Chapter 36: Pain Management in Children
A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain? decreased oxygen saturation palmar sweating plantar sweating decreased heart rate
decreased heart rate Explanation: Decreased heart rate is not a physiologic response to pain. Instead, infants demonstrate an increased heart rate, usually averaging approximately 10 beats per minute with possible bradycardia in preterm newborns. Decreased oxygen saturation and palmar and plantar sweating are common physiologic responses to pain in the infant.
The nurse is assessing the abdomen of a preschooler admitted for lower right quadrant pain. Which assessment questions provide helpful data? Select all that apply. "Does your tummy ache?" "Is your hurt getting better?" "The hurt—is it sharp or dull?" "Choose the face that shows how you feel now." (FACES pain rating scale) "Touch the spot on your tummy where it hurts."
"Touch the spot on your tummy where it hurts." "Choose the face that shows how you feel now." (FACES pain rating scale) Explanation: A preschooler is able to tell someone or indicate where it hurts. Starting at age 3 years, most can effectively use the FACES scale. However, preschoolers will have difficulty distinguishing between types and intensity of pain and even if pain is better or worse.
The nurse is aware of the special needs of children related to pain assessment. What is the priority for the nurse to consider when completing a pain assessment? Pain medication used and last dose administered Chronological age of child Reason for the pain Developmental age of child
Developmental age of child Explanation: Although all of the options are important for assessing pain in children, the priority to provide an appropriate pain assessment is knowing the developmental age of the child. The chronological and developmental ages may differ and care needs to be based on both, but the type of pain assessment tool used will be based on the developmental age. For children who are nonverbal the nurse needs to also consider the parent's statement of pain in the child.
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 Relaxation Thought stopping Imagery
Distraction Explanation: Distraction techniques aim at shifting a child's focus from pain to another activity or interest. In this case, blowing bubbles serves as a distraction.
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? "What questions do you have about what I am doing?" "Mrs. Jones, why don't you have him sit on your lap?" "Pick your favorite Band-Aid and show me which arm to use." "See how fast you can make this pinwheel whirl."
"Pick your favorite Band-Aid and show me which arm to use." Explanation: Allowing the child options related to the style of the Band-Aid and the extremity to use gives the child some control over the happenings. Offering a pinwheel is a distraction technique. Encouraging the parent to hold the child during the procedure promotes feelings of security. Encouraging the child or parents to ask questions facilitates communication.
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. _________ tablet(s)
3 Explanation: Desired dose = Prescribed amount (mg/kg) x weight (kg) = 10 mg/kg x 25 kg = 250 mg Dose available = 80 mg Dose to administer = Desired (mg)/ Available (mg) x Quantity (tabs) = 250mg/ 80 mg x 1 tab = 3.125 tabs rounded to 3
Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important? Keeping the room absolutely quiet so the child can sleep Asking the child to periodically count from 1 to 10 Keeping the child's head in a dependent position Assessing vital signs frequently, because they can become depressed
Assessing vital signs frequently, because they can become depressed Explanation: Moderate sedation is a medically controlled state of depressed consciousness that allows the protective reflexes to be maintained. The depressed state can be caused by many medications: midazolam, ketamine, propofol, etc. Children often pass through their intended level of consciousness to a deeper level. It is imperative that the child be continuously monitored, the person administering the drugs be skillfully trained in pediatric advanced life support, and there be emergency equipment and drugs available at all times during the procedure.
A 3-year-old client requires a peripheral blood draw and the parents wish to use topical lidocaine and prilocaine cream for the blood draw. What will the nurse recommend for the use of topical lidocaine and prilocaine cream to this family? Select all that apply. Clean the site with alcohol before applying the cream. Apply the cream upon arrival to the clinic for the blood draw. Tell the child they will not feel any pain with the blood draw. Apply the cream 1 hour before the blood draw occurs. Cover the cream with an occlusive dressing once applied.
Cover the cream with an occlusive dressing once applied. Apply the cream 1 hour before the blood draw occurs. Explanation: Topical lidocaine and prilocaine cream will reduce, but may not fully eliminate, the pain of the blood draw. The skin should first be cleansed with soap and water, not alcohol. Then a small amount of cream should be applied and covered with an occlusive dressing. The cream should be applied 1 hour prior to the blood draw to take effect.
