Pediatric Pain Assessment & Nursing Interventions PPT

what are the 3 types of measures to assess child’s pain?

behavioral, physiologic, and self-report

what behavioral things would you look at to assess a child’s pain?

sleep, emotions, physical fxn

what physiologic things would you look at to assess a child’s pain?

HR, RR, appearance

what self-reported things would you look at to assess a child’s pain?

use validated and age approved (not too young; 3yrs +)

what’s the NIPS scale?

Neonatal Infant Pain Scale

what age is the NIPS Scale used for?

birth to 12 mo

what does the NIPS scale look at?

facial expression, cry, breathing, arms, legs, and alertness

what is the CRIES scale used for?

postoperative pain management in infants (NICU too); birth to 6 mo

what is in the CRIES scale?

Crying,

Requires SpO2,

Increased vital signs,

Expression,

Sleeplessness

what are some general ways an infant would express pain?

• generalized response of rigidity, thrashing

• loud crying

• facial expressions of pain (grimace)

• no understanding of relationships between stimuli and subsequent pain

what are some general ways a child would express pain?

• loud crying, screaming

• verbalized “ow, “ouch”, “it hurts”

• thrashing limbs

• attempts to push away stimulus

• stalling behavior (“wait a minute”)

what is the FACES pain scale?

• used for 3 yrs +

• has a pain scale with faces on it

what demographic is at a greater risk for undertreatment of pain?

pain in children with communication and cognitive impairment — why the primary caregiver is such an important source of information

what age is the CRIES scale used for?

32 weeks gestation to 6 mo

what is the FLACC scale stand for?

Face

Legs

Activity

Cry

Consolability

what are some common pharmacological ways to manage pain in children?

acetaminophen, ibuprofen, fentabyl, morphine, dilaudid (NO motrin younger than 6 mo)

what are some common NONpharmacological ways to manage pain in children?

distracting, soothing, “sweeties”-sugar that you put in pacifiers w holes — child life specialists are your bffs

what are the general portions of a pain assessent?

• trust (a trusting relationship with child and family)

• onset - when did it start?

• duration - episodic? chronic? pattern?

• treatment - effective?

• influences - anything making it worse or bettter?

why might acetaminophen not be your #1 option for fever anagement of a child?

bc it doesn’t have anti-inflammatory effects

what’s the gold standard med for pain management of children?

morphine

refer to picture of pain scale summaries

refer to picture of pain scale summaries

to be legal, informed consent must be…

1. competent (conscious

2. voluntary (parents until 18, BUT the kid still has autonomy)

3. informed on everything (all parts: risks, alternatives, and the full explanation)

who is an emancipated minor?

a child who is under 18, but has full ability to make legal and medical decision independently

what is minor assent?

getting permission for a procedure or anything really that’s from a MINOR/child of any age — really important for reproductive consent (mom wanting to get a vaginal exam of child — you cannot force this exam)

what are some ways to improve the compliance (maintaining care and continuing care in recovery or illness) of a child?

1. family support

2. reminders

3. good communication

4. set out clear expectations for success

what are some ways to reduce anxiety in kids before a procedure?

• establish trust

• use the parent(s)

• give child control

• distraction

• imagery

• relaxation

• others… play, incorporating explanation in play; play therapy, involving the child

what are some important components and procedures for children?

• the treatment room

• expecting success

• distracting the child

• allowing expression of feelings

• praising the child

• therapeutic holding

• restraints/swaddling tactics

what are some very important features of safety that you should always be checking and thinking about for infants?

• general: name bands, identifiers, their environment, and activity supervision

• infection control: handwashing (children are always watching) & hygiene

what are the characteristics of a straight cath for an infant?

• you cath them 100% if they’re not potty trained

• it has to be sterile!! (bag cath isn’t sterile, so you can’t culture it for antibiotic specificity)

what are the characteristics of a stool collection for an infant?

can be straight from diaper (usually done for blood)

how many oz are in 1lb?

16

how many lbs are in 1kg?

2.2 lbs

what is the rule for oral meds in peds?

they must be given in liquid or suspension form (bc children often can’t swallow tablets)

what are some ways to give oral meds to infants?

oral syringe, cup, or spoon — depends on the

what should you ensure happens if giving enteric-coated tablets?

to NOT crush these

what’s an important note for giving oral meds for newborns/infants?

they have immature live & kidneys so they’ll have delayed metabolism & elimination

how do you determine drug dosage for children?

by kg of body weight!!

what is the preferred abd best site for IM injections?

vastus lateralis

how’s the site choice for IM meds chosen?

based on muscle development & child’s size

what should the needle length be for child IM injections?

.5 to 1 inch

what should the needle gauge be for child IM injections?

22-25 gauge

what shoul dyou do dosage-wise for IM meds?

you calculate to the nearesr hundredth, and use theTB syringe

what age is the NIPS scale for pain used for?

neonate pain— birth to 12 mo

what age is the CRIES pain scale used for?

32 weeks gestation to 6 mo

what age is the FLACC pain scale used for?

2 mo to 7 years old (nonverbal or preverbal children)

what does the NIPS scale measure?

neonate pain; facial expression, crym breathing, arm/leg movement, and state of arousal

what does the CRIES scale measure?

crying, oxygen need, vital signs, expression, & sleeplessness

what does the FLACC scale measure?

face, legs, activity, & cry consolability

what does a 0-2 on the NIPS scale indicate?

that a neonate is in minimal/no pain

what does a 3-4 on the NIPS scale indicate?

that a neonate is in mild-moderate pain

what does a 5 or greater on the NIPS scale indicate?

that a neonate is in severe pain

for all major pediatric pain scales (NIPS, CRIES, and FLACC), was does a low score indicate?

that they’re in less/no pain

for all major pediatric pain scales (NIPS, CRIES, and FLACC), was does a high score indicate?

they’re in pain/severe pain

what score for all major pediatric pain scales (NIPS, CRIES, and FLACC) would indicate the child is in severe pain?

7 or greater (NIPS cap= 7)

when giving oral meds to a child, what should their positioning be?

upright or held sideways on lap to prevent aspiration

what is a plastichood/ “oxyhood” an example of?

oxygen therapy devices

when are nasal cannula prongs used on a child?

for less than 3L ONLY and are referred to as “oxygen tents”

how, put shortly, would you use a metered-dose inhaler?

shake med → attach mouthpiece to rubber side of spacerf → breath all air OUT of lungs and make seal around mouth piece → press inhaler down to release med → breathe in slowly and deeply → hold breath for 5-10 sec, then breathe out slowly (if you can’t then breathe in and out slowly)

how, put shortly, would you use an epi pen?

blue to the sky, orange tip pointing down → remove blue safety cap (pull straight up, no twisting) → place orange top against middle of outer thigh → swing and push auto-injector firmly into thigh until click → hold in place for 3 sec → safety will auto cover needle after