Pharmacologic management The World Health Organization states that the principles for pharmacologic pain management should include the following: Using a two-step strategy Dosing at regular

Guided imagery Assist the child in an imaginary experience Including as many senses as possible (e.g., “feel the cool breezes,” “see the beautiful colors,” “hear

Appropriate routes Oral Nursing actions Route is preferred due to convenience, cost, and ability to maintain steady blood levels Take 1 to 2 hr to

Non-communicating children’s pain checklist: 3 years and older Behavior are observed for 10 min Six subcategories are each scored on a scale 0 to 3

Pain Assessment Intensity Assessment includes behavioral measures, multidimensional, and self-report. Self-report is used for children 4 years or older. Children under 4 are unable to

Physiologic Data Current health status Health maintenance pattern and last visit Up to date? Safety Activity and exercise Nutrition Sleep Family history Health background Changes

Cranial Nerves I—Olfactory Nerve Olfactory mucosa of nasal cavity (Smell) With eyes closed, have child identify odors, such as coffee, alcohol from a swab, or

Musculoskeletal system Length, position, and size of extremities are symmetric Joints Stable and symmetric with full range of motion and no crepitus or redness Spine

Abdomen Without tenderness, no guarding. Peristaltic waves can be visible in thinner children. Shape: Symmetric and without protrusions are around the umbilicus Infants and toddlers

Circulatory System Heart Inspection Precordial activity Shape and symmetry Heave: an obvious lifting of the chest wall during contraction, may indicate an enlarged heart Palpation

Chest and Lungs Chest shape Infants: Shape is almost circular with anteroposterior diameter equaling the transverse or lateral diameter Children and adolescents: The transverse diameter

Ears During the tympanic membrane exam: In infants – Pull pinna down and back In children older than 3 – Pull pinna up and back