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Introduction Aim Definition of Terms Assessment Pain Assessment Tools Physiological Indicators Key Considerations Special Considerations Companion Documents Links Education Evidence Table IntroductionPain assessment is crucial if pain management is to be effective. Nurses are in a unique position to assess pain as they have the most contact with the child and their family in hospital. Pain is the most common symptom children experience in hospital. Acute pain (noiciception) is associated with
tissue damage and an inflammatory response, it is self limiting of short duration and does not involve neural tissue. AimThe guideline specifically seeks to provide nurses with information regarding
Definition of TermsPain:
Pain assessment: is a multidimensional observational assessment of a patients’ experience of pain. Pain measurement tools: are instruments designed to measure pain. AssessmentPain
assessment is a broad concept involving clinical judgment based on observation of the type, significance and context of the individual’s pain experience. Pain assessment in infants and children is also challenging due to the subjectivity and multidimensional nature of pain. The dependence on others to assess pain, limited language, comprehension and perception of pain expressed contextually. In some children it can be difficult to distinguish between pain, anxiety and distress. Assessment and documenting pain is needed in order to improve management of pain. When assessing a child’s level of pain careful consideration needs to be given to their:
Pain measurement quantifies pain intensity and enables the nurse to determine the efficacy of interventions aimed at reducing pain. A pain assessment should be conducted during a patient’s admission. (link to Nursing Assessment nursing clinical guideline) Points to consider:
When to assess pain?
Tools used for pain assessment at RCH have been selected on their validity, reliability and usability and are recognized by pain specialists to be clinically effective in assessing acute pain. All share a common numeric and recorded as values 0-10 and documented on the clinical observation chart as the 5th vital sign. Three ways of measuring pain:
Pain Assessment Tools used at RCHThere are three main tools used for the neonate, infant and child 3-18 years these tools reflect a combination of self-report and behavioural assessment. 1. FLACC - The acronym FLACC stands for Face,Legs, Activity, Cry and Consolability. Behavioural
How to use FLACCEach category (Face, Legs etc) is scored on a 0-2 scale, which results in a total pain score between 0 and 10. The person assessing the child should observe them briefly and then score each category according to the description supplied. 2. Wong-Baker faces pain scale 3-18yo How to use? 3. Visual Analogue scale 8-years and older Self report How to use? Ask the child using numbers from 0 = no pain through to 10 being the worst pain Physiological indicators
Physiological indicators in isolation cannot be used as a measurement for pain. A tool that incorporates physical, behavioural and self report is preferred when possible. Key considerations
Special ConsiderationsMulti language Wong Baker and Numeric tools are available if needed https://www.briggshealthcare.com/Wong-Baker-Faces-Pain-Rating-Scale-8-Languages Modified PAT Tool is used in the Neonatal Intensive Care Unit http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_Pain_Assessment/ Comfort B is used for Ventilated paediatric patients assessing both pain and sedation http://www.rch.org.au/picu_intranet/guidelines/Nursing_management_of_the_patient_with_invasive_mechanical_ventilation_in_PICU/ Companion Documents
Further information on pain management principles and assessing pain in children can be found here:
Links
Education
Evidence TableThe evidence table for this guideline can be viewed by clicking here. Please remember to read the disclaimer. The development of this nursing guideline was coordinated by Sueann Penrose, CNC, Children's Pain Management Service, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2022. Which clinical manifestations with a nurse expect for a client who has myasthenia gravis?People with myasthenia gravis may experience the following symptoms:. weakness of the eye muscles (called ocular myasthenia). drooping of one or both eyelids (ptosis). blurred or double vision (diplopia). a change in facial expression.. difficulty swallowing.. shortness of breath.. impaired speech (dysarthria). In which clinical classification of myasthenia gravis is intubation indicated?Class V: Defined by the need for intubation, with or without mechanical ventilation, except when used during routine postoperative management. The use of a feeding tube without intubation places the patient in class IVb. Which conditions or factors in a middle aged woman diagnosed with GuillainRisk factors Guillain-Barre syndrome may be triggered by: Most commonly, infection with campylobacter, a type of bacteria often found in undercooked poultry. Influenza virus. Cytomegalovirus. Which procedure would the nurse expect as a treatment option for a client newly diagnosed with Guillain"Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms." What are the clinical presentations of myasthenia gravis?Droopy eyelids or double vision is the most common symptom at initial presentation of MG, with more than 75% of patients. These symptoms progress from mild to more severe disease over weeks to months. Difficulty in swallowing, slurred or nasal speech, difficulty chewing, and facial, neck, and extremity weakness occur.
Which of the following is are signs and symptoms associated with myasthenia gravis?There's no cure for myasthenia gravis, but treatment can help relieve signs and symptoms, such as weakness of arm or leg muscles, double vision, drooping eyelids, and difficulties with speech, chewing, swallowing and breathing.
What is the most common presentation of myasthenia gravis?Diplopia and ptosis are the most common presenting features of myasthenia gravis, but about 80% of patients will subsequently develop more generalised weakness. 2 Weakness is typically more noticeable in the upper limbs than the lower limbs and is often proximal.
What is an initial symptom in myasthenia gravis?Symptoms of myasthenia gravis
difficulty making facial expressions. problems chewing and difficulty swallowing. slurred speech. weak arms, legs or neck. shortness of breath and occasionally serious breathing difficulties.
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