PENGKAJIAN DAN MENAJEMEN

NYERI PADA ANAK

BY; HERMALINDA
Pengkajian nyeri pada anak
merupakan yang sangat penting.
Namun, beberapa profesional
kesehatan cenderung
mengabaikannya. Hal ini
disebabkan karena masih banyak
yang meyakini bahwa anak yang
tidak menunjukkan masalah fisik
tidak akan mengalami nyeri.
Let’s start with the first set
of slides
+ Bayi dapat mengalami nyeri
+ Bayi prematur memiliki
komponen anatomis dan
fisiologis untuk merasakan
nyeri atau “nociception“ ,
sehingga dapat menunjukkan
nyeri yang berat terhadap
stimulus nyeri
Fisiologi nyeri
+ Nosiseptif adalah saraf-saraf yang
menghantarkan stimulus nyeri ke otak
+ Reseptor yang menyalurkan sensasi nyeri adalah
nosiseptor
+ Terdapat empat proses dari nyeri nosiseptif,
adalah ; 1) transduksi, 2)transmisi, 3) persepsi,
4)modulasi
Fakta tentang nyeri pada anak
+ Unrelieved pain in infants can permanently
change their nervous system and may “prime”
them for having chronic pain.
+ Children’s tolerance to pain actually INCREASES
with age.
+ Children can tell you where they hurt
+ Children often demonstrate INCREASED
behavioral signs of discomfort with repeated
painful procedures
+ children’s developmental level, coping abilities,
and temperament, such as activity level and
intensity of reaction to pain, influence pain
behavior
+ Parents want to be involved in their child’s pain
control
Multidimensional Model of Pain Assessment
 QUEST

Q Question the patient

U Use pain rating scale

E Evaluate behavior & physiologic signs

S Secure family’s involvement

T Take cause of pain into account

T Take action and assess effectiveness

 Q = quest the child
• Tanyakan secara verbal
 U= Use pain rating scale

• 0-10 Numeric Scale

• Simple Descriptive Scale
• Visual Analog Scale (VAS)
• Wong-Baker FACES Pain Rating
Scale
 Numeric Scale
0 1 2 3 4 5 6 7 8 9 10

No Pain Worst Pain

 Simple Descriptive Scale

No Pain Mild Moderate Severe Very Severe Worst

VAS: Coloured Analogue Scale
(Ref: McGrath, PA, et al: Pain, 1996.)
Wong-Baker FACES
Pain Rating Scale

0 2 4 6 8 10
Sample of Child’s FACES Pain Rating Scale
Photographic/
Numeric Pain Scale

 Oucher scale
(Beyer)
 White child, 3
year-old male
E= Evaluate behaviors and physiologic changes

Physiological Indications of
Acute Pain
Dilated pupils
Increased perspiration
Increased rate/ force of heart rate
Increased rate/depth of respirations
Increased blood pressure
Decreased urine output
Decreased peristalsis of GI tract
Increased basal metabolic rate
Possible Physiologic Signs of Pain in the Neonate
Physiological Variables
+ HR, RR
+Pernafasan dangkal
+ pucat
+ berkeringat
Vocalizations:
+Crying
State changes:
+Changes in sleep/wake cycles
+Changes in activity level
Facial expression (most reliable sign):
+Eyes tightly closed or opened
+Mouth opened
+bulging of brow
+Quivering of chin
+Deepened nasolabial fold
Facial Expression of Physical Distress

NASO-
LABIAL FOLD
deepened
Behavioral Pain Rating Scales
+SKALA FLACC
S- Secure Family’s Involvement
+ Take pain history before pain is expected, such as on
admission to hospital or preoperatively
+ Involve family in recording response to pain relief
measures
T - Take Cause of Pain into Account

+Use common sense and

logic.
+Realize that for a an
infant and small child,
punctures are
proportionally larger
on their tiny bodies.
T - Take action and assess
effectiveness
The only reason to assess pain is TO TAKE
ACTION TO RELIEVE PAIN.
After intervention, assess child’s response to pain
relief measures.
+ Terdapat strategi non farmakologis yang sama
efektif dengan terapi farmakologis.
+ Teknik non farmakologi adalah distraksi, berdo’a,
relaksasi, imajinasi terpimpin, musik dan
biofeedback.
Questions, Comments, Concerns