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OBJECTIVES

AFTER THE LEARNING SESSION, THE LEARNERS WILL BE ABLE TO:

• DEFINE THE DIFFERENT PAIN ASSESSMENT TOOL


• DEMONSTRATE THE QUALITY/ TYPES OF PAIN
• APPRECIATE THE IMPORTANCE OF PAIN ASSESSMENT TO BE
USED FOR CHILDREN AND ADULT
WHAT IS PAIN?
• PAIN IS A SYMPTOM OF BEING HURT OR SICK. IT IS A BAD SENSATION THAT IS
PHYSICAL AND EMOTIONAL.

• MOST PAIN STARTS WHEN PART OF THE BODY IS HURT. NERVES IN THAT PART
SEND MESSAGES TO THE BRAIN. THOSE MESSAGES TELL THE BRAIN THAT THE
BODY IS BEING DAMAGED.
WHAT IS PAIN ASSESSMENT?

AN EVALUATION OF THE REPORTED PAIN AND THE FACTORS


THAT ALLEVIATE OR EXACERBATE IT, AS WELL AS THE
RESPONSE TO TREATMENT OF PAIN.
WHAT IS PAIN ASSESSMENT TOOL?

IS A MULTIDIMENSIONAL OBSERVATIONAL ASSESSMENT


OF A PATIENTS’ EXPERIENCE OF PAIN.
THREE WAYS OF MEASURING PAIN

• SELF REPORT ( SUBJECTIVE CUES )


• BEHAVIORAL ( HOW THE PATIENT BEHAVES)
• PHYSIOLOGICAL (CLINICAL OBSERVATION)
PAIN ASSESSMENT METHOD AND PAIN SCALE
PQRST PAIN ASSESSMENT METHOD
P = PROVOCATION/PALLIATION
WHAT WERE YOU DOING WHEN THE PAIN STARTED?
WHAT CAUSED IT?
WHAT MAKES IT BETTER OR WORSE?
WHAT SEEMS TO TRIGGER IT? STRESS? POSITION? CERTAIN
ACTIVITIES?
WHAT RELIEVES IT? MEDICATIONS, MASSAGE, HEAT/COLD,
CHANGING POSITION, BEING ACTIVE, RESTING?
WHAT AGGRAVATES IT? MOVEMENT, BENDING, LYING DOWN,
WALKING, STANDING?
PQRST PAIN ASSESSMENT METHOD
Q = QUALITY/QUANTITY
WHAT DOES IT FEEL LIKE?
USE WORDS TO DESCRIBE THE PAIN SUCH AS
SHARP, DULL, STABBING, BURNING, CRUSHING,
THROBBING, NAUSEATING, SHOOTING, TWISTING
OR STRETCHING.
PQRST PAIN ASSESSMENT METHOD
R = REGION/RADIATION
WHERE IS THE PAIN LOCATED?
DOES THE PAIN RADIATE? WHERE?
DOES IT FEEL LIKE IT TRAVELS/MOVES
AROUND?
DID IT START ELSEWHERE AND IS NOW
LOCALIZED TO ONE SPOT?
PQRST PAIN ASSESSMENT METHOD
S = SEVERITY SCALE
HOW SEVERE IS THE PAIN ON A SCALE
OF 0 TO 10, WITH ZERO BEING NO PAIN
AND 10 BEING THE WORST PAIN EVER?
DOES IT INTERFERE WITH ACTIVITIES?
HOW BAD IS IT AT ITS WORST?
DOES IT FORCE YOU TO SIT DOWN, LIE
DOWN, SLOW DOWN?
HOW LONG DOES AN EPISODE LAST?
PQRST PAIN ASSESSMENT METHOD
T = TIMING
WHEN/AT WHAT TIME DID THE PAIN START?
HOW LONG DID IT LAST? HOW OFTEN DOES IT OCCUR: HOURLY? DAILY? WEEKLY?
MONTHLY?
IS IT SUDDEN OR GRADUAL?
WHAT WERE YOU DOING WHEN YOU FIRST EXPERIENCED IT? WHEN DO YOU
USUALLY EXPERIENCE IT: DAYTIME? NIGHT? EARLY MORNING?
ARE YOU EVER AWAKENED BY IT? DOES IT LEAD TO ANYTHING ELSE?
IS IT ACCOMPANIED BY OTHER SIGNS AND SYMPTOMS?
DOES IT EVER OCCUR BEFORE, DURING OR AFTER MEALS?
DOES IT OCCUR SEASONALLY?
FACE, LEGS, ACTIVITY, CRY AND CONSOLABILITY.
0 1 2
No particular expression or Occasional grimace or frown, Frequent to constant frown,
Face smile withdrawn disinterested clenched jaw, quivering chin
0 1 2
Normal Position or relaxed Uneasy, restless, tense Kicking or legs drawn up
Legs
0 1 2
Lying quietly, normal position, Squirming, shifting back and Arched, Rigid, or Jerking
Activity moves easily forth, tense
0 1 2
No cry ( awake or sleep) Moans or whimpers, occasional Crying steadily, screams or
Cry complaints sobs, frequent complains
0 1 2
Content, relaxed reassured by occasional Difficult to console or comfort
touching, hugging or “talking
Consolability to.” Distractable