What behavioral responses to pain would a nurse observe from an infant younger than age 1? Low frustration level and striking out physically Localized withdrawal and resistance of the entire body Passive resistance, clenching fists, and holding body rigid Reflex withdrawal to stimulus and facial grimacing
Reflex withdrawal to stimulus and facial grimacing Explanation: Infants younger than age 1 become irritable and exhibit reflex withdrawal to the painful stimulus. Facial grimacing also occurs. Localized withdrawal is experienced by toddlers ages 1 to 3 in response to pain. The nurse would observe passive resistance in school-age children. Preschoolers show a low frustration level and strike out physically.
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? Pain control methods were discussed with the client prior to the procedure. The client is 12 years old. The client had a painful experience with an appendectomy at age 10. The parents describe the client as being a difficult child.
The client had a painful experience with an appendectomy at age 10. Explanation: Negative painful past experiences can intensify a child's response to pain. Temperament has not been shown to influence the actual intensity of the pain experience, but it does seem to influence a child's expression of pain behavior. Age does not intensify the pain experience. Discussion of pain control methods can alleviate stress and therefore decrease the pain experience.
The neonatal nurse is assisting the health care provider with a circumcision. Which pain relief method would be most beneficial? nonsteroidal anti-inflammatory drugs glucose on a pacifier morphine drops anesthetic cream
anesthetic cream Explanation: Anesthetic cream can be used effectively for pain relief with circumcision. It is a short procedure; therefore, morphine by mouth is not needed as it takes longer to wear off and has more side effects. Glucose on a pacifier may help but not as much as the anesthetic cream. NSAIDS would be beneficial after the procedure for pain relief but not during the procedure.
A young child with leukemia is scheduled for a bone marrow biopsy. The parents have been instructed to apply anesthetic cream to the site prior to the biopsy. Which is the best nursing instruction for the parents? "Apply the cream to the site and leave it open to air until the procedure." "Apply to the skin four hours before the procedure." "This can be purchased without a prescription, so you can keep it on hand for future procedures." "Do not let your child remove the dressing because the cream can cause damage if rubbed into the eyes."
"Do not let your child remove the dressing because the cream can cause damage if rubbed into the eyes." Explanation: The nurse should caution the parents not to allow their child to remove the dressing because the cream could anesthetize the gag reflex if eaten or cause eye damage if rubbed into the eyes. The time needed for effect between different brands varies from 30 minutes to 1 hour and so must be applied within that time frame before an expected procedure, not 4 hours. It is important to keep the site covered with an occlusive dressing, not open to air. Although some creams can be purchased without a prescription, that is not the most important teaching topic for the parents.
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: "This is the medication he gets every 4 to 6 hours. It will control his pain for that period of time." "He looks comfortable to me and was sleeping each time I checked. The medication given earlier seems adequate." "Please tell me and all of the nurses when you believe he is in pain." "We will check every 4 hours to see if he needs the pain medicine." "His vital signs are stable, telling me he must be comfortable."
"Please tell me and all of the nurses when you believe he is in pain." Explanation: Having the mother share her assessments is very helpful. She knows the child the best. The statements about the medication and checking every 4 hours may be true but do not acknowledge the mother and the importance of her input. Looking comfortable (stillness) and even sleeping can be a coping strategy used by the child. Stable vital signs can be misleading. (Continually elevated signs can be interpreted as stable.) Many events can raise vital signs, including anxiety or happy excitement. Physiologic signs should be interpreted with care and combined with behavioral signs of pain.
Parents asks the nurse why their child with gastroenteritis is rubbing the abdomen. What is the nurse's best response? "Children do this in response to pain, like pulling on an aching ear." "Let me contact the health care provider for a prescription of pain medicine." "There is nothing to worry about; this is a normal reaction to pain." "Rubbing the stomach helps distract the brain from feeling pain."
"Rubbing the stomach helps distract the brain from feeling pain." Explanation: The gate control theory of pain attempts to explain how pain impulses travel from a site of injury to the brain, where the impulse is registered. This theory envisions gating mechanisms in the substantia gelatinosa of the dorsal horn of the spinal cord that, when activated, can halt an impulse at that level of the cord. This prevents the pain impulse from being received at the brain level and interpreted as pain. Rubbing the painful area is cutaneous stimulation, a type of gating mechanism. Although children pull on a painful ear, it is not the same as cutaneous stimulation and does not relieve pain. Telling the parents not to worry is not answering their question. Contacting the health care provider for pain medication is not necessary unless the child is reporting pain because this is an expected response to gastroenteritis.
