Review – Pain Assessment & Management in the Pediatric Client

HESI-Comprehensive-Review-for-the-NCLEX-RN

Pain Assessment & Management in the Pediatric Client

Description: Historically, pain in  the  pediatric  population has been unrecognized or undertreated. Research has shown that children, including neonates and infants, experience pain. Untreated pain may lead to complications,  such as delayed recovery, alterations in sleep patterns, and alterations in nutrition.

Pain assessment is often referred to as the fifth vital sign.

Nursing Assessment

1. Verbal report by the child. Children as young as 3 years of age are able to report the location and degree of pain they are experiencing.
   1. Observe for nonverbal signs of pain, such as grimacing, irritability, restlessness, and difficulty in sleeping or feeding.
   2. Include the child’s parents in the assessment.
   3. Observe for physiologic responses to pain, such as increased heart rate, increased respiratory rate, diaphoresis, and decreased oxygen levels.
   4. Physiologic responses to pain are most often seen in response to acute pain rather than in response to chronic pain.
2. Analysis (Nursing Diagnoses)
   1. Acute pain related to . . .
   2. Anxiety related to . . .
   3. Disturbed sleep pattern related to . . .
   4. Ineffective infant feeding pattern related to . . .

Nursing Plans and Interventions

1. A pain rating scale appropriate for the child’s age and developmental level should be used.
   1. CRIES can be used with infants 32 to 60 weeks of gestational age.
   2. Pain Rating Scale (PRS) can be used with children 1 to 36 months of age.
   3. FACES Pain Rating Scale and the Poker Chip Scale can be used by children of preschool age and older (Fig. 5-1).
   4. Numeric Pain Scale can be used by children 9 years of age and older.
   5. The Oucher Pain Scale is  a  scale  used  for  chil dren 3 to 12 years of age with culturally specific photographs showing different levels of pain and discomfort.
   6. Documentation of a child’s self-report of pain is essential to effectively treating the child’s pain.
   7. A nonverbal child can be assessed using the FLACC pain assessment tool. This tool has the nurse evaluate the child’s facial expression, leg movement, activity, cry, and consolability.
2. Nonpharmacologic interventions
   1. They should be used according to the child’s age and developmental level.
   2. Infants may respond best to pacifiers, holding, and rocking.
   3. Toddlers and preschoolers may respond best to distraction. Distraction may be provided through books, music, television, and bubble blowing.
   4. School-aged children and adolescents may use guided imagery.
   5. Other interventions may include massage, application of heat or cold, and deep-breathing exercises.
3. Pharmacologic interventions
   1. Prior to administering a pain medication to a pediatric client, verify that the prescribed dose is safe for the child on the basis of the child’s weight.
   2. Monitor the child’s vital signs following administration of opioid medications.
   3. Children as young as 5 years  of  age  may  be taught to use a patient-controlled analgesia (PCA) pump.
   4. Children may deny pain if they fear receiving an IM injection.

Wong-Baker FACES Pain Rating Scale. (From Hockenberry MJ,Wilson D: Wong’s Essentials of Pediatric Nursing, ed 9, St. Louis, 2013, Mosby. Used with permission. Copyright Mosby.)