Oleh : Rinik Eko Kapti

What is pain ?
Pengalaman sensori dan emosional yang tidak
menyenangkan akibat kerusakan jaringan yang
aktual atau potensial
(Brunner & Suddarth, 2002)
Tanda dari tubuh bahwa ada sesuatu yang tidak
beres dalam tubuh
(Caroline Bunker, 1999)
Physical pain is an unpleasant feeling that comes
with physical injury, damage or disease
(http://pediatric-pain.ca/ppga/ppga-wha.html)
Myth in pain
Myth: Infants Cannot Feel Pain Because
their Nervous System is Immature
Myth: Children Do Not Feel as Much
Pain as Adults
Myth: an Active or Sleeping Child is Not
in Pain
Myth: Children Always Tell the Truth
About Pain
Myth: Children Cannot Describeand
Locate Their Pain
Sources of pain

 Injuries
 Stress
 medical tests and
treatments
 diseases
Behavioral Manifestations of
Pain
Children’s developmental level,
coping abilities, and
temperament, such as activity
level and intensity of reaction to
pain, influence pain behavior.
Karakteristik respon nyeri pada anak

Young Infant (0-6 bln)

 Rigidity and thrashing
 Menangis keras
 Ekspresi muka
 Tidak menunjukkan dengan jelas hubungan antara stimulus
dengan area nyeri
Older Infant (6-12 bln)
 Respon lokal : menarik cepat dari area nyeri
 Menangis keras
 Ekspresi muka
 Perlawanan : mendorong, menghindari
Karakteristik respon nyeri pada anak

Young child (12 bln – 7 thn)

 Menangis keras & menjerit
 Ekspesi verbal : “aw”, “aduh sakit”
 Menggerakkan tangan & kaki
 Tdk kooperatif
 Berpegangan erat pada ortu/perawat
 Butuh dukungan emosional
 Sensitif dengan nyeri berikutnya, lebih
waspada thd tindakan yang menimbulkan
nyeri
Karakteristik respon nyeri pada anak

School age child (7 – 12 thn)

 Spt “young child” tapi lebih terkendali
 Mengungkapkan alasan
 Otot kaku, mata terbuka, tubuh kaku, dahi
berkerut
Adolescent
 Sedikit protes, gerakan ekstremitas
 Lebih banyak ekspresi verbal
 Tubuh terkontrol
Why is Pain Assessment
Important?
Provides an avenue for more effective
management of pain
Promotes communication between the child,
parents and health professionals
Supports evidence based practice
Provides continuity through the hospital
Allows children to indicate the intensity of
their pain
Challenges with Assessing
Children!
Pain Assessment Tools
Newborn/ Infant:
 CRIES
 Developed for use in preterm and ft infants in ICU
 Measures crying, O2 sat, HR, BP, expression and
sleeplessness
 Neonatal Infant Pain Scale (NIPS)
 Evaluates facial expression, cry, breathing, arms, legs and
state of arousal
 Premature Infant Pain Profile (PIPP)
 Gestational age, behavioral state, HR, O2 sat, brow bulge,
eye squeeze, and nasolabial furrow; often used for
procedural and post-op pain
Facial Expression of Physical Distress

NASO-
LABIAL FOLD
deepened
Pain Assessment Tools
Toddler
 FLACC
 Oucher
 Faces pain-rating scale

Preschooler
 Oucher
 Faces Pain-rating Scale (usually 3 and over)
 FLACC
 Acronym for face, legs, cry and consolability
 Body Outline (3 and over)
FLACC
 Oucher Pain Scale

A B C

© 2006 by Pearson Education, Inc.

Jane W. Ball and Ruth C. Bindler Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.
Faces Pain Scale
Pain Assessment Tools
Adolescent
 Numeric Pain Scale
 Oucher
 Faces Pain-relating scale
 Poker chip
 Work graphic
 Visual analogue
 Adolescent pediatric pain tool
Numeric Pain Scale
Numeric Rating Scale
 Let’s say 0 means no pain and 10 means
the worst pain anyone could have. How
much pain do you have? (score 0-10)
 Simple Descriptive Scale

No Pain Mild Moderate Severe Very Severe Worst

Visual-Analogue Scale*

No Pain Worst Pain

Usually 0-10 cm long line.

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

0 2 4 6 8 10
Poker Chip method
Children are asked to say how many "pieces of
hurt" they feel
 One chip is "just a little hurt."
 The second chip is "a little more hurt."
 The third chip is "more hurt."
 The fourth chip is "the most hurt you could have."
What the child says is checked by saying, for
example, "Oh, that means you have a little
hurt."
How the child's body is reacting

Heart rate, blood pressure, skin sweating and the

amount of oxygen or carbon dioxide in the blood
change in response to short sharp pain.
Measurement of pain in babies, especially sick
babies, is perhaps the most difficult of all. Changes in
heart rate, changes in the amount of oxygen in the
blood and changes in facial expressions are the most
widely used.
Although there are problems, pain measurement
should be done regularly and recorded in the child's
medical chart.
Pain Management
When we know ahead of time that
something will be painful, we should do
everything we can to prevent the pain
Psychological and physical methods

Kehadiran Ortu/orang terdekat

Informasi yang akurat
Express feelings
Libatkan anak dalam prosedur
Nafas dalam
Distraksi
Relaksasi
 Play
 Touch
 Heat, cold, vibration
Medicine
Tindakan invasif :
 EMLA (US, Canada)
 Anestesi lokal
 Sedation
Pengkajian

 Lama nyeri (duration)

 Lokasi
 Kuantitas
 Kualitas
 Faktor yang me / me nyeri
 Riwayat sebelumnya
Pengkajian (lanjutan)
 Efek nyeri terhadap aktifitas
 Faktor yang mempengaruhi respon nyeri :
budaya, usia, efek plasebo (faktor sugesti)
 Sumber nyeri
 Klasifikasi nyeri :
 Nyeri akut : 1” – 6 bulan
 Nyeri kronis : > 6 bulan
 Nyeri fisceral/deep visceral
 Nyeri alih
 Nyeri sebar
 Diagnosa Keperawatan
• Gangguan rasa nyaman : nyeri b.d
injury, luka pasca bedah
• Tidak efektif koping individu b.d
kurangnya pengetahuan
Intervensi
 Sesuai dengan manajemen nyeri
Four aspects must be addressed:
(Concept of “Total Pain Management”)
1. Physical
2. Psychological
3. Social
4. Spiritual
Two positions of comfort