The Child s Response to Pain Lecture 4 Review Concepts Developmental care Developmental versus chronological age Stages individual yet predictable Family centered care Stages of family development Family as client Mom knows the child very well Atraumatic care pain Cognizance of developmental impact Least traumatic care possible Most preparation possible Family presence What does illness hospitalization or surgery mean to a child and family Acute versus chronic New pain When did pain start Age of onset Cognitive level Knowledge of condition Impact on abilities Duration Pain injury or changes in appearance Ability for parents and caregivers to meet child s needs Stressors coping Environmental stressors Many times children won t verbalize how they feel Support systems Parent could be alone or surrounded by a nice network Look at whole unit Individualized Stress Response Major stressors Pain Bodily injury Loss of control Separation Changes in behavior Fear of unknown in enormous Patterns of coping How does illness hospitalization or surgery stress a child What affects their ability to cope The Pain Experience Pain is a subjective response to physical psychological stressors Each time a person feels pain physiologic psychological cognitive sociocultural spiritual factors influence the experience The more the pain is experienced the overall experience is changed Have YOU experienced pain Types of Pain Acute pain is usually temporary has a sudden onset is localized Rise in HR and RR usually results from tissue injury Somatic pain arises from nerve receptors often with N V Visceral pain arises from the body organs typically a dull pain that is poorly localized Referred pain is pain that is perceived in an area that is distant from the stimulus ex a person with appendicitis or chest pain Chronic pain is prolonged pain 6 mo Person needs to learn to cope with because it is here to stay Often unresponsive to treatment Categories Recurrent acute pain defined episodes Patient knows to brace for it On going time limited pain cancer or burns End is coming Chronic nonmalignant pain persists longer then anyone thinks it should Low back pain complain on and off forever Chronic intractable nonmalignant pain syndrome inability to cope Becomes a disability Central pain related to a brain lesion that produces bursts of impulses perceived as pain vascular lesion tumor trauma can look like seizures or a tick Phantom pain following amputation itching and tingling confusing to patient because their limb is no longer there tell child about ways to cope with this not necessarily that they will be like this for the rest of their life this could scare them Psychogenic pain pain in the absence of physiologic cause Response Perception Factors The physical response to pain involves specific neurologic changes for all therefore we have the same pain threshold Perception is different Perception varies with Culture Gender males shouldn t cry Age Development Older more pain threshold theoretically Past experiences implicates how one copes Supportive family develops healthy attitude Nursing Responsbilities Pain is whatever the person says it is therefore a nurse s attitude is important If child complains of pain your attitude must be that you want to help Goals of pain management reduce incidence severity of pain educate clients to communicate re pain so that we understand what they are feeling enhance client comfort satisfaction this in turn reduces post op complications shortens hospital stays Myths of Pain Medication Fear of addiction actual incidence less than 1 of population that population is different then using street narcotic drugs narcotic addiction is compulsive drug seeking behaviors may also experience chronic pain pain meds raise serotonin levels drug tolerance is involuntary physiologic need for increasing doses physical dependence is involuntary physiologic withdrawal we see the withdraw with babies that are born to mothers who are addicts Assessment Subjective information What is the client saying How is he behaving Verbal statemenets mean a great deal including a description of the pain Objective facts be careful you can be fooled Ask patient to show you where the pain is Flushing BP pulse respiration sweating restlessness oxygen sats Some responses are identical to respiratory failure Hypoxia is very much painful QUESTT Question the client Use the pain rating scales Evaluate behavior physiologic change Look at them before and after you medicate Secure family involvement Take cause of pain into account Take action evaluate results Evaluate child every hour when they are in pain Pain Measurement Tools Pain rating scales provide a subjective quantitative measure of pain scale must match client s cognitive abilities must use same tool for consistent measure Use scale plus interview questions to determine nursing action then record findings action evaluation on flow sheet and monitor Pain Scales Faces Scale 0 5 facial expression scale 3y 10yr Oucher Scale 0 100 real facial expression 3y 13y Numeric Scale 0 10 straight line or non visual 5y Glasses Scale 0 5 glasses filled with pain 6y 12y CHEOPS 6 behaviors that are scored by the nurse based on specific definition to quantify pain 1 7yrs after age 7 can use numeric works very well between nurses FLACC Face Legs Activity Cry Consolability 2 7yrs Pain Management Nonpharmacological methods lessen the perception of pain must be careful with assessment b c sometimes with a smart child they will suffer in silence ex playing music therapy rubbing back massage video games touch therapy Strategies for children distraction relaxation exercises Strategies for adults acupuncture hypnotism biofeedback TENS Pharmacological Management Right drug mild moderate or severe pain look at action of drug if severe you want fast action Right dose control pain without causing side effects dose is based on their weight if adolescent they metabolize medicine fast so you will see ranges for doses Right time around the clock although breakthrough pain may still occur Right Route most effective less traumatic route if child doesn t swallow pills don t give pills PCA patient controlled analgesia IV infusion device that patient controls can deliver a continuous baseline amount patient controlled bolus as needed usually morphine or hydromorphone Demerol is typically not given Evaluation Regardless of management careful nursing assessment evaluation of client comfort is essential