Skip to main content

How to Assess Pain in Nonverbal, Special-Needs Kids

While treating nonverbal children with complex medical conditions, hospital nurses often face the challenging task of assessing whether or not a young patient is in pain, according to a new study published in the American Journal of Nursing.

“While most kids can be in and out of the primary care provider’s office in under an hour for an ear infection, children with complex needs stay in the hospital for a week just to find the ear infection,” said lead author Brenna L. Quinn, Ph.D., R.N., N.C.S.N., C.N.E., of the Solomont School of Nursing at the University of Massachusetts, Lowell.

“Identifying pain early so teams may get to work finding and addressing the source is essential in avoiding long hospital stays, family stress, poking and prodding, or even surgery and death.”

For the study, researchers analyzed the symptoms, diagnostic testing, and nursing assessment of pain in 46 children with profound intellectual and developmental disability who are completely dependent on caregivers or medical devices (such as feeding tubes) for their care.

The patients ranged in age from infants to young adults (average age was 13 years). Most had several chronic conditions, most commonly seizure disorders and cerebral palsy; all were unable to communicate their pain verbally: where they were hurting, how much pain they were experiencing, or whether they were in pain at all.

The most common symptoms leading parents or caregivers to seek medical help for their child were abdominal pain or bloating, irritability, or other signs of pain. In some cases, the parents said that their child was just “not acting like herself [or himself].”

While in the hospital, the children underwent an average of five diagnostic tests, most commonly X-rays, and were evaluated by an average of four specialty services.

The children received more than 3,300 pain assessments; an average of seven assessments per patient per day. Since the children couldn’t communicate their pain, the nurses used a number of assessment tools based on observable pain behaviors (facial expressions, crying, etc).

The most common diagnoses were infections, including urinary tract infections (30 percent of children); constipation (20 percent); and increased seizure activity related to low levels of antiepileptic medications (13 percent). After other conditions were ruled out, a diagnosis of chronic pain was made in 22 percent of patients.

Although they represent a small percentage of hospitalizations, medically complex children use a high proportion of health care services.

“Like all patients, nonverbal children with medical complexity require a balance of standardized and individualized care,” Quinn and coauthors write. Based on their findings, they offer the following recommendations for pain evaluation in this group of patients:

  • Asking for and using the parents’ or caregivers’ knowledge of the child. As shown in previous research, the findings suggest that parents are often able to identify behavior changes indicating their children are in pain.
  • Assessing the presence of pain, even when the child appears to be sleeping or when there are indications of a change in mental status.
  • Using pain assessment tools matched to the patient’s cognitive abilities, incorporating behavior assessments and input from parents.
  • Being alert for potentially life-threatening sources of pain while also not overlooking more common problems like infections or constipation.

The researchers say more studies are needed in children with complex medical conditions, particularly those who cannot express their pain with words. Currently, the researchers are working to develop a tool to aid in comprehensive, efficient assessment of common causes of pain in this vulnerable group of patients.

“When pain assessment is inadequate or lacking, these children suffer unnecessarily,” Quinn and coauthors conclude.

Source: Wolters Kluwer Health



from Psych Central News https://ift.tt/2OHkufu
via IFTTT

Become a patron of The Carlisle Wellness Network. Show everyone that you think this service is worth at least a buck. Go to; https://www.patreon.com/carlislewellness and pledge one dollar per month and help improve the resources it takes to gather the articles you see here as well as create fresh content including interviews an podcasts. We only need one dollar per month from all of our patrons to give The Carlisle Wellness Network a bright furture in the health and wellness social media ecosystem.

Comments

Popular posts from this blog

Hair Pulling, Nail Biting, Skin Peeling and Biting

All my life I’ve bitten my nails. It’s caused me a lot of trouble, especially with my bipolar mother who has always thought screaming and shouting at me (and often a smack when I was younger) would make me stop.At around 7 I also started biting and peeling the skin on my fingers which has caused a lot of social and health issues for me from being to ashamed to join in with prayers at school, to getting my fingers getting a fungal infection causing long lasting damage to my fingers.Soon after I started to pull out the tiny hairs on my legs during school assembles and by 12 I began to pull my eyebrow hair out.How can I stop doing this to myself? I don’t even realise I’m doing it half the time (I started biting the skin around my fingers just writing this and caused it to bleed a little). I’m afraid to bring this up with my parents because of how they have reacted in the past and I’m far too embarrassed to ask anyone I would typically trust. It has severally impacted how I interact with …

Painful Memories Evoke More Intense Emotions in Those With Depression

People with major depressive disorder (MDD) experience more intense negative emotions while recalling painful memories compared to non-depressed people, according to a new study published in the journal Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.And although those with MDD were able to turn down their negative emotions about as well as non-depressed people, they used different brain circuits to do so.The new findings pinpoint brain differences in MDD associated with the processing of autobiographical memories — one’s memories of personal events and knowledge of one’s life — that help us develop our sense of self and guide our interactions with the world around us.“This study provides new insights into the changes in brain function that are present in major depression,” said journal editor Cameron Carter, M.D. “It shows differences in how memory systems are engaged during emotion processing in depression and how people with the disorder must regulate these systems i…

New video by FDMX Fitness on YouTube

TRX Back and Shoulder workout
Here we are back with the TRX Suspension trainer for a back and shoulder workout! We will be wearing our polar h7 heart rate monitors, to keep track of our heart rate zones and calories burned. We will be doing the following exercises in this TRX workout video 1. TRX Shoulder press 2. TRX Low Rows 3. TRX W-Drills/ TRX L-Drills 4. TRX Mid Rows 5. TRX Shoulder press 6. TRX High Rows 7. TRX W-Drills/ TRX L-Drills 8. TRX Mid Rows Be sure to check out all of our TRX workout videos at http://ift.tt/2n62Kj3


View on YouTube

Become a patron of The Carlisle Wellness Network. Show everyone that you think this service is worth at least a buck. Go to; http://ift.tt/2i70pBW and pledge one dollar per month and help improve the resources it takes to gather the articles you see here as well as create fresh content including interviews an podcasts. We only need one dollar per month from all of our patrons to give The Carlisle Wellness Network a bright furture in the health an…