^release of hormones - altered nutritional
intake, hypoglycaemia
Immune - depressed immune & inflammatory responses -
^risk of infection with delayed wound healing
Gastrointestinal- decreased gastric acid secretions &
intestinal mobility = impaired gastrointestinal
functioning, poor nutritional intake, ileus
what is the pain tool used for a neonate
PIPPS premature infant pain profile
what is the pain tool used for a infant 0-23mths
CHIPPS children and infants postoperative pain scale
what is the pain tool for a toddler
FLACC (use in prelanguage development) Face Legs Arms Cry and Consolability
Used more than CHIPPS - used in infants and toddlers and developmentally delayed children
0 = no pain
1-3 = mild pain
4-6 = mod pain
6 ^ = severe pain
when assessing a child in pain what are the steps required? Using QUESTT acronym
QUESTT Question the child Use a pain rating scale Evaluate the behaviour and physiological changes Secure parents involvement Take cause of pain into account Take action & Evaluate results
how does development impact what pain a child is experiencing?
in the way they communicate the pain they are in
Infant - cant tell you = cry, withdraw,taut mouth
toddler - autonomy vs shame = protest, withdraw
preschooler - initaitive vs guilt = cry , guard body part
school age - industry vs inferiority = assume pain is
punishment for doing the wrong thing, body
image concerns
adolescents - identity vs role confusion = assume pain
will be treated, they assume you know what
they are thinking.
