Question

Acute Arm Pain

Jose is a 10-year-old boy who fell off his skateboard. He has an obvious deformity to his right wrist that has been splinted. He is pale, refuses to move his arm, and is sitting in a rigid position, but he states that his pain is 0 on a scale of 1 to 10.

Subjective Data

Fell from his skateboard 1 hour ago.

Displays no loss of consciousness.

Denies pain.

Objective Data

Weight: 34 kg

Vital signs: temp, 37.0º C; pulse, 116 bpm; resp, 40 breaths/min; blood pressure, 138/74 mm Hg; oxygen (O2) saturation: 100%

Radial pulse: strong

Capillary refill time: brisk to right upper extremity

Questions:

What nonverbal cues might lead Jose’s nurse to believe that he is in pain?
Why would a child of Jose’s age deny pain that he is having?
What are the preferred routes for administration of pain medications?
What are appropriate pain scales to use for Jose?

Answer 1

The nonverbal cues that the nurse to believe that he is in pain are;

1. Refuses to move his hand
2. Looks pale
3. Sitting in a rigid position
4. Sitting inactive
5. Rapid pulse
6. Increased respiration
7. Increased systolic Blood pressure

A child of Jose’s age deny pain that he is having can be

• due to fear of medical treatment
• fear of injections
• fear of disappointing the care givers or parents
• fear of hospitalization
• fear of restriction of physical activity by caregivers
• To show the bravery

The preferred routes for administration of pain medications are

• If severe pain, when the pain score above 7, provide intravenous and intramuscular pain medications
• Oral analgesics can be provided
• For school age child transdermal patches, topical applications like ointments, sprays are very appropriate

The appropriate pain scales to use for Jose are

• Numeric pain rating scale- verbal rating scale ranging from 1 to10
• Face scale - represents facial expression in 5 levels of pain
• Visual analog scale- ranges from most pain to no pain
• Objective pain scale- conists of physiological items related to pain