In the care provision of a patient, the families play an important part in modifying the health outcomes of the patient (Kokorelias et al., 2019). The care of the patient is changed from paternalistic to patient-centred approach but in the case of the pediatric patient, this is modified to a family-centred approach as children do not have autonomy. In the present case, the child who is autistic got injured in the playground and is presented in the emergency department. As the patient is unsettled and is crying uncontrollably, first it should be made sure that the patient is not in unfamiliar surroundings. If this is not the first visit to the hospital, then it is better if the family is shifted to either the pediatric department where the child is aware of the staff members. For an autistic child, it can be stressful to be in the midst of unknown people all alone and it has to be made sure that the child is with the parent so that she is most comfortable. The family should be made comfortable and all the required and complete information regarding the treatment should be given to the patient and family members (Dudley et al., 2015).
Informed consent should be obtained from the parents before any intervention is given to the child and it is better than the intervention is given in a relatively private environment. The basis of family-centred care is the one in which the importance is given to the building of trust and rapport between the patient, family members and healthcare. It is required so that the needs of the patient and the family can be understood and appropriate care can be provided to the patient while making sure that the family's preferences are taken into consideration and that they are comfortable.
The assessment of the pain should be done to know the extent of pain so that an appropriate measure can be taken to address the pain that is present. One of the best ways to do so is to use the pain assessment tools which can be used for the assessment of pain. Pain has two components subjective and objective and both of them are important for appropriate treatment (Turk &Gatchel, 2018). Pain assessment in children is tricky as they might be able to perceive the pain in a different manner or concentrate only on pain and it varies with age and intellectual development (Carter et al., 2016).
Minnie in the present case is a three-year-old autistic patient and assessment of pain can become ever-challenging. A visual analog scale can be used in which is scale numbered from one to ten and is a subjective pain scale and the child can choose a number which is closest to her pain and it is suitable for the patients who are aged three and older (Le May et al., 2018). Another scale that can be used for the assessment of the pain is faces scale and the patient can be asked to select the face which closely represents what they think might be their expression (Le May et al., 2018). This scale can be used because it is simple and the child can easily choose what they feel and this scale does not require translation. FLACC is a scale which is most apt in the given case of Minnie. It is a tool which usesbehavioural indicators of face, legs, activity, cry and consolability and under each, there is a range from zero to two (Le May et al., 2018).
Pharmacological pain management for Millie- Traditional non-steroidal anti-inflammatory drug is the routine medication that is administered to the patient. One of the drugs that can be administered to the patient is acetaminophen which has lower adverse effects and is one of the most commonly prescribed medications. It can be given to children with moderate to severe pain which is given orally in the dose of 10-15 mg/Kg body weight every four to six hours (O’Donnell & Rosen, 2014).
Non-pharmacological management of pain for Millie- One of the non-pharmacological therapies that can be used is environmental strategies according to which the patient is kept in a familiar environment which the child can identify by other senses like smell and touch (Riddell et al., 2015). This will them become a little calm and the pain can be reduced.
Another strategy that can be used is a distraction. The attention of the child needs to be diverted from the pain and the source of pain. In case of Millie, she can be distracted by giving her some toy to play with or video game which can help to take the focus off the pain and can provide some relaxation (Riddell et al., 2015). Another strategy that can be done is Kangaroo care in which the patient is in close contact with the parent so that there is a sense of belonging and safety. This is a relaxation technique which can help in the reduction of the pain as the focus is shifted from the source of pain. Another non-pharmacological pain management that can be done for Millie is music therapy which can help in having a soothing effect which in turn reduces that pain (Mu et al., 2010).
Even though the routine analgesia was given one hour ago it is possible that the patient is unsettled due to the occurrence of pain or increase of pain and the tolerance is reduced. The next line action would be to consult the doctor and informing the doctor regarding the change in the condition and to increase the opioid pain medication (Verghese&Hannallah, 2010).
There are many formulas which can be used for the calculation of drug dosage. As the child is a three-year-old girl and the dosage is given in mg/kg body weight the requirement is the weight of the child. As the information is not provided we would use the information as average weight which is 14.2 Kg. The dose of oxycodone which is required per administration is 1.42 mg and as one mg is equal to one ml the dose in ml is also 1.42.
Carter, B., Simons, J., Bray, L., &Arnott, J. (2016).Navigating uncertainty: Health professionals’ knowledge, skill, and confidence in assessing and managing pain in children with profound cognitive impairment. Pain Research and Management, 2016. HYPERLINK "https://doi.org/10.1155/2016/8617182" https://doi.org/10.1155/2016/8617182.
Dudley, N., Ackerman, A., Brown, K. M., Snow, S. K., American Academy of Pediatrics Committee on Pediatric Emergency Medicine, & Emergency Nurses Association Pediatric Committee. (2015). Patient-and family-centered care of children in the emergency department. Pediatrics, 135(1), e255-e272. HYPERLINK "https://doi.org/10.1542/peds.2014-3424" https://doi.org/10.1542/peds.2014-3424.
Kokorelias, K. M., Gignac, M. A., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family centered care: A scoping review. BMC Health Services Research, 19(1), 564. HYPERLINK "https://doi.org/10.1186/s12913-019-4394-5" https://doi.org/10.1186/s12913-019-4394-5.
Le May, S., Ballard, A., Khadra, C., Gouin, S., Plint, A. C., Villeneuve, E., ...&Auclair, M. C. (2018). Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale. Pain, 159(8), 1508-1517. https://doi.org/10.1097/j.pain.0000000000001236.
Mu, P. F., Chen, Y. C., Tsay, S. F., & Cheng, S. C. (2010).The effectiveness of non-pharmacological pain management in relieving chronic pain for children and adolescents. International Journal of Evidence-Based Healthcare, 8(3), 229-230. https://doi.org/10.11124/jbisrir-2007-757.
O’Donnell, F. T., & Rosen, K. R. (2014). Pediatric pain management: A review. Missouri medicine, 111(3), 231. HYPERLINK "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179554/" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179554/.
Riddell, R. R. P., Racine, N. M., Gennis, H. G., Turcotte, K., Uman, L. S., Horton, R. E., ... &Lisi, D. M. (2015). Non‐pharmacological management of infant and young child procedural pain. The Cochrane Database of Systematic Reviews, 2015(12). HYPERLINK "https://doi.org/10.1002/14651858.CD006275.pub3" https://doi.org/10.1002/14651858.CD006275.pub3.
Turk, D. C., &Gatchel, R. J. (Eds.). (2018). Psychological approaches to pain management: a practitioner's handbook. Guilford publications.Verghese, S. T., &Hannallah, R. S. (2010).Acute pain management in children. Journal of Pain Research, 3, 105.https://doi.org/10.2147/jpr.s4554.
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