Chapter 14: Pain Management in Children - ML6
The nurse is working with a 5-year-old boy who must receive repeated intravenous injections as part of his treatment. He hates the injections, however, and is frightened whenever he sees the syringe and needle. In an attempt to overcome this fear, the nurse holds the syringe up for him to see and tells him, "This looks kind of like a space rocket, don't you think? Here comes the space rocket—it needs to refuel." Which pain management technique is the nurse using here?
Imagery
The nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priority following administration of the medication?
Monitor the client's respiratory status.
The nurse is caring for a 5-year-old child who underwent a painful surgical procedure earlier in the day. The nurse notes the child has not reported pain to any of the nursing staff. Which action by the nurse is indicated?
Observe for behavioral cues consistent with pain.
The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond?
Give the mother the FACES pain rating scale to use with her son.
A 5-year-old child has been admitted to the hospital and is going to have an IV started in the procedure room. Which instructions will be most helpful for the child and the parent?
Have the parent sing softly to the child during the procedure.
A nursery nurse is explaining to a new parent about how to assess the newborn for pain. Which manifestation indicates that an infant is in pain?
inability to be consoled
When providing education to a parent regarding pain management for a toddler with otitis media, which statement by the parent indicates further teaching is needed?
"I should give my toddler one baby aspirin."
The nurse is caring for a client who is in a sickle cell crisis. The child is hospitalized for pain management during the crisis. The parents tell the nurse that they do not think their child needs any pain medication because the child is sleeping a lot. How should the nurse respond?
"I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."
The health care provider has prescribed patient-controlled analgesia (PCA) for a 12-year-old child who just underwent an appendectomy. The nurse has provided education to the child and parents. Which response(s) by the child indicate the need for further instruction? Select all that apply.
"I will need to check with the nurse before I push the button to receive the pain medication." "It is important that I only push the button when the pain is so severe I cannot handle it anymore." "It will be best for my parents to push the button to receive the medication."
A child awaiting a blood draw procedure states, "I am so nervous and really do not want to have this done." Which response by the nurse is best?
"Imagine that you are swimming in a cool, shady pool where nothing can harm you."
The parents of a newborn are deciding if they want their newborn circumcised. The parents ask the nurse if their newborn can feel any pain during the procedure. How should the nurse respond?
"It is hard to know for sure, but research shows that it is possible for newborns to experience pain."
The nurse is caring for a child who is experiencing postoperative pain after having undergone surgery several hours ago. The child's parent reports having taken meperidine for postoperative pain and wonders if that medication would be of benefit to the child. What response by the nurse is indicated?
"Meperidine is associated with toxicity issues in children and is usually avoided."
The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?
"Pick your favorite Band-Aid and show me which arm to use."
The mother of a child who just had abdominal surgery holds his hand and smooths his hair. When the nurse appears to administer a scheduled analgesic, the mother says she believes the child has been in pain the last hour or more. The nurse's best response is:
"Please tell me and all of the nurses when you believe he is in pain."
An adolescent has been injured while playing sports. The adolescent describes only minimal pain but the nurse observes clenched fists, rapid breathing and increased muscle tension. Which approach would be best to offer this adolescent pain medication?
"Sports injuries can be very painful. Reducing the pain can help in the healing process."
A child is in treatment for cancer and has been experiencing pain. The nurse is talking with the parents about assisting with pain management using distraction. Which statement(s) indicates an understanding of the information provided? Select all that apply.
"The underlying principle of distraction is focusing on stimuli other than the pain being experienced." "Using media such as TV or movies can be a distraction technique." "Some people may find singing or counting a good form of distraction."
The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?
"This can be taken with other medications we have at home that didn't require a prescription."
The nurse is caring for a 17-year-old child who has sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the adolescent indicates the need for further instruction?
"This medication should be taken on an empty stomach."
The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching?
"We should start the method after he feels pain."
The nurse realizes that many factors influence a child's pain experience. Which pain scale is appropriate to use with a 5-year-old child?
Oucher pain rating scale
The pediatric nurse is mentoring a new graduate in the care of children experiencing pain. The nurse knows the teaching was effective when the new graduate makes which statement as the rationale for considering pain assessment?
Pain assessment needs to be done at regular intervals.
The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include?
Pain medication should be given on a routine basis.
When caring for pediatric clients, which distraction technique is age-appropriate for the nurse to use?
Provide action-oriented video games to a 15-year-old client.
What behavioral responses to pain would a nurse observe from an infant younger than age 1?
Reflex withdrawal to stimulus and facial grimacing
The nurse is working with the mother of a 6-year-old girl to think of an effective means of distracting the girl from a painful procedure that she will shortly undergo. To be effective, the distraction technique must have which characteristics?
Requires concentration of the child
A nurse is caring for a 4-year-old child who is exhibiting extreme anxiety and behavioral upset prior to receiving stitches for a deep chin laceration. Which nursing intervention is a priority?
Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen.
The nurse is caring for a 3-year-old child who has an intravenous line. When medications are delivered through the line the child experiences burning. What action by the nurse will be most helpful?
Sit with the child and use distractions such as toys during the infusion.
A young child is in the emergency department with swelling and pain in the right ankle. The client states that while playing soccer, she somehow twisted her ankle and could not walk off the field. The health care provider tells the client that it is a sprain. Which type of pain is this client experiencing?
