pain management lesley foster eb nurse clinical nurse specialist, (paediatric) debra uk patients’...
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Pain Management
Lesley Foster
EB Nurse Clinical Nurse Specialist, (Paediatric) DebRA UK
Patients’ photographs have been removedfrom this presentation
Acute Pain from Bullae / Wounds
• Give prescribed analgesia• Prepare dressings• Lance blisters to prevent from
enlarging. Use Cryogesic spray (Ethyl Chloride) if pain / anticipatory fear
• Select atraumatic dressing • Use silicone medical adhesive remover
spray (Appeel) if adherence has occurred
Use a Pain Assessment Tool• Patient focused• Individual • Cultural / social• Assess and
formulate a baseline pain score
• Use a recognised tool
• Behavioural characteristics
• Physiologically induced changes
Guided Imagery
A therapeutic technique that allows two peopleto communicate on a reality that one of them has chosen to construe through an altered state of consciousness and achieved in the process of imaging.
BH Whitaker
Pain Management
• Mild Pain – combine simple analgesia with a non steroidal e.g. paracetamol with ibuprofen
• Severe pain – Opioid analgesia and anxiolytic sedation e.g. midazolam
Fentanyl lozenges. Entonnox (occasional use)
• Chronic background pain – may require long acting morphine (MST)
• Fentanyl patches (Appeel for safe removal)• Neuropathic pain – may respond to low dose
amitriptylline or gabapentin
Peripheral opioid use• 10mg of morphine
sulphate in 15mg Intrasite gel with dressing changes
(0.2mg/kg of morphine)
Concentration may be increased for optimal effect
Peripheral opioids in inflammatory painArchives of Disease in Childhood 2004;89:679-681Watterson G, Howard R, Goldman A.
Dressings with ibuprofen?
• Biatain –Ibu• foam dressing with ibuprofen designed to
provide moist wound healing and reduce pain at the wound site.
• For moist wounds only. • Only just available.• Not licensed for those under 12 years!• ?absorption – stop oral anti inflammatory
drugs until further studies taken
The environment
• Child friendly
• Undisturbed
• Distraction available
• Close window, switch off fan
• Personal choice – be realistic.
Preparation
• Templates
• Dressings cut to size
• Anticipate – wound swab, adherence – Appeel spray –demonstrate before need
• Analgesia & / sedation given
• Check for stinging from products e.g. honey