NU 352 Peds Pain
What are behavioral measures in a child? How is assessment of these useful in children?
How does the child look? Me looking at the child. Vocalizations, crying, body movements, etc.
Any distress behaviors present? Sometimes difficult to determine if pain or another emotion like fear or anxiety.
Useful in infants and pre-verbal children.
Used in conjunction with other measures for children 4 years old and older.
What pain scale is commonly used for non-verbal patients?
FLACC. Most efficient btwn 2-7 years or if non-verbal. For those who have trouble describing their pain. If consolable, it might no even be pain.
Nurse assesses the face, legs, activity, cry, and consolability of patient who cannot describe pain at all.
What are some physiologic symptoms of pain?
HR, RR, BP all rise
Increased oxygen demand – main reason for increases
Queasy stomach – n/v
Pertinent for all ages
When are self reports of pain useful in children? What is a common pain scale for the verbal child?
Generally used for children 4 years old or greater.
Used in conjunction with other assessment measures.
There are multiple pain rating scales for children available.
Wong-Baker FACES scale: Let the child choose based on picture of face. Or the nurse could judge based on assessment of behavioral measures
When are multidimensional measures used for pain rating in a child?
Typically used in children 7-10 yrs of age or older.
Includes child having enough cognitive skill to describe/rank intensity, quality, and location of pain.
Several tools available
What are some cultural issues in pain assessment?
Unfortunately, many the tools we use have only been validated using white, English-speaking children.
Hispanics: observational scale and interviewing may not be reliable as self-report scales.
Chinese: have fewer errors if vertical scale used.
Also consider pain scales for other ethnic groups: Caucasian, African-American, Hispanic
What are the principles of pain assessment in children with chronic illnesses and complex pain?
Traditional pain assessments may not work.
Children with cancer have multiple pain areas so unable to isolate pain symptoms.
Other symptoms complicate assessment
nausea/vomiting, diarrhea/constipation, extreme fatigue
Ratings may not reflect actual degree of pain.
For kids with chronic pain trust makes a difference.
ADL’s, sleeping, eating, playing may all be affected by pain.
Important to assess OLDCART along with mood, function, and interactions.
What are some non-pharmacological pain management principles?
Communication is key
Before procedure-education parents/child appropriately
Distraction, relaxation, guided imagery, positive self-talk, thought stopping, behavior contracting
Infants – pacifiers, kangaroo care, swaddling
Fear, stress, and anxiety can make pain worse than it really is.
Educate the parents and the child on what to expect. If the parent is scared/stressed/fearful, the child knows and will react.
Want to be as honest as we can w/o scaring them to death. Don’t tell them a shot isn’t going to hurt. Tell them it’s a pinch but it’ll be over quick. But don’t tell them it’s going to hurt really bad either.
How is pain managed pharmacologically in the pediatric client?
Mild to Moderate Pain – NSAIDS/Tylenol
Moderate to Severe Pain - OPIOIDS
Coanalgesics - Not specifically for pain, but do have analgesic effects. Steroids for inflammation, nerve meds, antiemetics
Closely observe for side effects, priority is respiratory
Narcan reverses opioids. If note resp depression with a pt on a PCA, STOP THE PUMP and go get Narcan.
What are the principles of managing long-term opioids? How should a nurse handle addiction fears?
Parents of children that have long-term chronic pain are worried about addiction. Reassure them that their child is not addicted when the body becomes tolerant to a certain dose of medicines.
Physical Dependence is a physiological state that results in withdrawal syndrome after abrupt stoppage of the opioid. Expected occurrence in anybody that’s had long-term opioid use. Does not imply that they’re addicted, just implies that the body is dependent on it.
Tolerance a neuro adaptation that forms bc of the effects of opioids when they’re chronically used.
Addiction is characterized by a pattern of dysfunctional use. Could be where the child takes home the medicine, gets used to it, and wants it even when not in pain. Might want to medicate in anticipation of pain. Still addicted. Many times, will have adverse consequences if discharged w/ controlled substances.
Withdrawal can happen anytime you abruptly stop an opioid. Titrate off of the dose over time.
Initial signs of withdrawal: Lacrimation, rhinorrhea, yawning, sweating
Later signs: Increased restlessness, irritability, tremors, anorexia, dilated pupils, n/v, goosebumps.
What are some common pain sites in children?
Pain in primary care- ear infections, strep, herpangina
Invasive procedures – lab draw, finger pricks
Burns – hard to control multi-dimensional, have to medicate frequently
Recurrent headaches, might be braces, might be eye problems and they need glasses
Recurrent abdominal pain – at least 1x a month for 3 months w/ periods of pain free time, may have GERD if they have epigastric pain and it's worse at a certain time of day
Pain with sickle cell disease, want to treat as short as possible
Cancer pain – could be caused by chemo
Why do we treat pain?
To improve the quality of our client’s care
There are consequences to untreated pain or poorly managed pain.
-Prolong the stress response
-Adversely affect recovery especially if they can’t participate in activities of recovery
-Predispose to chronic pain syndromes