Age Group: 2 months to 18 years


WONG-BAKER FACES PAIN SCALE

Age Group: 3 years to 18 years


VISUAL ANALOGUE SCALE

Age Group: 8 years and above


OBJECTIVES
THE LEARNERS CAN NOW:

• DEFINE THE DIFFERENT PAIN ASSESSMENT TOOL


• DEMONSTRATE THE QUALITY/ TYPES OF PAIN
• APPRECIATE THE IMPORTANCE OF PAIN ASSESSMENT TO BE
USED FOR CHILDREN AND ADULT
OBJECTIVES
AFTER THE LEARNING SESSION, THE LEARNERS WILL BE ABLE TO:

• UNDERSTAND THE PEDIATRIC ASSESSMENT


• ILLUSTRATE THE PEDIATRIC ASSESSMENT TOOL
• CONFORM THAT PEDIATRIC ASSESSMENT IS DIFFERENT FROM GERIATRIC
WHAT IS A PEDIATRIC ASSESSMENT?
PEDIATRIC ASSESSMENT – IS AN ASSESSMENT TO IDENTIFY THE CURRENT HEALTH
STATUS OF A CHILD. TO DO THIS, THE PEDIATRIC ASSESSMENT TRIANGLE WAS
INTRODUCED AND USED. PEDIATRIC ASSESSMENT TRIANGLE IS A RAPID
ASSESSMENT TOOL THAT USES ONLY VISUAL AND AUDITORY CLUES, REQUIRES NO
EQUIPMENT, AND TAKES 30–60 S TO PERFORM.
WHAT MAKES A PEDIATRIC DIFFICULT THAN
AN ADULT?
• GATHERING INFORMATION
• EXPLANATION OF PROCEDURE
• COOPERATION DURING THE EXAM
• CONCEPT OF INVASIVE VS. NON-INVASIVE
• RELATIONSHIP WITH THE FAMILY IS AS IMPORTANT AS THE CLIENT
THEMSELVES.
PEDIATRIC ASSESSMENT TRIANGLE
WORK OF BREATHING
Characteristics Abnormal Features

Abnormal Airway Sounds Snoring, muffled or hoarse


speech, stridor, grunting ,
wheezing
Abnormal Positioning Sniffing position, tripoding,
preference for seated posture

Retractions Supraclavicular, intercostal or


substernal retractions, head
bobbing, infants
Flaring Flaring of the nares on
inspirations

This part of the Pediatric Assessment Triangle looks at the child’s respiratory status.
APPEARANCE
TONE