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." "Here is a dose of pain medication so you can be better relaxed while your injury is treated." "Pain medication is available for you. Do you want a dose at this time?" "When you feel you would like a dose of pain medication, I will administer it."
"Sports injuries can be very painful. Reducing the pain can help in the healing process." Explanation: Adolescents have problems with accepting pain because of body image concerns and fear of losing control. They fear their behavior will make them look juvenile and thus try to remain stoic and not exhibit emotion. The nurse should address these concerns by being very matter-of-fact and truthful. The nurse can validate the adolescent's pain by stating the injury will cause pain. Explaining that reduction in pain can help in healing is a positive way to offer the pain medication and not make the adolescent appear to lose control. Telling the adolescent pain medication is available or that the adolescent should ask for medication can prolong the pain as the adolescent may be embarrassed to ask because of not wanting to risk being seen as weak or childish. Pain medication should be administered for pain, not as a relaxing agent to be used for treatment.
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 visceral pain Chronic cutaneous pain Acute referred pain Chronic somatic pain
Acute referred pain Explanation: Acute pain means sharp pain, as is the case in this scenario. It generally occurs abruptly after an injury. The pain of a pin prink is an example. Chronic pain is pain that lasts for a prolonged period or beyond the time span anticipated for healing. Referred pain is pain that is perceived at a site distant from its point of origin. In this case, the typical ice cream "brain freeze" is a headache that results from the contact of the cold ice cream with the digestive tract.
The nurse is caring for children on a postoperative unit. Which nursing action promotes the most efficient pain control? Avoid opioids as these may cause dependency and respiratory depression. Instruct parents to notify the nurse if the child's pain worsens. Assess the child's pain on a scale of 0 to 10, with 10 being the worst. Anticipate when pain will occur and plan interventions to prevent it.
Anticipate when pain will occur and plan interventions to prevent it. Explanation: The mark of efficient pain control is to anticipate when pain will occur and plan interventions to prevent it rather than let it occur and then relieve it. Three common reasons why nurses and other pediatric providers may not provide adequate pain relief to children include a belief that infants and young children do not experience pain, a fear children will become addicted to pain relief medications, and a fear of causing respiratory depression from analgesics. Infants and young children do experience pain, and there is little chance that children receiving opioids during a short hospital stay will become opioid dependent or that opiates cause greater respiratory depression in children than in adults (Fanning, Stucke, Christensen, et al., 2012). It is helpful to have parents notify the nurse if the child's pain worsens, as well as to assess pain using a standardized tool. However, it is better to anticipate pain and prevent it than to just assess and relieve it.
The nurse plans to apply a cream with lidocaine and prilocaine to decrease the pain of an injection. What would be the best technique? Wipe it off at least 15 minutes before the procedure. Apply it immediately prior to the painful procedure. Do not cover it after application to prevent it from discoloring. Apply it at least 1 hour before the procedure.
Apply it at least 1 hour before the procedure. Explanation: A topical anesthetic cream containing lidocaine and prilocaine must be applied at least 1 hour prior to a superficial procedure (injections, IV starts) to be effective. It needs to be applied at least 2 to 3 hours prior to a deep procedure such as a bone marrow aspiration. The drug should be applied in a thick layer over the area. It is not rubbed into the skin. It should be covered after application with a transparent dressing. This allows for maximum absorption and to prevent the child from tasting it (which could anesthetize the gag reflex). The drug is wiped when the skin is prepped for the procedure. Lidocaine and prilocaine cream is effective in reducing pain from procedures such an IM injection up to 24 hours after the injection.
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? Administer the cream about 4 hours before the procedure. Do not apply the cream until you are at the hospital, a few minutes before the procedure is to begin. Do not cover the site of the cream application with any kind of dressing. Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them.
Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them. Explanation: To reduce the pain of procedures such as venipuncture, lumbar puncture, and bone marrow aspiration, a local anesthetic cream that contains 4% lidocaine can be used. The cream is applied to the skin, and the site is then covered with an occlusive dressing or plastic wrap to keep young children from wiping away or tasting the cream. The time needed for effect between different brands varies from 30 minutes to 1 hour, so it must be applied within that time frame before an expected procedure. Caution the parents not to allow their child to remove the dressing as the cream could anesthetize the gag reflex if eaten or cause eye damage if rubbed into the eyes.
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? Right before leaving home for the clinic The parents should not apply EMLA cream due to their child's age. At 11:45 a.m. Between 1:15 p.m. and 1:45 p.m.
Between 1:15 p.m. and 1:45 p.m. Explanation: The EMLA cream needs to be in place 60 to 90 minutes prior to the procedure in order to attain local analgesia. Applying it at 11:45 a.m. (3 hours prior to the procedure) is necessary for deeper analgesia needed for such things as a lumbar puncture. Right before leaving their home (approximately 20 minutes before the procedure) is effective when lidocaine is used since it needs to be in place 20 to 30 minutes before a procedure. EMLA cream is approved for use in children ages 37 weeks and older.
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. Explain to parents that children perceive pain differently. Acknowledge parental fear and withhold the opioid pain medication. Implement complementary therapies in place of opioid pain medication.
Educate the parents about the need for pain relief in proper doses. Explanation: It is important for the nurse to explain the need for pain relief, complication from undertreated pain, proper doses, and taking actions to involve the parents in the assessment and evaluation process. Children may perceive pain differently, and the nurse needs to acknowledge the parents' fears, plus complementary therapies may help lessen pain. However, providing appropriate pain relief is critical for the child's recovery.
The nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first? Assess the status of bowel sounds. Assess for any adverse reaction. Ensure naloxone is readily available. Premedicate with acetaminophen.
Ensure naloxone is readily available. Explanation: When administering parenteral or epidural opioids, the nurse should always have naloxone readily available in order to reverse the effects of opioids, should respiratory distress occur. Premedication with acetaminophen is not required with opioids. After administration, the nurse should continually assess for an adverse reaction. The nurse should assess bowel sounds for decreased peristalsis after administration.
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? Pain that is short in duration in infancy will not influence the child later. There are no studies that consider the impact of pain in infancy on the child later in life. Experiences with pain even in infancy can influence an individual's response to pain later. Although the pain is severe at this time a child under the age of 2 will not be able to recall the event.
Experiences with pain even in infancy can influence an individual's response to pain later. Explanation: Repeated exposure to painful procedures and events can have long-term consequences. Memories of pain may be stored in the child's nervous system, influencing later reactions to painful stimuli.
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? Pain diary Adolescent pediatric pain tool (APPT) Face, leg, activity, cry, and consolability (FLACC) descriptors Numeric rating scale
Face, leg, activity, cry, and consolability (FLACC) descriptors Explanation: If the child has cognitive deficits, use tools for pain assessment that are appropriate for developmental level. Do not use chronologic age as a basis for pain assessment. When the child is unable cognitively to communicate pain, assessment methods used for infants may be employed, such as a FLACC scale. Use of a pain diary requires handwriting skills and use of a numeric rating scale or APPT scale requires verbal and/or cognitive skills.
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? Select the visual analog scale as the best one to use. Substitute the word-graphic rating scale for the poker chips. Show the child once more how to use the chips. Give the mother the FACES pain rating scale to use with her son.
Give the mother the FACES pain rating scale to use with her son. Explanation: Different pain rating scales are appropriate for different developmental levels. Children often regress when in pain, so a simpler tool such as the FACES scale may be needed. It is also helpful to enlist the assistance of the parent. Expecting the child to select a chip is developmentally inappropriate when the child shows signs of regression. The child wouldn't understand the phrase "word-graphic scale," and this scale or the visual analog scale is more complex than this 4-year-old can handle.
The nurse wishes to use a distraction technique when administering an injection to an anxious child. Which technique would be best for the nurse to implement? Have the child blow bubbles. Have the child create a mental image of something pleasant. Have the child practice controlled deep breathing. Have the child repeat a pleasant thought out loud.
