Neonatal Pain Management 1
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NEONATAL PAIN ASSESSMENT &MANAGEMENT Common Approaches to a Common Problem “The inability to communicate in no way negates the possibility that an individual is experiencing pain and is in need of appropriate pain relieving treatment” (IASP, 2001,p2)
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Transcript of Neonatal Pain Management 1
NEONATAL PAIN ASSESSMENT &MANAGEMENT
Common Approaches to a Common Problem
“The inability to communicate in no way negates the possibility that an individual is experiencing pain and is in need of appropriate pain relieving
treatment” (IASP, 2001,p2)
Neonatal Pain Assessment &Management
Presented By
Khaula F. Reid R.N
StudentThe College of the Bahamas
Nursing EthicsNursing 402
Common Approaches to a Common Problem
Objectives: Define nociception, perception,
pain Describe common myths about
neonatal pain Case Study Baby A Common Nursing Diagnoses Outline methods for assessing
neonatal pain in the NICU Outline methods for relieving
neonatal pain including Fentanyl Nurses as advocates for neonates:
Recent Findings Conclusion: Moving Forward Bibliography: Giving Account
Neonatal Pain Assessment &Management
Neonatal Pain Assessment &Management
Nociception, Perception, Pain
Neonatal Pain Assessment &Management
Neonatal Pain:
Common Myths
The neural and endocrine systems of the newborn infant are not developed to the stage that allows for transmission of painful stimuli
Newborn term and preterm infants cannot “remember” pain and therefore, there can be no sequelae of pain.
Pain cannot be adequately assessed in the newborn infant
No self report of pain hence no pain intensity rating.
Common methods for relieving pain are not “baby friendly”.
Neonatal Pain Assessment &Management
Neonatal Pain:
Case Study: Baby A
Name: Baby A, Twin Female Age: 4 days as of April 7th, 2009BW: 930gms
Delivery Hx: C-section, decreasing fetal heart rate, decreased tone, respiratory distress. Apgar 71, 85,
Maternal Hx: 34 yr old G2 P0+1
Blood Group A-, GBS+, UTI for 2 wks, prior to delivery. Placental growth discordance.
Social Hx: Mom, dad, grand mom support
Parent/infant/child attachment, altered, risk forParenting, alteredParenting, altered, risk forRole performance, alteredSocial interaction, impairedSocial isolation
Neonatal Pain Assessment &Management
Neonatal Pain: Nursing Diagnosis
NANDA Nursing Diagnosis
PainAcuteChronic
Neonatal Pain Assessment &Management
Neonatal Pain: Sources Birth Events
Major Surgery and Invasive Procedures Diagnostic Examinations Neonatal Conditions
1.No Documentation of Sedative Techniques
2.Report of No Sedative Used
3. Practices have not changed in the NICU
Neonatal Pain Assessment &Management
Neonatal Pain:
Summary of Ethical Issues surrounding Neonatal Pain Management
-routine procedures done without anesthesia or sedation
Background of Ethical Issues-Procedures such as heel sticks,
blood harnessing, intubations, lumbar punctures.
Personal Position
Supporting Evidence/Justification-Bahamas-General
Ethical Perspectives
Neonatal Pain Assessment &Management
Neonatal Pain:
Assessment Methods
Commonly Used Pain Rating Scales
Premature Infant Pain Profile Crying, oxygen requirement,
increased vital signs, expression, sleeplessness
Face, Legs, Activity, Cry, Consolibility
Neonatal Infant Pain Scale Neonatal Facial Coding System Others: Modified post-operative
comfort score, Pokela’s Behavioral pain score, Modified Behavioral Pain Scale and Infant Body Coding System
Sedation Scores
Neonatal Pain Assessment &Management
Neonatal Pain:
Assessment Criterion
Points to ConsiderNewborns, even the most immature
feel painNewborns in the NICU are subjected
to multiple painful procedures that may result in an altered pain response later in infancy
If a procedure is painful in adults it should be considered painful in the newborn.
Adequate treatment of pain may be associated with decreased clinical complications and decreased mortality.
Consider a combination of therapies to relieve pain.
Types of Pain Management Therapies
Prevention Non-Pharmacological Pharmacological
Neonatal Pain Assessment &Management
Neonatal Pain: Management Strategies
Neonatal Pain Assessment &Management
Neonatal Pain: Nursing Advocates
References:
A discussion of Neonatal Pain Among Health Professionals:
Procedural pain in newborns at risk for neurologic impairment
Bonnie Stevens, R.N. PhD et al
Healthcare professionals’ perceptions of pain in infants at risk for neurologic impairment.
Lynn M Breau et al
Consistent Management of Repeated Procedural Pain with Sucrose in Preterm Neonates: Is it effective and safe for repeated use over time.
Bonnie Stevens, R.N. PhD et al
Evaluation and development of potentially better practices to improve pain management of neonates.
Paul J. Sharek et al
Neonatal Pain Assessment &Management
Neonatal Pain:
Conclusion
References: contd: 1. Human Neonates and Pain J. Boumeester, M. van Dijk & D. Tibboel, Sophia
Children’s Hospital and Erasmus University Rotterdam, The Netherlands.
2. Assessment And Management Of Acute Pain In The Newborn
developed for AWHONN by Robin Koeppel, MS, RNC, CPNP.
3. Pain Management and Sedation in the NICU
N. Abalavanan MD, Assistant Professor, Division of Neonatology, University of Alabama at Birmingham. Feb 2003.
A society will be judged on the basis of how it treats its weakest members and among the most vulnerable are surely the unborn and the dying," ~Pope John Paul II (and the newborn)
Thank You
