Pediatrics : Appropriate routes

    • 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 reach peak analgesic effects. Oral medications are not suited for children experiencing pain that requires rapid relief or pain that is fluctuating in nature
      • Topical/transdermal
        • Nursing actions
          • Lidocaine and prilocaine is available in a cream or gel
            • Used for any procedure in which the skin will be punctured (IV insertion, biopsy) 60 min prior to a superficial puncture
            • Place an occlusive dressing over the cream after application
            • Prior to procedure, removing the dressing and clean the skin. Indication of an adequate response is reddened or blanched skin
            • Demonstrate to the child that the skin is not sensitive by tapping or scratching lightly
            • Instruct parents to apply medication at home prior to the procedure
          • Fentanyl
            • Use for children older than 12 years of age
            • Use to provide continuous pain control. Onset of 12 to 24 hr and a duration of 72 hr
            • Use an immediate-release opioid for breakthrough pain
            • Treat respiratory depression with naloxone
      • Intravenous
        • Nursing actions
          • Bolus
            • Rapid pain control in approximately 5 min
            • Use for medications (morphine, hydromorphone)
            • Continuous: provides steady blood levels
          • Patient-controlled analgesia (PCA)
            • Self-administration of pain medication
            • Can be basal, bolus, or combination
            • Has lockout to prevent overdosing
          • Family-controlled analgesia
            • Same concept as PCA
            • Parent or caregiver manages the child’s pain
      • Nonpharmacological measures
        • Distractions
          • Tell jokes or a story to the child
          • Involve parent and child in identifying strong distractors.
          • Involve child in play; use radio, smartphone, tablet, or computer game; have child sing or use rhythmic breathing.
          • Have child take a deep breath and blow it out until told to stop.
          • Have child blow bubbles to “blow the hurt away.”
          • Have child concentrate on yelling or saying “ouch,” with instructions to “yell as loud or soft as you feel it hurt; that way I know what’s happening.”
          • Have child look through kaleidoscope (type with glitter suspended in fluid-filled tube) and encourage him or her to concentrate by asking, “Do you see the different designs?”
          • Use humor, such as watching cartoons, telling jokes or funny
          • stories, or acting silly with child.
          • Have child read, play games, or visit with friends.
        • Relaxation
          • Infant or young child
            • Hold or rock the infant or young child
              • Rock in a wide, rhythmic arc in a rocking chair, or sway back and forth, rather than bouncing child.
            • Assist older children into a comfortable position, well-supported position, such as vertically against the chest and shoulder
            • Assist with breathing techniques
              • Repeat one or two words softly, such as “Mommy’s here.”
          • Slightly older child
            • Ask child to take a deep breath and “go limp as a rag doll” while exhaling slowly; then ask child to yawn (demonstrate if needed)
            • Help child assume a comfortable position (e.g., pillow under neck and knees).
            • Begin progressive relaxation: starting with the toes, systematically instruct child to let each body part “go limp” or “feel heavy.” If child has difficulty relaxing, instruct child to tense or tighten each body part and then relax it.
            • Allow child to keep eyes open, since children may respond better if eyes are open rather than closed during relaxation.

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