Have the child blow bubbles. Explanation: Behavioral-cognitive strategies are useful for pain management in many ways and forms. They involve measures requiring the child to focus on a specific area rather than the pain. A distraction technique helps the child focus on another stimulus. Examples of this are counting, saying ouch, blowing bubbles, and music. Having a child create a mental image of something pleasant is a form of imagery. Using controlled deep breathing is a form of relaxation. Teaching the child to make positive statements such as "it will be over soon" is a form of thought stopping.
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? Hypnosis Biofeedback Thought stopping Imagery
Imagery Explanation: Imagery involves the use of the imagination to create a mental image. This mental image usually is a positive, pleasurable image, but it need not be real. As an example, a child could imagine a venipuncture needle as a silver rocket ship probing the moon or a submarine diving under the water to escape a torpedo just in time. Thought stopping is a technique in which children learn to stop anxious thoughts by substituting a positive or relaxing thought in its place. Hypnosis involves the child entering a trance-like state to effectively avoid sensing pain. Biofeedback is based on the theory people can regulate internal events such as heart rate and pain response in response to a stimulus. A biofeedback apparatus is used to measure muscle tone or the child's ability to relax.
The adolescent is receiving morphine IV for pain control. Which intervention(s) will be included in the nursing care plan? Select all that apply. Monitor for fever. Provide stand-by assistance when the client uses the bathroom. Have naloxone readily available. Monitor for itching. Assess suppressed cough reflex.
Monitor for itching. Provide stand-by assistance when the client uses the bathroom. Have naloxone readily available. Explanation: Naloxone should be readily available to reverse possible respiratory depression, a side effect of morphine. Dizziness and sedation are likely to accompany this pain control. Therefore, safety measures such as assistance when getting up to go to the bathroom or ambulating plus use of side rails are important inclusions in the nursing care plan. Itching, particularly of the face and hands, is a relatively common side effect of morphine sulfate. It can be treated with cool compresses or an antihistamine and included in the nursing care plan. Assessing for a suppressed cough reflex and monitoring for fever are not needed for the portion of the care plan that addresses pain control through the use of IV morphine.
The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include? Crying is good for the infant to decrease risk of pneumonia after anesthetic. Encourage use of pacifier after surgery. Allow the infant to be as active as possible after surgery. Pain medication should be given on a routine basis.
Pain medication should be given on a routine basis. Explanation: After any surgery on a child, the plan should include pain medication administration on a routine basis. The child's pain should be assessed regularly using the appropriate assessment tool. Providing pain medication will help the infant in the postoperative period. The infant having a cleft lip repaired should not use a pacifier for at least 10 days or upon instructions from the surgeon. Sucking is very limited immediately after surgery. If the infant is breastfed, the infant may begin to feed much sooner than a bottle-fed baby. This is because the breast nipple conforms to the mouth. If bottle fed, the infant will need to use special feeding devices. Crying is not good for the infant, because it irritates the mouth and lips and has the potential to cause bleeding as it produces tension on the suture line.
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? Conducting a baseline physical assessment. Ensuring the lighting is adequate for the procedure but not so bright to cause discomfort. Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen. Ensuring that emergency equipment is readily available.
Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen. Explanation: When a child is manifesting extreme anxiety and behavioral upset, the priority nursing intervention is to serve as an advocate for the family and ensure that the appropriate pharmacologic agents are chosen to alleviate the child's distress. Ensuring emergency equipment is readily available and lighting is adequate for the procedure is also part of the nursing function, but secondary interventions. Conducting a baseline physical assessment is important but would likely be difficult if the child was crying inconsolably or was extremely anxious.
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? Visceral Somatic Chronic Cutaneous
Somatic Explanation: Pain is classified in two categories. Acute pain has a rapid onset, usually as a result of tissue injury and it resolves with the injury healing. The other type of pain is chronic. This type does not end when the injury heals and affects a client's activities of daily living. One type of acute pain is somatic pain. Somatic pain originates from deep body structures, such as muscles or blood vessels. The pain of a sprained ankle is somatic pain. Visceral pain is pain occurring in the organs. Cutaneous pain affects the skin.
A parent expresses concern to the nurse that her 18-month-old child might have an ear infection. Which symptom would alert the nurse that this is a possibility? The child has a temperature of 100°F (38°C). The child is pulling on the ear. The child is crying nonstop. The child expresses "ouchie" in the ear.
