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pain reports and behaviors associated with these reports? Newborns & infants demonstrate knitted brows, squinted eyes with cheeks raised, eyes closed, crying, jerky or flailing movements & stiff posture in response to pain.
interpret pain reports and behaviors associated with these reports Infants & toddlers – restlessness or agitation, hyperalertness or vigilance, sleep disturbances & irritability.
interpret pain reports and behaviors associated with these reports Children & adolescents School-age children & adolescents may not exhibit distress in direct proportion to their pain intensity thus behavioral measures may not match child’s self report of pain intensity.
When pain medication does not last from one ordered dose to the next-what action should the Nurse take? Review child’s record to verify that opioid was given at appropriate dose & frequency before asking physician to modify child’s pain medication.
How would the Nurse best explain the PCA to a parent? method to obtain pain relief which allows child to control the amount of medicine received by using machine. It is programmed by HCP to limit amount of medicine child can get to what doctor ordered, ensuring safety.
What alternatives to analgesia would benefit a 2-year-old? Cutaneous stimulation – gently rub painful area, massage skin gently, and hold or rock the child. Distraction – engage a child in wide variety of pleasant activities that help focus attention on something other than pain & anxiety.
Neonatal infant pain scale (NIPS) measures procedural pain up to 6 weeks after birth
FLACC behavioral pain scale designed to measure acute pain in infants & young children following surgery & can be used until child is able to self report pain with another pain scale;
Pain location children 3 years & older can localize pain if given outline front & back of body
SELF REPORT PAIN SCALES child must be developmentally ready & able to understand concept of little or a lot of pain well enough to tell the nurse. Children 2-3 years of age are usually able to understand concept of “more or less”.
Oucher scale – self report scale - Caucasian, African American, and Hispanic children 3-12 yo;
FACES pain rating scale – (6 cartoon-like faces) for children with acute pain 3-6 years of age
Poker chip tool child is asked to pick up to 4 chips that best match pain felt
Word-graphic rating scale uses words for increasing pain intensity on 10-cm horizontal line
Adolescent pediatric pain tool human figure drawing, word-graphic rating scale, and list of words to describe pain.
What kind of pain control would be best for a child who must have a bone marrow aspiration? Child should be premedicated with analgesia & sedation (valium, versed, pentobarbital).
What instructions post-op should be provided to parents who are taking their child home after day-surgery? Make sure parents know that sudden increase in pain intensity may indicate development of complication requiring medical attention when efforts to manage child’s pain have been made.
How should the Nurse handle complaints of pain from a child with a cast? Assess color, temperature, capillary refill & ensure proper positioning.
What assessments should be made on a child after medication for pain? Be able to identify normal from abnormal vital signs by age. . Check for side effects of analgesics such as sedation, nausea, vomiting, itching, urinary retention & constipation. Assess the child for pain every 15-30 min following intravenous pain medication & 1 hr after oral pain medication
List the advantages of using a pain scale. They’ve been tested for validity (extent to which scale measures what it is supposed to measure) & reliability (extent to which the same score is obtained when a scale is used by different persons or by same person at different times).
Review the pain management/assessment techniques relative to various cultural and ethnic back-ground. Oucher scale for Caucasians, African Americans, and Hispanics. Infants & children may express pain but they are dependent upon parents & caregivers to recognize their pain & respond.
What alternatives to analgesia could be used for pain with lab samples? Involve parents to actively participate by holding, cuddling, massage, engaging in play, music, stories, rhythmic breathing, guided imagery