IN THE PEDIATRIC TRIANGLE WILL BE YOUR ASSESSMENT


OF THE CHILD’S MUSCLE TONE. DOES THE CHILD SEEM
LISTLESS OR IS THE CHILD ACTIVE. PAY ATTENTION TO
THE CHILD’S NECK FOR MUSCLE TONE CLUES DURING
YOUR PEDIATRIC ASSESSMENT. IS THE CHILD LEANING
THEIR HEAD AGAINST AN OBJECT OR SUPPORTING THE
WEIGHT OF THEIR OWN HEAD?
APPEARANCE
INTERACTIVENESS

CAN BE ASSESSED BY OBSERVING HOW THE CHILD


RELATES TO FAMILY OR ANYONE ELSE PRESENT.
THIS PART OF THE PEDIATRIC TRIANGLE WILL LOOK
FOR SIGNS THAT THE CHILD IS ABLE TO ENGAGE IN
THEIR ENVIRONMENT. DOES THE CHILD GRAB
ONTO A PARENTS LEG OR TURN TOWARDS FIRST
RESPONDERS WHEN THEY WALK INTO THE ROOM?
APPEARANCE
CONSOLABILITY

IS A LITTLE TRICKIER BECAUSE IT CAN BE AFFECTED BY


THE CHILD’S NORMAL TEMPERAMENT. HOWEVER, THIS
PORTION OF THE PEDIATRIC TRIANGLE WILL ASSESS
WHETHER THE CHILD CAN BE CONSOLED. IS THE CHILD
COMFORTED BY PARENTS OR CAREGIVERS. ARE THEY
INCONSOLABLE? DOES THE CHILD KNOW WHAT’S GOING
ON AROUND THEM. ALL OF THESE FACTORS
CONTRIBUTE TO YOUR OVERALL IMPRESSION OF THE
CHILD.
APPEARANCE
LOOK AND GAZE

IS USUALLY AN EASY PART OF THE PEDIATRIC


ASSESSMENT TRIANGLE. EMTS AND
PARAMEDICS CAN LOOK FOR SIGNS THAT THE
CHILD IS INTERESTED IN THE ENVIRONMENT AND
IS “PRESENT.” DOES THE CHILD LOOK AT YOUR
FACE, LOOK AT THE OBJECTS YOU’RE CARRYING,
OR STARE OUT INTO SPACE WITH A VACANT
GAZE?
APPEARANCE
THE SPEECH AND CRY

PORTION OF THE PEDIATRIC TRIANGLE CAN


BE ASSESSED BY DETERMINING IF THE
PATIENT HAS SPONTANEOUS SPEECH AND A
STRONG CRY. DOES THE CHILD REMAIN
SILENT, SPEAK QUIETLY, ONLY SPEAK IF
PROMPTED, OR IS THE CHILD TOO
WITHDRAWN TO SPEAK.
CIRCULATION
Characteristics Abnormal Features
Pallor White or Pale skin or mucus
membrane coloration

Mottling Patchy skin discoloration due


to varying degrees of
vasoconstriction
Cyanosis Bluish discoloration of skin
and mucus membranes

The last side of the Pediatric Assessment Triangle is circulation


OBJECTIVES
THE LEARNERS CAN NOW:

• UNDERSTAND THE PEDIATRIC ASSESSMENT


• ILLUSTRATE THE PEDIATRIC ASSESSMENT TOOL
• CONFORM THAT PEDIATRIC ASSESSMENT IS DIFFERENT FROM GERIATRIC
REFERENCES
• HTTPS://WWW.RCH.ORG.AU/RCHCPG/HOSPITAL_CLINICAL_GUIDELINE_INDEX/PAIN_ASSESSMENT_A
ND_MEASUREMENT
• HTTPS://EMEDICINE.MEDSCAPE.COM/ARTICLE/1948069-OVERVIEW
• HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC4318552/

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