The child is pulling on the ear. Explanation: Pulling on the ears is a typical symptom of an ear infection in a preschool child. Nonstop crying is not necessarily related to the ear, nor is an elevated temperature. An 18-month-old would not be able to express having an "ouchie" in his ear.
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 wants attention. The child may be in pain. The child is acting out. The child is afraid of the nurse.
The child may be in pain. Explanation: Some children of school age will regress with pain such as returning to baby talk, thumb sucking, or lying in a fetal position. This child is not seeking attention, acting out, or appearing to be fearful of the nurse.
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 child is not experiencing any significant level of pain or discomfort. The child is feeling too shy to communicate any pain or discomfort. The child is most likely tired.
The child's nonverbal behaviors may indicate the presence of discomfort. Explanation: Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain.
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? Newborns are rarely subjected to painful procedures without anesthesia. The newborn will not remember pain and does not need analgesia for painful procedures. The newborn does not have fully developed pain receptors, and therefore needs little or no pain medication. The newborn's pain pathway components are developed enough at birth to experience pain.
The newborn's pain pathway components are developed enough at birth to experience pain. Explanation: Neuroanatomical and neuroendocrine components of the pain pathway are sufficiently developed in the neonate to allow the transmission and perception of pain. While infants may not remember painful experiences as distinct actual events, the functional structures for long-term memory—specifically the integrity of the limbic system and diencephalon—are well developed in newborns. These early painful experiences may be stored as procedural memory, not accessible to conscious recall. Ample evidence indicates that both term and preterm neonates have the capacity to experience and remember pain much like older children and adults do. Newborns should receive analgesia for painful procedures.
A postoperative 12-year-old client is receiving hydromorphone intravenous and will be transitioning to oral hydromorphone. What does the nurse anticipate for the dose of oral hydromorphone for this client? The oral dose will be the same as the intravenous dose. The oral dose will be greater than the intravenous dose has been. The oral dose will be half of the intravenous dose. The oral dose will be given more frequently than the intravenous dose.
The oral dose will be greater than the intravenous dose has been. Explanation: The nurse will anticipate that the client receives an equianalgesic dose of hydromorphone to maintain adequate pain control. The oral dose required for equivalent analgesia is a greater dose of oral hydromorphone than the intravenous dosage.
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? The client is experiencing symptoms consistent with withdrawal between the medication dosing periods. The client's condition is worsening, making this analgesic regimen ineffective. Tolerance to the medication is beginning to take effect. The child is beginning to display signs consistent with addiction.
Tolerance to the medication is beginning to take effect. Explanation: Drug tolerance occurs when increasing doses are required to manage the pain. Physical dependence can occur after as few as 5 days of continuous use of the drug; symptoms of withdrawal begin if it is suddenly stopped. There are no signals that addiction is of concern for this client.
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? FLACC Pain Assessment Tool CRIES Pain Measurement Scale Wong-Baker Faces Pain Rating Scale COMFORT Behavior Scale
Wong-Baker Faces Pain Rating Scale Explanation: The FACES pain scale is an appropriate scale for children 3 years and older to rate their pain using a range of cartoon-like faces. The CRIES and COMFORT pain scales are intended for neonates and are not appropriate for a 5-year-old child. The FLACC pain scale measures nonverbal responses when the child cannot provide input and is not the appropriate choice for this child.
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 please show me which photograph and number best describes your hurt? Would you point to the spot where your pain is? Would you say that the pain you are feeling is sharp or dull? Would you point to the cartoon face that best describes your pain?
Would you say that the pain you are feeling is sharp or dull? Explanation: A preschooler may have difficulty distinguishing between the types of pain such as if the pain is sharp or dull. It also limits the information being obtained by the nurse. They can, however, tell someone where it hurts and can use various tools such as the FACES scale (cartoon faces) or the OUCHER scale (photograph and corresponding numbers) to rate their pain.
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? IV morphine IV hydromorphone conscious sedation diphenhydramine
conscious sedation Explanation: Conscious sedation allows a child to be both pain free and sedated for a procedure. Unlike the use of general anesthesia, protective reflexes are left intact and a child can respond to instructions during the procedure. The technique is used for painful procedures, as well as for magnetic resonance imaging and endoscopy, both of which require a child to lie still for a long period of time and can be potentially frightening.
