Class Notes (1,100,000)
CA (650,000)
York (40,000)
NURS (90)
Lecture 5

NURS 3524 Lecture Notes - Lecture 5: Palliative Care, Fentanyl, Weight Loss


Department
Nursing
Course Code
NURS 3524
Professor
Mavoy Bertram
Lecture
5

This preview shows pages 1-2. to view the full 8 pages of the document.
NURS 3524 Wk 6 (no Wk 5)
NURS 3524: Paediatrics
Pain, Childhood Cancers and End of Life/Bereavement Care
Mavoy Bertram
October 16, 2014
Agenda
Pediatric Pain
Childhood cancers
End of life/bereavement care
Pain
Definition:
It is what the patient says it is and exists when (s)he says it does – Merskey, 1979
It is complex and subjective
It has an emotional, behavioural and physiological components
“An unpleasant sensory and emotional experience associated with actual or potential
tissue damage, or described in terms of such damage” – McCaffery & Bebbe, 1989
Types of Pain
Categorized according to duration, location and etiology
Acute pain
Chronic pain
Recurrent
Functions of Pain
Adaptive function
Protective mechanism
Past experiences define pain experience
Child Factors Affecting Pain
Age
Developmental/cognitive level
Culture
Previous experience of pain
Parental presence
Goals of Paediatric Pain Management
Decrease pain and suffering
Minimize side effects
Increase comfort & well being
Enhances coping abilities
Educate children and their families to communicate about pain
Benefits of Effective Pain Management
Relief and comfort – increased satisfaction
Less complications connected to stress
Earlier mobilization and healing
Increased participation in needed diagnostic and therapeutic interventions
Reduced negative impact on future medical encounters – memory
Reduced stress for family members
Shortened hospital stays and reduced costs
Effects of Untreated Pain
Physiological complications
1

Only pages 1-2 are available for preview. Some parts have been intentionally blurred.

NURS 3524 Wk 6 (no Wk 5)
Psychological stress
Family disruption
Interruption of hospital routine
Prolonged hospitalization with increased costs
Barriers to Effective Pain Management
Myths and misconceptions
Lack of knowledge, education and policies & procedures
Attitudes and beliefs
Inadequate assessment
Fear of side effects and sedation
Inappropriate dose, route or schedule
Pain is not a priority
Myths about paediatric pain
Children Don’t Feel Pain…
Spinal tract for pain transmission developed by 30th week of gestation
Lack of myelination does not equal a lack of sensation – slower conduction of impulse
No previous pain experiences
Sleeping and Playing Children are not in pain…
Play is the work of childhood
Sleeping children can be sleeping in pain
Discordant behaviors indicate a need for valid measures and thorough assessment
You can not measure pain in children…
Valid tools exist to measure pain
Nurses underutilize self report of children
Parents are the next best in regards to comfort
Complex to measure - requires skilled nursing and excellent communication
Children as young as three can self report – problem may rest with the “listener”
There is a right amount of pain for specific interventions
Experience of pain is highly subjective
Children experience pain differently but no less than adults
Coping mechanisms of children can betray the intensity
Pain is not an acceptable outcome of hospitalization
Children become addicted
Less than 1% develop addiction
Addiction is compulsive use of drug for other than its intended symptom relief
Physiological dependence – physical need for the drug
Tolerance – development of the need to increase dosage for desired clinical effect
Your Responsibilities
Make pain a priority
Adhere to standards and evidence base practice
Aim at pain management as an outcome of your care
Use resources to maximize effectiveness to ensure quality outcomes
Pain Assessment in Children
Behavioural measures
Physiological measures
Self-report measures
2
You're Reading a Preview

Unlock to view full version

Only pages 1-2 are available for preview. Some parts have been intentionally blurred.

NURS 3524 Wk 6 (no Wk 5)
Question the child (if appropriate age)
Use pain rating scales/tools
Evaluate behaviour
Secure parental input
Take cause into account
Take action
Assessment Tools
Behavioural Measures
Used for infants to preschoolers of age 3 years
Assessment based on vocalizations, facial expressions and body movements/positioning
Most reliable for short, sharp procedural pain
Less reliable for recurrent or chronic pain
Less reliable for pain in older children
May need to utilize parents
Examples – FLACC, CHEOPS, TPPPS, PPPRS
Physiological Measures
Profound physiological measures usually accompany the experience of pain
Are not able to distinguish physical responses to pain and other forms of stress to the
body
Measures assessed: HR, RR, BP, shallow respiratory effort, palmar sweating,
transcutaneous oxygen, increase muscle tone, provide useful information about general
distress levels of children experiencing pain
May prove more useful for infants and non-verbal children
Self Report Measures
Children as young as three
The ability to measure, classify and seriate can be carried out by the age 7 onwards
Important to ask the location and pain quality as well
Valid tools available: oucher, pain thermometers, numeric scales, word scales
Must be culturally valid tools
Word Scale/Verbal Analog Scale (VAS)
Ask the child to classify the pain into one of 4 categories:
“none”
“a little”
“medium”
“a lot”
Faces Pain Scale
Six cartoon faces
Smiling face = “no pain”
Tearful face for “worst pain”
The child chooses a face that describes his or her pain
Numeric Pain Ratings
For 8 years and older
“0 to 10” scale widely used (“no pain to worst pain”)
Easy to use
Self report for procedural, acute and chronic pain
Able to count up to 10, understand classification and seriation
3
You're Reading a Preview

Unlock to view full version