Pediatric Pain Management Learning Objectives

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Describe the consequences of untreated pain in children
Both behavioral and physiological consequences of untreated pain
Discuss the myths about pain in children
2 prevalent myths about the effects of pain medications on infants and child say that they put the children at risk of respiratory depression and physical addiction of pain medications
Other myths include: infants cannot feel pain, children have no memory of pain, children are not in pain if they can sleep, parents exaggerate their child’s pain, repeated painful experiences teach the child how to be more tolerant, children recover more quickly than adults, children tell you if they are in pain, and that children have a high risk of addiction
Examine the role of the nurse caring for a child in pain
Ass the pain by evaluating behavior and physiologic signs, using a developmentally appropriate pain assessment tool. Nurses should not rely on personal, subjective appraisals of behavioral and psychological indicators.
Apply knowledge of pain assessment and management when caring for a child in pain
Managing pain in children requires a calm environment, as well as non-pharmacologic and pharmacologic interventions
Pain Definition
Whatever the person experiencing the pain says it us, existing whenever the person says it does

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

Gate Control Theory
A gate mechanism in the spinal cord facilitates or inhibits the transmission of pain signal. Stimulation of the larger afferent nerves, which carry benign sensations, can blunt the transmission of pain signals
Pharmacologic Interventions for Pediatrics
Mild-moderate pain commonly receive acetaminophen. Moderate to severe acute and chronic pain commonly receive opioids
Non-Pharmacologic interventions for Pediatrics
Distractions, Breathing techniques, guided imagery, biofeedback, progressive muscle relaxation, hypnosis, acupuncture, topical heating and cooling, massage, and transcutaneous electrical nerve simulation
JCAHO Pain Standards (2001)
Standards for the assessment and management of pain

Patients are educated about pain and managing pain
Patients have the right to an appropriate pain assessment and management
The patient is monitored before and after a painful procedure

Childhood Developmental Tasks
Infant – Trust
Toddler – Autonomy
Preschooler – Initiative
Grade Schooler – Industry
Adolescent – Identity
Pain Assessment Scales
Infant: CRIES
Young Children: FLACC, VAS, FACES
School Aged/ Adolescent: Oucher, Adolescent Pediatric Pain Tool (pg. 975-977)
QUESTT Pain Assessment
Q – Question the child
U – Use a pain rating scale
E – Evaluate behavior and physiologic changes
S – Secure parental involvement
T – Take cause of pain into account
T – Take action and evaluate results
D – Document
Nursing Principles while caring for a child in pain
Family Centered Care, encourage parental participation, and comfort items from home
Goals of pain management
1) Relieve pain
2) Maximize function
3) Minimize side effects of medications
Non-pharmalogic intervention nursing strategies
Should supplement and not replace for pharmacologic interventions, enhance the effects of the analgesic, gives child a sense of control over pain
Pharmacologic intervention nursing strategies
WHO recommendations (pg. 970), Oral route preferred, use ATC, use topical anesthetic creams for procedures, IV provides steady blood level, morphine is gold standard for severe pain, avoid IM, no placebos lol
Important Considerations
Developmental and cognitive level, past experience, culture
Palliative Care
philosophy of care and an organized program for delivering care to children with life limiting conditions; focuses on enhancing quality of life for the child and family, minimizing suffering, and providing opportunities for growth and development
Hospice Care
philosophy of care that combines palliative and hospice care principles, hospice care is a philosophy that regards dying as a natural process and care of dying patients as including management of the physical, psychosocial, and the spiritual needs of the patient and family

Caring, not curing

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