Tatalaksana Nyeri IDAI
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Transcript of Tatalaksana Nyeri IDAI
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Pediatric Emergency and Critical Care Working Group
Indonesian Pediatric Society
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Introduction
Children admitted to the hospital have pain caused
either by the underlying disease or by the diagnostic or
therapeutic procedures.
More often than not, patients receive insufficient
analgesic treatment, even for painful procedures.
Effective management of pain in children is a major
priority for patients, parents, and health-care providers,
highlighted as a priority in the Childrens
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Introduction
The long-term negative effects of pain are becoming more apparent
Inadequately treated pain, particularly in the neonatal period
INCREASES MORBIDITY AND MORTALITY
Pediatrics in Review Vol.24 No.10 October 2003
WHY?
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Introduction
Children admitted to the hospital have pain caused
either by the underlying disease or by the diagnostic or
therapeutic procedures.
More often than not, patients receive insufficient
analgesic treatment, even for painful procedures.
Effective management of pain in children is a major
priority for patients, parents, and health-care providers,
highlighted as a priority in the Childrens
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Definition
As defined by the International Association for
the Study of Pain (IASP):
PAIN is "an unpleasant sensory and emotional
experience associated with actual or potential
damage, or described in terms of such
damage."
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Effect of acute pain
Increased heart rate Increased respiratory
rate Increased blood
pressure Decrease in oxygen
saturation
Physiologic
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Effect of acute pain
Increased heart rate Increased respiratory
rate Increased blood
pressure Decrease in oxygen
saturation
Physiologic
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Effect of acute pain
Facial expression of pain
Behavioural
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Factors that Modify Pain Perceptions
Age
Cognition
Gender
Previous pain experience
Temperament
Cultural and family factors
Situational factors
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Pain scale on Pediatrics??
COMFORT scale anxiety or pain?
VAS visual Autonomic system?
FLAGS Autonomic system?
WBPS patient must consciousness
NIPS Neonatal Infant Pain Scale
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NIPS
(1) facial expression (2) cry (3) breathing patterns (4) arms (5) legs (6) state of arousal
Interpretation: minimum score: 0 maximum score: 7
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FFACE
LEGS
ACTIVITY
L
A
CRY
No particular expression or smile 0
Occasional grimace or frown, withdrawn, disinterested 1
Frequent to constant quivering chin, clenched jaw 2
Normal position or relaxed 0
Uneasy, restless, tense 1
Kicking or legs drawn up 2
Lying quietly, normal position, moves easily 0
Squirming, shifting back and forth, tense 1
Arched, rigid or jerking 2
No cry, (awake or asleep) 0
Moans or whimpers; occasional complaint 1
Crying steadily, screams or sobs. Difficult to console. 2
C
Content, relaxed 0
Reassured by occasional touching, hugging or being talked to.
1
Difficult to console or comfort 2
CONSOLE
C
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Wong Baker Pain Scale (3 yrs and older)
Brief word instructions: Point to each face using the words to describe the
pain intensity. Ask the child
to choose face that best describes own pain and record the appropriate number.
Wongs Essentials of Pediatric Nursing, 6/e, St. Louis, 2001, P.
1301.
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Crit Care Nurse 2009;29:59-66
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Crit Care Nurse 2009;29:59-66
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Nonpharmacologic Sensorimotor strategies for infants
Cognitive/behavioral strategies for older children
Child participation strategies
Physical strategies
Management
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Distraction
Blowing bubbles
Playing with pop-up toys
Looking through a kaleidoscope
Imagining a superhero
Suggestion
Breathing techniques
Guided imagery
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Combine pharmacologic and nonpharmacologic
options when possible and appropriate
Procedure related pain
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WHO step ladder
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WHO step ladder
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Monitoring
A cardiac / respiratory monitor is used for infants less than 7 months
Oximetry monitors for other patients during use of IV opioids
Unstable respiratory status
History of difficult airway management
Neurologically impaired