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 not knowing how to express pain feeling anxiety about pain not having words to describe the pain
fearing getting a "shot" to relieve the pain Explanation: The nurse should be aware that some children may be reluctant to admit pain because they are trying to be brave. Some may be reluctant to say they have pain because they are afraid they will receive a "shot" to relieve it, which will cause more pain. Although children may not know how to express pain, it is still important to assess their pain level. Anxiety about pain may be high, but it does not prevent children from trying to express it.
A new nurse is orienting to the pediatric postoperative unit and asks the charge nurse why some children express pain differently. How does the charge nurse explain the factors affecting the expression of pain in children? Select all that apply. participation of parents in pain assessment culture ability to communicate verbally chronological age gender developmental level
gender culture chronological age developmental level ability to communicate verbally participation of parents in pain assessment Explanation: All of these affect how pain is expressed in children. Health care providers may depend on parents to speak up if their child is in pain, as they know their child best. Keeping in mind each child's developmental level as well as chronological age are important when assessing pain because expression of pain varies widely from that of a nonverbal infant to a very verbal adolescent. Cultural differences also influence how pain is expressed. Gender may also influence how pain is expressed by the child, as sometimes boys are taught to be stoic and not cry.
A nurse is providing immunizations to a 5-year-old client. What strategy uses the gate-control theory of pain to reduce immunization pain for this client? telling the child to close their eyes and hold their breath during the immunization having child count during administration of the immunization letting the child look at the needle prior to administration of the immunization asking the parents to provide acetaminophen prior to the immunization
having child count during administration of the immunization Explanation: Distraction, such as counting, is a strategy that reduces the transmission of pain impulses to the brain. Closing the eyes and holding the breath may increase anxiety and increase pain, and looking at the needle may also increase anxiety and pain. Acetaminophen is pharmacologic pain relief, not based on gate-control theory. Additionally, acetaminophen is unlikely to be effective or necessary for short-term pain that accompanies injection with immunization.
An adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer? hydromorphone acetylsalicylic acid (aspirin) naproxen ibuprofen
hydromorphone Explanation: For managing severe or acute pain, such as postoperative pain or the pain of a sickle cell crisis, opioids (e.g., morphine, oxycodone, and hydromorphone) are frequently prescribed. NSAIDS and acetylsalicylic acid would not help severe pain.
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? crying inability to be consoled chin quivering high-pitched cry
inability to be consoled Explanation: Crying, chin quivering, and a high pitched cry could be due to pain, but they can also be due to other situations. However, when an infant cannot be comforted or consoled, it is usually due to pain.
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 discomfort no pain no boo-boo no owie
no hurt no owie no boo-boo Explanation: Children at 3 years will spontaneously use the word "hurt." Other common words for pain used by toddlers or young preschoolers are "owie" and "boo-boo." Children tend not to use the word "pain" until around 6 years of age. A child age 3 would not understand the word "discomfort." This word could be used for an adolescent. Individual children will have their unique descriptors for pain. Nurses need to know these and use them when assessing for pain.
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? 4-year-old child who just had stitches placed postoperative 6-year-old child who is unable to accurately report pain level 10-year-old child with a broken femur in traction 7-year-old child who is getting ready to undergo a dressing change
postoperative 6-year-old child who is unable to accurately report pain level Explanation: The FLACC behavioral scale is a behavioral assessment tool that is useful in assessing a child's pain when the child is unable to accurately report his or her level of pain or discomfort and is reliable for children from age 2 months to 7 years. A 7-year-old child who is getting ready to undergo a dressing change and a 4-year-old child who just had stitches placed would be able to report pain and could use the Faces, Oucher, poker chip, or visual analog scales. A 10-year-old with a broken femur in traction would be able to self-report pain using the numeric scale. In alert children verbally able to report pain, self-report is the primary source for the measurement of pain.
The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority? respiratory depression pruritus urinary retention nausea and vomiting
respiratory depression Explanation: Respiratory depression, although rare when epidural analgesia is used, is always a possibility. However, when it does occur it usually occurs gradually over a period of several hours after the medication is initiated. This allows adequate time for early detection and prompt intervention. The nurse should also monitor for pruritus, urinary retention, and nausea and vomiting but the priority is to monitor for respiratory depression.
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? chronic pain visceral neuropathic deep somatic
visceral Explanation: Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.