December 8, 2019
“Pain Assessment” by Catherine Dowling for OPENPediatrics

“Pain Assessment” by Catherine Dowling for OPENPediatrics


The purpose of this video is to provide general
information and education about the care of a critically ill child. It is in no way a substitute for the independent
decision making and judgment by a qualified health care professional. The information contained in this video should
not be used to make a diagnosis or to overrule the advice of a qualified health care provider,
nor should it be used to provide advice for emergency medical treatment. Pain Assessment by Catherine Dowling. Please note that in this video we will be
following the guidelines used at Boston Children’s Hospital. Some of this information may need to be modified
based on the equipment, guidelines, and practices in place in your institution. Hi. My name is Catherine Dowling. I’m a nurse at Children’s Hospital Boston
in the cardiac ICU. The objective of this presentation is to discuss
pain assessment tools. Introduction. There are many ways institutions evaluate
and categorize pain. The most quantitative way is by using a scale. Some of the scale options include the FLACC,
Wong-Baker, numeric rating scale, the individualized numeric rating scale, and the evaluation of
physiological parameters in the chemically paralyzed patient. Patient assessment includes the evaluation
of pain and should be considered with as much importance as a vital sign. Frequency of Pain Assessment. Pain should be scored using an evidence-based
scale at a minimum of every four hours, and before and after the treatment of pain. Scoring pain at these intervals allows for
assessment and the effectiveness of pain treatment. Pain Scales, FLACC. The appropriate pain scale is chosen based
on the developing age and neurological status of the patient. The FLACC stands for face, legs, activity,
crying, and consolability. It is an observer rated pain scale performed
by a health care provider, such as a doctor or a nurse. The FLACC pain scale was designed for newborns
up to the age of 7. It provides a pain management assessment scale
between zero and ten, with zero representing no pain. The scale has five criteria, which are each
assigned a score: one, two, or zero. Pain Scales, Wong-Baker FACES Scale. The Wong-Baker FACES scale is recommended
for a patient who is 3 years and older. In this scale, the result is determined by
the patient. Explain to the patient 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. The zero is very happy because he does not
hurt at all. Face one hurts just a little, face two hurts
a little bit more, face three hurts even more, and face four hurts a whole lot. Face five hurts as much as you can imagine,
although you don’t have to be crying to feel this bad. Ask your patient to choose the face that best
describes how he or she is feeling. Pain Scales, The Numeric Scale. The numeric scale is designed to be used by
patients over the age of 9. In the numeric scale, the user has the option
to verbally rate their scale from zero to ten, or to place a mark on a line indicating
their level of pain. Zero indicates the absence of pain, while
ten represents the most intense pain possible. Pain Scales, The Individualized Numeric Rating
Scale. The individualized numeric rating scale is
an adaptation of the numeric rating scale that asks a parent or caregiver to identify
an individual patient’s typical behavior, and ask them to qualify that behavior on a
scale from zero to ten. It was developed at Children’s Hospital Boston
to help intensive care nurses observe, consistently document, and communicate the unique pain
behaviors of intubated and non-verbal critically ill children after major surgical procedures. On this scale, the mother of the patient has
identified talking, smiling, and giggling as no pain and screaming loudly as the most
pain her child will exhibit. Assessing Pain in the Paralyzed and Sedated
Patient. Patients who are chemically paralyzed and
sedated should be continuously assessed for pain. The assessment includes checking pupils, monitoring
heart rate, and blood pressures. If there’s an increase in blood pressure and
heart rate, you can assume that there is pain or agitation. If pain or agitation is noted, it should be
treated and reassessed within one hour. The pupils should also be carefully assessed
at least once an hour with a flashlight with a focus on pupil size and reactivity. They should be equal and reactive to light. If they are larger in diameter than the previous
hour, pain may be present. It should be treated and reassessed within
the hour. That concludes our video on pain assessment. Thank you. Please help us improve the content by providing
us with some feedback. What did or didn’t you like about this video? Was the content too simple, just right, or
too difficult? Was the length too short, just right, or too
long? Any additional comments? You can either click the Start A New Discussion
button, and type in feedback, or send us an email at [email protected] hildrens.harvard.edu. Note, feedback is not required to complete
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1 thought on ““Pain Assessment” by Catherine Dowling for OPENPediatrics

  1. Very Good, i would like a review of sedation and management of delium and abstinence in patient with prolonged intubation

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