Somatic
The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?
The child's nonverbal behaviors may indicate the presence of discomfort.
The nurse is caring for a 12-year-old postoperative spinal rod placement client with scoliosis. Which factor might intensify the child's postoperative pain experience?
The client had a painful experience with an appendectomy at age 10.
After receiving pain medication for 7 days, the client has begun to request pain medication more frequently. What inference about this occurrence is most credible?
Tolerance to the medication is beginning to take effect.
A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the health care provider diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain?
Visceral
A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is:
Acute referred pain
What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients?
After achieving a relaxed state, begin by encouraging the 13-year-old client to imagine walking down a sandy beach and collecting seashells, a favorite activity.
The nurse is caring for a burn client with orders for oral ibuprofen and morphine PRN to control pain. Which nursing interaction is the most beneficial for the nurse to implement for pain management?
Alternate these medications around the clock to diminish peaks and valleys in pain control.
An adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer?
hydromorphone
A new nurse is orienting to the newborn nursery and asks the nurse mentor why newborns were not considered to experience pain. How does the mentor explain the rationale used in the past that infants do not experience pain?
incomplete nerve myelination
The nurse wishes to reassure a 3-year-old girl that there will be no discomfort when her peripheral IV site is examined. The nurse will use which words? Select all that apply.
no hurt no owie no boo-boo
A young child is hospitalized with pneumonia. Upon admission the client states not having pain but just a bad cough. A few hours later, the child he begins reporting pain in the right lower back. This first report of feeling pain refers to:
pain threshold.
The nurse is preparing to use the FLACC behavioral scale to assess the pain level of a child. For which child will the use of this scale be the most appropriate?
postoperative 6-year-old child who is unable to accurately report pain level
The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority?
respiratory depression
What are some negative effects that chronic pain can have on the pediatric population?
sleep disturbances, exhaustion, irritability, mood disturbances, and depression
A child is getting ready to have a lumbar puncture. The nurse recognizes which medication prescription is best to reduce the pain for this procedure?
topical lidocaine cream
The nurse is caring for a school-age child who had an appendectomy the day before. The parents express concern about the use of pain medications. Which is the best nursing response?
Educate the parents about the need for pain relief in proper doses.
The nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first?
Ensure naloxone is readily available.
The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse?
Experiences with pain even in infancy can influence an individual's response to pain later.
When educating a parent on how to support the child while experiencing a painful procedure, what is the best information for the nurse to convey?
Explain in detail the role of the parent as a coach and emphasize the coping plan.
The nurse is preparing to assess the pain of a developmentally and cognitively delayed 8-year-old. Which pain rating scales should the nurse choose?
FACES pain rating scale
The nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this client?
Face, leg, activity, cry, and consolability (FLACC) descriptors
The nurse is preparing a 6-year-old child for a bone marrow biopsy. The child is very anxious about going through this procedure. Which nursing diagnosis best fits this situation?
Fear related to anticipation of painful procedure
Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain in pediatric clients?
Gently massaging a preterm infant's leg for 2 minutes prior to obtaining a blood sample from a heel stick.
The nurse plans to apply a cream with lidocaine and prilocaine to decrease the pain of an injection. What would be the best technique?
Apply it at least 1 hour before the procedure.
A nurse is explaining to a parent about avoiding the use of aspirin for pain relief for flu-like symptoms. Which rationale does the nurse provide?
Aspirin with the flu can lead to Reye syndrome.
Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important?
Assessing vital signs frequently, because they can become depressed
A nurse is instructing the parents of a toddler on the use of an anesthetic cream in advance of an upcoming procedure the child will have. What information should the nurse mention to them?
Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them.
Parents are to bring their kindergarten child to the outpatient department for a venous blood sample. They have EMLA cream to apply at home prior to the procedure and have been shown two areas on the child's arms where they should place the cream. Transportation time is 15 minutes. Their appointment is for 2:45 p.m. At what time should the parents apply the cream and occlusive dressings to both arms?
Between 1:15 p.m. and 1:45 p.m.
The nurse is caring for a 12-year-old in sickle cell crisis. The nurse determines that the child is very tense and might benefit from relaxation techniques. Which is the best approach for the nurse to take when implementing this pain reduction technique?
Close the door to the client's room, dim the lights, and close the curtains before beginning.
A nurse is caring for a child who is grimacing but reports having no pain. What might be the rationale for a child being reluctant to express pain?
fearing getting a "shot" to relieve the pain
The nurse is caring for a 7-year-old postoperative child who is reporting an 8 out of 10 on a pain intensity scale. The child's parent is requesting pain medication. The child received ibuprofen 3 hours ago. What is the correct nursing action?
Contact the health care provider and request an opioid pain medication.
The nurse is caring for children on a postoperative unit. Which nursing action promotes the most efficient pain control?
Anticipate when pain will occur and plan interventions to prevent it.
The nurse is providing postsurgical care for a 5-year-old. The nurse knows to avoid which question when assessing the child's pain level?
Would you say that the pain you are feeling is sharp or dull?
A 4-year-old child is scheduled for a magnetic resonance imaging of the skull following a bicycle accident. Which medication would the nurse administer to keep the child still during this procedure?
conscious sedation
A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain?
decreased heart rate