Vital Signs: Pain Assessment
The physician, registered nurse (RN), licensed practical nurse (LPN) is responsible for assessment of pain. Unlicensed assistive personnel (UAP) may obtain subjective reports of pain. When measurement is obtained by the UAP, any variance from baseline is reported to the licensed caregiver.
Each healthcare institution should identify standardized assessment tools appropriate for use in each age group or patient group (e.g., use an appropriate tool for infants, young children, school age/adolescents, for cognitively impaired children, nonverbal due to clinical condition). Select from these tools when choosing a method of pain assessment for an individual child; if the preferred tool is not effective, try one of the others. After identifying a tool that works for the child, use this consistently unless the situation changes (e.g., the child is comatose and can no longer use a self-report tool) (see Chapter 7).
Assess pain level within the first hour of admission to an acute care setting or during an outpatient contact to obtain baseline data regarding the comfort status of the child.
For a child who has chronic pain, frequency of pain assessments are based on child’s condition but are performed at least monthly.
Assess pain level every 8 to 12 hours in an acutely ill child and more frequently as clinically indicated. Pain assessment is an ongoing process; each caregiver performs a comprehensive pain assessment when initially assuming care of the child. After the initial assessment, if the child’s status changes; if the child demonstrates signs of pain or is subjected to a presumably painful event; or if there is change in infusion rates of sedation, analgesic medication, or anesthetic medication, perform another comprehensive pain assessment.
If the child is comfortable, it is not necessary to perform a comprehensive pain assessment with each set of vital signs. However, be aware of each state’s law, because some require that pain assessment be recorded each time vital signs are recorded.
Assess pain level before and after pain interventions within 1 hour of any intervention for an acutely ill child (time interval is dependent on the specific intervention) to assess response to treatment regimes.
Pain assessment tool, developmentally appropriate for child; use a self-report tool when possible. If self-report is not an option, use a reliable and valid multidimensional tool (see Chapter 7).
CHILD AND FAMILY ASSESSMENT AND PREPARATION
Obtain an initial history from the child and/or the family members of the current pain, including the following:
What words the child uses to communicate pain (use these words when talking with the child)
Presence of pain: “Are you having any pain?” If yes, then obtain the following:
Character and quality: “Tell me what the pain feels like” (e.g., burning, stabbing, aching, pinching)
Onset: “When did the pain start? Did anything happen to set off the pain?”
Location and radiation: “Where is the pain? Does it go to other places?” For younger children: “Point to where the pain is.” Coloring pain location on a body outline tool may help a child identify the site.
Duration: “How long have you been feeling this pain?”
Frequency: “How often does the pain occur? Is it all the time or just at certain times?”
Exacerbation: “Does anything make the pain worse?”
Relief and present pain regimen: “Does anything help make the pain better?” “What are you doing to try to make the pain go away?” Ask about medications—prescription and over-the-counter medications, herbs, nonpharmacologic interventions, effectiveness of regime, side effects of regime
Association: “Have daily routines and habits changed because of the pain?” “What is the effect on eating, sleeping, elimination, activity, or other behavior patterns?”
For a child who is preverbal or has special needs, ask the family and record in child’s plan of care how the child usually behaves when he or she is in pain and what interventions may help.
Assess what coping techniques the child and the family have previously used successfully.
Reinforce to the child that pain is not a punishment for misdeeds, particularly for preschool-aged and young school-aged children.
Teach the child and the family how to use a developmentally appropriate pain assessment tool, before a painful event, when possible. Select tool based on developmental age of the child and type of pain or medical condition (e.g., procedural or postoperative pain). Assess the child’s ability to understand tool (e.g., understands the concept of seriating, greater than, less than). Introduce a different tool if the child does not understand how to use the first tool to express his or her pain level.
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