2.

4 PAIN Activity

Instructions:
1. REVIEW: Pain Assessment in your textbook.

2. Complete and submit "Pain Activity,":

o While considering appropriate nursing responses in the situations below, also identify factors that
may be influencing the nurse, the child, and the family (i.e., growth and development, stress, life
experiences).

How to Submit:

When you have completed your Nursing Diagnosis, save in Word (.doc), rich text (.rtf), or text (.txt) format
and submit to the instructor using Assignments.
Situation
1. When preparing a 4 year-old child No. A preschooler will
for an IV insertion, you state,
“This is going to hurt”.
2. A neonate is NPO for lab. The
child is lying in the isolette,
crying, and refusing the
pacifier. You continue to
place the pacifier in the
infant’s mouth and the child
continues to cry.
3. A 1 month-old infant has just
returned to your unit
following abdominal surgery.
There is an order for
Morphine 1 mg q 3-4 hours
PRN. The child is crying and
thrashing. You note that the
last dose was given 3 hours
ago. You give another dose
Is this an appropriate Better response would be:
response? Provide
rationale:
It is important to prepare
anticipate painful the child for the procedure
procedures. Preschoolers and provide support or
benefit from medical play
allow the parent to stay.
prior to a painful procedure;
can help decrease their Consider the use of
anxiety and any subsequent distractions. Then say “this
pain. may pinch, but only for a
second.”
Yes, A neonate can localize The better response would
and purposefully withdraw be to console/comfort the
from painful stimuli. There neonate by picking him up
is a distinctive cry when
or having the parent do so.
experiencing acute pain.
High-pitched and shrill, Continue to try the pacifier
followed by apnea and the or a gloved finger.
short gasps or burst of
crying. The eyebrow is
furrowed, the mouth is taut,
and the tongue is thrusted
during the cry, as well as
nasal flaring and a distressed
facial expression.
Yes this is appropriate.
Postoperative pain is
included as acute pain. The
uses of opioids for pain
relief are effective when
administered in small
frequent doses.
 of Morphine.
4. A 6 year-old child is
preparing to go to whirlpool
for treatment of 2nd degree
burns on her arm. There are
prn orders for acetaminophen
and morphine. The child has
rated her pain during therapy
as a 10 on a scale of 1-10.
You administer
acetaminophen and plan for
the child’s mother to read to
her during the treatment.
5. A 14 year-old is 2 days post-
abdominal surgery. As you
enter the room, she smiles at
you and continues to talk and
joke with her visitor. She rates
her pain as 8 on a scale of 1-
10. You chart “In no acute
distress and appears
comfortable, talking and
joking with a visitor.”
6. A 12 year-old is 3 days post-
scoliosis surgery. She does not
smile and is lying very still in
bed. She rates her pain as 8 on
scale of 1-10. You chart:
Rates surgical pain as 8 on a
scale of 1-10.
7. You are starting an IV on a 5
year-old who had EMLA
cream applied to 2 sites 15
Yes this is appropriate.
Preventing pain is important
in a school age child. Pain is
usually all or nothing. A
child this age may view pain
as punishment for a bad
deed. Provide factual
information about the cause
of the pain and reasons
painful interventions are
necessary. The use of
distraction during therapy is
also beneficial such as the
mother reading the book to
her during treatment.
Include the use of relaxation
and consider hypnosis.
No. Adolescents may feel Acknowledge and
they need to hide their pain. frequently assess pain.
They may deny pain to Even though they prefer
prove strength or in hopes to
independence it is
go home; or to show
maturity. They may even be important to include family
concerned that taking in discussions on effective
medications for pain will pain treatment. Explain the
lead to addiction. Distraction preferred level of pain as
is used to cope with pain well as how this is
such as talking, sleeping achieved. Leave time to
watching TV or playing
discuss concerns about
games.
addiction and management
of pain and medicate
accordingly.
No the nurse did not It is important to
thoroughly assess her pain. thoroughly assess pain. By
Help the child measure the day 3 post-op she should be
pain themselves. Adequate
feeling like getting up. Self
pain control promotes
shorter hospital stays and exercises such as positive
promotes quicker return to thinking and guided
normal functioning and lead imagery can be used.
to a more positive hospital Relaxation therapy can also
experience. be used, the child might be
afraid to move.
It is appropriate to use Explain procedure in age
analgesic cream prior to IV appropriate terms as “this
procedure. It is also will pinch.” Encourage the
 minutes ago.
8. An 8 year-old has an order for
5-10 mg of Morphine q 3-4
hours for post-op pain. He has
just returned from surgery.
He has a pain-rating goal of 2
on a scale of 1-10. At 2 pm he
received 5 mg, pain was 8, R-
30, P-100, and he was restless.
At 4 pm he reported pain was
4. At 5 pm he reported pain
was 8, R=24, P-96. You
administer 10 mg.
9. A 9-year-old returns from
orthopedic surgery. The child
has cerebral palsy, is
nonverbal, and unable to
respond to a verbal pain
assessment tool.. She weighs
33 lbs. Her orders read:
• Morphine Sulfate 1 mg
continuous IV infusion
• Morphine Sulfate 1 mg every
1-2 hours intravenous bolus for pain.
breakthrough pain
important to prepare the
client shortly before the
procedure to enhance
coping. Allow a parent to
comfort or sit next to and
support the child.
Post operative pain is
considered acute pain. The
appropriate control of pain is acute post-op pain by
maintaining pain below a 3.
Even though the patient is
nonverbal, it is important to
use the FLACC behavioral
pain scale or the COMFORT
behavior scale and scoring
form. Objective pain
measures are ideal for a
child with cerebral palsy.
The blood pressure doesn’t
indicate the child is in acute
parent to support the child
by sitting next to him. The
parent can also help support
the limb to start the IV on.
Encourage the child to be
very still and to say, “stop”
if any pain is experienced,
but to not move.
It would have been more
appropriate to control his
frequently medicating at
every 3 hour interval. If his
pain was at an 8 and
relieved down only to a 4
two hours after med
administration and then
back up to 8 the next hour, I
would have given him 7mg
and monitored his response.
You can always administer
more medication in an hour
or two if the pain is still
severe. It is better to have
smaller frequent dosing to
control pain; the client
should never experience
peak pain. If however, he
still is experiencing pain
spikes at the full 10mg, it
would be important to
notify the physician.
It is important to discuss the
fears of the parent. The
client should be regularly
assessed for pain and
treated accordingly.
One hour after starting the continuous
IV infusion, her eyes are open wide
and her blood pressure is 128/90. The
patient’s mom says, “I think she is in
severe pain.” The nurse administers
the 1 mg ordered for breakthrough
pain and documents “The patient’s
mother states the patient is in severe
pain. Patient’s eyes are open wide, BP
128/90. Morphine administered as
ordered for breakthrough pain.”

0-59% or
90-100% or 75-82% or 7.5- 0-5.9
83-89% or 8.3-8.9 points 60-74% or 6.0-7.4
9-10 points 8.2 points points
VERY GOOD points WEAK
EXCELLENT ADEQUATE POOR

(1) Responds fully to the assignment (follows

directions)
(2) Thoroughly comprehends key concepts
(3) Exercises good critical thinking
(4) Expresses understanding clearly and
persuasively
(5) States facts correctly
(6) Provides adequate supporting arguments with
reasons, evidence, and examples
(7) Is focused and well organized
(8) Uses college level vocabulary
(9) Correctly documents and cites sources
including textbook and module lessons
(10) Is free of errors in grammar, punctuation, word
choice, spelling, and format
Overall Evaluation