Pain Assessment and Intervention

Pain Assessment and Intervention
Signs and Symptoms by Developmental Stage
■ Infant: Grimacing, frowning, startled expression, flinching, high-pitched, harsh cry, generalized, total-body response, extremities may thrash about, tremors, increased HR and BP, ↓ oxygen saturation. ■ Toddler: Guarding, may touch or rub area, generalized restlessness, loud cry, increased HR and BP, may verbalize with words such as “owie” or “boo-boo.” ■ Preschooler: May perceive pain as punishment, may deny pain to avoid treatment, may be able to describe location and intensity, may exhibit crying and kicking, or may be withdrawn. ■ School-aged: Fear of bodily harm and mutilation, awareness of death, able to describe pain, may exhibit stiff body posture, may withdraw, and may attempt to delay procedures. ■ Adolescent: Perceives pain at physical, emotional, and mental levels, is able to describe pain, may exhibit increased muscle tension, may be withdrawn, and may show decreased motor activity.
Interventions for Pain
Nonopioid Analgesics ■ Acetaminophen (Tylenol): 10–15 mg/kg PO q.4h., max five doses/day. ■ Ibuprofen (Advil): (>2 yr) 7.5 mg/kg PO q.i.d., max 30 mg/kg/day. ■ Naproxen (Naprosyn): (>2 yr) 5 mg/kg PO b.i.d., max two doses. Opioid Analgesics ■ Codeine: (>1 yr) 0.5 mg/kg (15 mg/m2) PO, IM, SC q.4–6h., max four doses/day. Note: Not recommended for IV use. Infants may receive SC or IM codeine at same dose. ■ Meperidine (Demerol): 1.1–1.8 mg/kg PO, IM, SC q.3–4h. p.r.n., max 50–100 mg/dose. ■ Morphine: 0.1–0.2 mg/kg IV, IM, or SC p.r.n., max 15 mg/dose. ■ Sublimaze (Fentanyl): (>2 yrs) 2–3 ug/kg IV. Nonpharmacologic Interventions ■ Distraction: Music, TV, games, dolls, stuffed animals, art, etc. ■ Minimize environmental stimuli: Noises, bright lights, etc. ■ Provide comfort: Positioning, rest, and relaxation ■ Cutaneous stimulation: Massage or heat or cold therapy. ■ Guided imagery: Guide the child to either a make-believe place or someplace he or she has visited in the past (i.e., Disneyland). Encourage the child to describe this place.
Pediatric IM Injection Sites
	Muscle*	Needle	Max Volume
Infant	Ventrogluteal or vastus lateralis	5/8–7/8”	1 mL
Toddler	Ventrogluteal or vastus lateralis	5/8–1”	1 mL
Older child	Ventrogluteal or deltoid	5/8–1”	1 mL
*The dorsogluteal site is contraindicated in infants and children.