Question

How would a nurse assess pain snd discomfort an infant versus an adult?

Answer 1

PAIN IS THE FIVE VITAL SIGNS.SO ITS REALLY IMPORTANT TO ASSESS .

INFANTS PAIN INTENSITY AND DISCOMFORT IS DETERMINED BY MEASURING BEHAVIOURAL INDICATORS SUCH AS FACIAL EXPRESSIONS ,PHYSIOLOGICAL INDICATORS SUCH AS HEART RATE AND OXYGEN LEVEL IN THE BLOOD ,AND CONSIDERING CONTEXTUAL INDICATORS SUCH AS THE BABYS AGE AND THEIR SLEEP.

INFANTS ,INCLUDING NEW BABIES ,EXPERIENCE PAIN SIMILARILY AND PROBABILY MORE INTENSELY THAN OLDER CHILDREN AND ADULTS .THEY ARE ALSO AT RISK OF ADVERSE LONG TERM EFFECTS ON BEHAVIOUR AND DEVELOPMENT,THROUGH INADEQUATE ATTENTION TOWARDS PAIN RELIEF IN EARLY LIFE .

PAIN IS DEFINED AS AN UNPLEASENT SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE.OBVIOUSLY ,THIS DEFINITION MAY NOT BE EASILY APPLICABLE IN DAY TO DAY SITUATIONS ,PARTICULARLY IN INFANTS WHOSE RESPONSE TO PAIN ARE NOT VERY DIFFERENT FROM THEIR RESPONSE TO FEAR AND DISTERESS DUE TO NON PAINFUL CONDITIONS.

INFANT PERCEIVE PAIN UN THE SAME WAY AS ADULTS.THE RECEPTORS OF NOCICEPTIVE STIMULI ARE FREE NERVE ENDING THAT ARE WIDELY DISTRIBUTED ALL OVER THE BODY.THEY ARE MAXIMALLY PRESENT IN THE SUPERFICIAL LAYERS OF THE SKIN AND INTERNAL TISSUES SUCH AS PERIOSTEUM,ARTERIAL WALLS,AND JOINT SURFACES.

=ASSESSMENT OF PAIN AND DISCOMFORT AN INFANT;

ALTHOUGH SELF REPORTING OF PAIN IS THE GOLD STANDARD FOR ASSESSMENT OF THE SITE ,NATURE ,AND SEVERITY OF PAIN ,IT IS NOT PRECISELY APPLICABLE IN CHILDREN BELOW 3 YEARS OF AGE. HENCE IN INFANTS ,SURROGATE MARKERS ARE USED .

IN ORDER TO INTRODUCE OBJECTIVITY IN THE ASSESSMENT OF INFANTS PAIN AND DISCOMFORT ,VARIOUS PAIN SCALES HAVE BEEN DESIGNED AND VALIDATED.THESE ARE BASED EITHER ON PHYSIOLOGICAL VARIATIONS,BEHAVIOURAL CHANGES ,OR A COMBINATION OF BOTH.

=PAIN ASSESSMENT SCALES IN INFANTS

based on behavioural changes

*INFANT BODY CODING SYSTEM

*LIVERPPOL INFANT DISTRESS SCALE

*MODIFIED BEHAVIOURAL PAIN SCALE

*BEHAVIOURAL PAIN SCORE

*CLINICAL SCORING SYSTEM

combination of physiological and behavioural changes

*CRIES( ACRONYM FOR CRYING,CHANGE IN TRANSCUTANEOUS OXYGEN SATURATION ,HEART RATE,BLOOD PRESSURE,FACIAL EXPRESSION AND ALTERATION IN SLEEP PATTERN

* PAIN ASSESSMENT TOOL

*COMFORT SCORE

ASSESSMENT OF BEHAVIOURAL AND PHYSIOLOGICAL RESPONSES REMAINS THE MOST READILY AVAILABLE ,RELIABLE, AND FEASIBLE METHOD OF ASSESSING PAIN IN INFANTS

IN CLINICAL SETTINGS,SIMLPE ACTIONS SUCH AS REMOVALOF STICKING TAPES,LIMB COMPRESSION DURING RESTRAINT,POSTURAL CHANGES DURING VENTILATION,AND PHYSIOTHERAPY MANOEUVRES CAN BE INTENSELY PAINFUL.

