Chapter 36: Pain Management in Children

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.

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain?

Numeric pain intensity scale

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.

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

Which statement is the goal of distraction techniques used to control pain?

to divert the child's attention away from the pain through controlled, purposeful behaviors

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

A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified?

"I hope that you will be a brave boy and not cry."

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."

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 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 parent of a child with periorbital cellulitis comes to the nurses' station and asks to speak with the nurse. The parent states, "The oral pain medication you gave my child 45 minutes ago is not working!" What is the nurse's best response?

"Oral medications take about 45 minutes to start working. I will be back in 20 minutes to check the pain level again."

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."

Parents asks the nurse why their child with gastroenteritis is rubbing the abdomen. What is the nurse's best response?

"Rubbing the stomach helps distract the brain from feeling 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."

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."

A parent expresses concern about a child who is reporting shoulder pain following abdominal laparoscopic appendectomy. What is the nurse's best response to this concern?

"This is referred pain and is normal after surgery."

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 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.

A child with Down syndrome has had surgery and experiences periodic pain. The child is 13 years old but functions much like an 8-year-old. Which pain scales may be appropriate for pain assessment? Select all that apply.

Poker chip tool FACES pain rating scale

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.

The nurse needs to heel stick a premature infant to obtain blood for laboratory samples. Which technique would the nurse utilize to provide the most pain relief?

Provide nonnutritive sucking with sucrose.

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

The nurse is preparing a female toddler for the repair of an eyebrow laceration. The girl is most likely to demonstrate which response in anticipation of the procedure?

Scream and cling tightly to her parent.

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.

A school-age client is in the clinic for a sprained ankle and is prescribed to take a nonsteroidal anti-inflammatory drug (NSAID) for pain control. What should the nurse inform the parent may be associated with long-term administration of any NSAID?

Severe gastric irritation

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 teaches a preschooler to use a FACES pain rating scale prior to surgery. At that time, the preschooler points to the smiling face. Following surgery when the nurse suspects the child has pain, the preschooler points again to the smiling face. How would the nurse interpret this response?

The child is using the scale to predict what they would like, not what the child has.

A six-year-old child is observed sucking the thumb and baby talking while hospitalized for cellulitis. How would the nurse explain this to the parents?

The child may be in pain.

The nurse working in the emergency department is caring for an 8-year-old boy who was hit by a car while running across the street and has suffered extensive abrasions, contusions, and broken bones. IV morphine analgesia has been given. The child is unable to follow simple directions to allow for procedures to be completed. What is the best action to take for this child?

The child should be sedated.

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.

The nurse is caring for a term neonate suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures as related to a neonate?

The newborn's pain pathway components are developed enough at birth to experience pain.

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?

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?

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 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 several pediatric clients on the surgical unit. Which client(s) would the nurse consider a candidate for using patient-controlled analgesia (PCA)? Select all that apply.

An 8-year-old child who is currently in the care of a foster family A 7-year-old child under the custody of the grandparent as medical guardianship

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; Visceral pain involves sensations that arise from internal organs, such as the intestines.

The nurse is caring for a 3-year-old client following a Fontan procedure to repair a hypoplastic left heart (above). What assessment finding(s) by the nurse indicates the child may be in pain? Select all that apply.

heart rate diminished breath sounds guarding and moaning blood pressure

An adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer?

hydromorphone

A pediatric nurse is caring for children on a surgical unit. When would the nurse advocate for the use of a patient-controlled analgesia (PCA)?

if the child's pain is constant or frequent

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects?

impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression

Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects?

morphine

A 10-year-old child is scheduled for open reduction and internal fixation of the tibia following a skateboard accident. The nurse anticipates which pain medication and administration method will best provide postsurgical pain relief for this child immediately after surgery?

morphine given as an intravenous injection

A child who is being treated for chronic pain comes to the clinic. During the initial assessment, the nurse notes an abnormal body posture. Which further assessment is most important for the nurse to complete?

neurologic assessment

The neonatal nurse is preparing to perform a heel prick for blood work on a 3-day-old infant. Which procedural pain management will the nurse provide the client?

pacifier with oral glucose

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

The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for?

respiratory depression, constipation, and pruritis

What are some negative effects that chronic pain can have on the pediatric population?

sleep disturbances, exhaustion, irritability, mood disturbances, and depression

The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?

uses words for pain such as owie, boo-boo, or hurt

The nurse is caring for a client who has been diagnosed with a tumor in the small intestine that is pressing on the liver. Which type of pain does the nurse anticipate the client will report?

visceral

The nurse is preparing to administer a dose of ketorolac to a 15-year-old adolescent. How should the nurse administer the medication to reduce the potential for gastrointestinal upset?

with meals

The nurse is preparing to administer an IM injection to a 5-year-old and asks the student working with the child to assist by blowing bubbles for the client while the nurse gives the injection. Which type of pain management is blowing bubbles?

Distraction

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.

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 is instructing the parents of a 5-year-old child receiving morphine via patient-controlled analgesia (PCA) about safe use of the PCA for this child. What will the nurse include in this teaching?

If administering a PCA dose to their child, the parents must first ensure the child is alert and awake.

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.

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.

The nurse provides a popsicle to a child after a tonsillectomy. What is the mechanism(s) of pain management that is the rationale for this intervention? Select all that apply.

Cold constricts the capillaries and decreases edema. Cold reduces the tissue pressure that causes pain.

A 4-year-old child is scheduled for an MRI. The child's parent is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have?

Conscious sedation

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

A child has been admitted to the emergency department with a pneumothorax. Which intravenous medication prescription does the nurse select prior to the insertion of a chest tube in the child?

fentanyl

A 7-year-old child has a prescription for 10 mg/kg PO acetaminophen. The child weighs 55 lb (25 kg). The acetaminophen is supplied as 80 mg tablets. How many tablets should the nurse administer? Record your answer using a whole number.

3

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 a group of children who have had recent surgery. Which children will the nurse question to determine the location of their pain? Select all that apply.

3-year-old post tonsillectomy 4-year-old with a fractured tibia 5-year-old with sickle cell crisis 6-year-old with juvenile arthritis 7 year old post appendectomy

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.

When preparing to perform an IV insertion, what is the most important nursing intervention?

Apply EMLA cream to two possible insertion sites and wait at least 10 minutes before attempting.

A nurse is admitting a 5-year-old hospitalized child with normal speech and verbal development. Which pain scale will the nurse use to assess this child?

Wong-Baker Faces Pain Rating Scale

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