The purpose of this video is to provide general information and education about the care of
a critically ill child.
It is in no way a substitute for the independent decision making and judgment by a qualified
health care professional.
The information contained in this video should not be used to make a diagnosis or to overrule
the advice of a qualified health care provider, nor should it be used to provide advice for
emergency medical treatment.
Pain Assessment by Catherine Dowling.
Please note that in this video we will be following the guidelines used at Boston Children's
Hospital.
Some of this information may need to be modified based on the equipment, guidelines, and practices
in place in your institution.
Hi.
My name is Catherine Dowling.
I'm a nurse at Children's Hospital Boston in the cardiac ICU.
The objective of this presentation is to discuss pain assessment tools.
Introduction.
There are many ways institutions evaluate and categorize pain.
The most quantitative way is by using a scale.
Some of the scale options include the FLACC, Wong-Baker, numeric rating scale, the individualized
numeric rating scale, and the evaluation of physiological parameters in the chemically
paralyzed patient.
Patient assessment includes the evaluation of pain and should be considered with as much
importance as a vital sign.
Frequency of Pain Assessment.
Pain should be scored using an evidence-based scale at a minimum of every four hours, and
before and after the treatment of pain.
Scoring pain at these intervals allows for assessment and the effectiveness of pain treatment.
Pain Scales, FLACC.
The appropriate pain scale is chosen based on the developing age and neurological status
of the patient.
The FLACC stands for face, legs, activity, crying, and consolability.
It is an observer rated pain scale performed by a health care provider, such as a doctor
or a nurse.
The FLACC pain scale was designed for newborns up to the age of 7.
It provides a pain management assessment scale between zero and ten, with zero representing
no pain.
The scale has five criteria, which are each assigned a score: one, two, or zero.
Pain Scales, Wong-Baker FACES Scale.
The Wong-Baker FACES scale is recommended for a patient who is 3 years and older.
In this scale, the result is determined by the patient.
Explain to the patient that each face is for a person who feels happy because he has no
pain or sad because he has some or a lot of pain.
The zero is very happy because he does not hurt at all.
Face one hurts just a little, face two hurts a little bit more, face three hurts even more,
and face four hurts a whole lot.
Face five hurts as much as you can imagine, although you don't have to be crying to feel
this bad.
Ask your patient to choose the face that best describes how he or she is feeling.
Pain Scales, The Numeric Scale.
The numeric scale is designed to be used by patients over the age of 9.
In the numeric scale, the user has the option to verbally rate their scale from zero to
ten, or to place a mark on a line indicating their level of pain.
Zero indicates the absence of pain, while ten represents the most intense pain possible.
Pain Scales, The Individualized Numeric Rating Scale.
The individualized numeric rating scale is an adaptation of the numeric rating scale
that asks a parent or caregiver to identify an individual patient's typical behavior,
and ask them to qualify that behavior on a scale from zero to ten.
It was developed at Children's Hospital Boston to help intensive care nurses observe, consistently
document, and communicate the unique pain behaviors of intubated and non-verbal critically
ill children after major surgical procedures.
On this scale, the mother of the patient has identified talking, smiling, and giggling
as no pain and screaming loudly as the most pain her child will exhibit.
Assessing Pain in the Paralyzed and Sedated Patient.
Patients who are chemically paralyzed and sedated should be continuously assessed for
pain.
The assessment includes checking pupils, monitoring heart rate, and blood pressures.
If there's an increase in blood pressure and heart rate, you can assume that there is pain
or agitation.
If pain or agitation is noted, it should be treated and reassessed within one hour.
The pupils should also be carefully assessed at least once an hour with a flashlight with
a focus on pupil size and reactivity.
They should be equal and reactive to light.
If they are larger in diameter than the previous hour, pain may be present.
It should be treated and reassessed within the hour.
That concludes our video on pain assessment.
Thank you.
Please help us improve the content by providing us with some feedback.
What did or didn't you like about this video?
Was the content too simple, just right, or too difficult?
Was the length too short, just right, or too long?
Any additional comments?
You can either click the Start A New Discussion button, and type in feedback, or send us an
email at openpediatrics@c hildrens.harvard.edu.
Note, feedback is not required to complete this activity in the guided learning pathway.