Ped's variations & NSG pain management

• Pediatric interventions go from least invasive to most invasive
• During pediatric assessments, want to prevent / minimize physical stressors

  Example: comfort holds
• Part of family centered care includes, preventing or minimizing child and family separation.
• Pediatric interventions can include promoting a sense of control, enhancing communication, and teaching children and families
• Pain: Sensory and emotional experience associated with actual or potential tissue damage
• Narcotics: opium derivatives used to treat and relieve pain
• This picture demonstrates the neural pathways of pain

  
• Gate-Control Theory Pain: Sensory & emotional experience where transmission of impulses and be adjusted.
• In the Gate-Control Theory of Pain, interneurons can act as "gates"
• Factors that influence the Gate-Control theory of pain include: experience, culture, individual tolerance, placebo effect, can activate the descending inhibitory nerves from the upper central nervous system
• General Principles of pain management in children

  • Perspective
  • Acute/Chronic
  • Painful consequences, challenges assessing pain
  • Paralyzed by ancient mythology
• Indicators for assessing pain

  • What the child is doing
  • How the child's body is reacting
  • How the child's behaviour has changed
• Assess children by using QUESTT

  • Question the child
  • Use pain rating scales
  • Evaluate behaviors & physiological changes
  • Secure the parents' involvement
  • Take into consideration: cause of pain
  • Take action & evaluate results
• This is a FLACC scale for pain: good to use for ages 7 months - 7 years or unable to communicate

  
• This is a FACES scale for pain: good for young children, drawback is having to understand which face correlates to current pain level

  
• This is a VAS (Numerical) scale for pain: 0 = no pain 10 = worst pain imaginable. Used for acute & chronic pain.

  
• Management of pain: Pharmacologic

  • Acetaminophen
  • Ibuprofen
  • Narcotic doses: weight base, need antagonist readily available
• Management of pain: Non-Pharmacologic

  • Behavioural (cognitive strategies)
  • Relaxation, Distraction
  • Biophysical- heat & cold applications
  • Massage and pressure
  • Coaching to cope
• Children are more sensitive to adverse effects with pain medications such as narcotics, particularly CNS and constipation
• Many children are opioid naive
• Parents may be nervous when you are giving pain medications to their children, and not all drugs have pediatric dosing.