Effective nursing care for a child in pain requires individualized assessment using age-appropriate tools and a multimodal management approach that combines medication with behavioral strategies.
1. Assessment: The QUESTT Principle
Accurate assessment is the foundation of pain management. The text highlights the QUESTT framework as a key guide:
• Question the child.
• Use a reliable, valid pain scale.
• Evaluate behavior and physiologic changes.
• Secure parental involvement.
• Take the cause of pain into account.
• Take action.
Choosing the Right Tool:
• Infants & Non-verbal: Rely on behavioral and physiologic indicators (facial expressions, crying, heart rate, oxygen saturation) and scales like NIPS or FLACC.
• Toddlers to Teens: Move toward self-report tools. Use FACES (ages 3+) or Numeric scales (ages 5+).
• Crucial Myth-Busting: Nurses must recognize that newborns do feel pain, and a child who is playing or sleeping may still be in significant pain.
2. Management: A Multimodal Approach
Treatment should be tailored to the child's developmental level and the intensity of the pain.
• Non-Pharmacologic: These are essential for reducing anxiety and pain perception.
◦ Cognitive/Behavioral: Distraction, relaxation, guided imagery, and positive self-talk.
◦ Biophysical: Heat/cold application, massage, and nonnutritive sucking with sucrose for infants.
• Pharmacologic: Involves the use of analgesics (opioids/non-opioids), adjuvants, and anesthetics.
3. The Nurse’s Role
Beyond administration, the nurse acts as a safety monitor and advocate.
• Procedural Pain: Minimize trauma by using topical anesthetics, therapeutic hugging, and preparing the child ahead of time.
• Monitoring: Continually assess vital signs (specifically for respiratory depression) and watch for common opioid side effects like constipation and pruritus (itching)