PAIN ASSESSMENT TOOLS

PAIN ASESSMENT IN INFANTS AND CHILDREN IS CHALLENGING DUE TO THE SUBJECTIVITY AND MULTIDIMENSIONAL NATURE OF PAIN

A PAIN ASSESSMENT SHOULD BE CONDUCTED DURING A PATIENT ADMISSION

POINTS TO CONSIDER

=PAIN HISTORY

=LOCATION OF PAIN'

-=INTENSITY OF PAIN

=COGNITIVE DEVELOPMENT AND UNDERSTANDING OF PAIN

PAIN ASSESSMENT TOOLS USED FOR ASSESSING ACTE PAIN.ALL SHARE A COMMON NUMERIC AND RECORDED AS VALUES 0-10 AND DOCUMENTED ON THE CLINICAL OBSERVATION CHART AS THE 5TH VITAL SIGN

THE IMPORTANCE OF USING THE SAME NUMERIC VALUE 0-10 IS THAT THE NUMBER RELATES TO THE SAME PAIN INTENSITY IN EACH TOOL.

THREE WAYS OF MEASURING PAIN;

SELF REPORT--WHAT THE CHILD SAYS

BEHAVIOURAL -HOW THE CHILD BEHAVES

PHYSIOLOGICAL-CLINICAL OBSERVATIONS

THERE ARE MAIN TOOLS USED FOR THE INFANT ,NEONATE AND CHILDREN 3-18YRS THESE TOOLS REFLECT A COMBINATION OF SELF REPORT AND BEHAVIOURAL ASSESSMENT

1.FLACC-

F-FACE

L-LEGS

A-ACTIVITY

C-CRY

C-CONSOLABILITY

-2 MONTHS -8 YEARS AND ALSO USED UP TO 18YEARS FOR CHILDREN WITH COGNITIVE IMPAIREMENT AND /DEVELOPMENTAL DISABILITY.

-IT MAY BE DIFFICULT TO ASSESS CHILDREN WITH COGNITIVE IMPAIRMENT AND ARE NON VERBAL .ASK THE PARENT TO HELP YOU EXPLAIN THEIR CHILDS PAIN BEHAVIOUR

HOW TO USE FLACC

EACH CATEGORY FACE ,LEGS ETC.IS SCORED ON A 0-2 SCALE,WHICH RESULTS IN A TOTAL PAIN SCORE BETWEEN O AND 10.THE NURSE ASSESSING THE CHILD SHOULD BE OBSERVE THEM BRIEFLY AND THEN SCORE EACH CATEGORY .

NOTE-flacc has a high degree of usefulness for cognitively impaired and many critically ill children

FLACC

FACE 0 1 2

no particular expression,or smile occational grimace. frequent to constant frown disinterested clenched jaw

0 1 2

LEGS normal position uneasy,tense kicking or legs drawn up

0 1 2

ACTIVITY lying quietly,moves easily tense/squirming arched,rigid/ jerking

0 1 2

CRY no cry whimpers crying steadily,screams or sobs

0 1 2   CONSOLABILITY relaxed reassured by occational touching , difficult to console or comfort

FOR ADULT WE CAN USE WONG-BAKER FACES PAIN SCALE

EXPLAIN TO THE PERSON THAT EACH FACE IS FOR A PERSON WHO FEELS HAPPY BECAUSE HE HAS NO PAIN OR SAD BECAUSE HE HAS SOME OR A LOT OF PAIN

FACE1 IS VERY HAPPY ,DOESNOT HURT AT ALL

FACE2- HURTS A LITTLE BIT

FACE4 -HURTS LITTLE MORE

FACE 6=HURTS EVEN MORE

FACE8-HURTS WHOLE LOT

FACE 10=HURTS AS MUCH YOU CAN IMAGINE

ASK THE PERSON AND CHOOSE THE FACE THAT BEST DESCRIBES HOW HE IS FEELING

=NEXT SCALE FR ADULT IS

VISUAL ANALOQUE SCALE( 8 YEARS AND OLDER)

ASK THE CLIENT USING NUMBERS FROM 0-NO PAIN THROUGH TO 10 BEING THE WORST PAIN

note;in certain circumstance the ventilated or sedated child physiological indicators of pain can be helpful to determine a patient experience of pain..that heart rate ,bp,respiratory rate,o2 saturation

THE NURSE SHOULD ASSESSS THE PAIN SCORE AND DOCUMENTED FOR ALL CHILDREN AT LEAST ONCE PER SHIFT IN FLOW SHEET

CHILDREN WITH PAIN SHOULD HAVE PAIN SCORES DOCUMENTED MORE FREQUENTLY

CHILDREN WHO ARE RECEIVING ORAL ANALGESIA ,EPIDURALS SHOULD HAVE HOURLY PAIN AND SEDATION SCORES DOCUMENTED

ASSESS AND DOCUMENTES BEFORE ANALGESIA ,,

ASSESS AND DOCUMENT PAIN ON ACTIVITY SUCH AS PHYSIOTHERAPY.