1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 39 Pain Management in Children

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: A Child in Pain Assessment Nursing diagnosis Outcome identification, planning Implementation Outcome evaluation

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiology of Pain Acute pain Chronic pain Cutaneous pain Somatic pain Visceral pain Referred pain

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiology of Pain (cont’d) Gate-control theory –Distraction

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment: Type and Degree of Pain Infant Toddler, preschooler School age, adolescent

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment: Type and Degree of Pain (cont’d)

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment Pain experience inventory CRIES neonatal postoperative pain scale COMFORT behavior scale FLACC pain assessment tool Poker Chip Tool

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment (cont’d)

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment (cont’d) FACES pain rating scale Oucher pain rating scale Numerical or visual analog scale Adolescent Pediatric Pain Tool Logs and diaries

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment (cont’d)

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment (cont’d)

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment (cont’d)

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Management Dependent upon –Age –Degree of pain –Type of pain

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonpharmacologic Pain Management Distraction Substitution of meaning or imagery Thought stopping Hypnosis Aromatherapy, essential oils

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonpharmacologic Pain Management (cont’d) Magnet therapy Music therapy Yoga, meditation Acupuncture Crystal or gemstone therapy Herbal therapies

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonpharmacologic Pain Management (cont’d) Biofeedback Therapeutic touch, massage Transcutaneous electrical nerve stimulation Heat or cold application

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacologic Pain Relief Topical anesthetic cream Oral analgesia Intramuscular injection Intravenous administration Patient-controlled analgesia

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacologic Pain Relief (cont’d) Conscious sedation Intranasal administration Local anesthesia injection Epidural analgesia

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A 5-year-old boy has been crying when the nurse enters the room. He denies having any pain, although he is cradling his fractured left arm. What would be the most likely reasons he denies having any pain? A.He received an injection in the emergency room. B.He thinks he needs to be brave. C.He is afraid of going to sleep. D.He is afraid of the nurse.

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. He received an injection in the emergency room. Rationale: If children fear an injection, they may not be honest about their pain. Other methods and routes of managing pain must be considered in the pediatric population to avoid inflicting additional pain and fear with injections.

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Conscious sedation is a pain-management technique that is used with children. During conscious sedation for a preschooler, which of the following actions would be most important? A.Keeping the room absolutely quiet so the child can sleep. B.Assessing vital signs frequently, because they can become depressed. C.Asking the child to periodically count from 1 to 10. D.Keeping the child’s head in a dependent position.

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Assessing vital signs frequently, because they can become depressed Rationale: Conscious sedation is the use of a drug such as pentobarbital sodium to induce a conscious but sleepy state. Vital signs must be monitored closely to be certain the child’s vital centers do not become depressed.