The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

More documents

Recommendations

Info

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 12: The Care of Children and Adolescentspoint to underlying pain. Adults who spend a lot of time with the child are able to describechanges or patterns in behavior suggestive of pain. But it is almost never too early to ask thepatient directly. Even very young children can provide important information. Their descriptions26canpicasbe charmingly accurate and to the point. Unfortunately, they also learn quickly thattelling the doctor or nurse about a problem may lead to more tests that cause further pain anddiscomfort, so a child’s denial of a symptom that seems likely to be present must be taken incontext as well. For instance, a therapeutic trial of analgesia is sometimes the best way to sortout how much pain is contributing to the patient’s current condition.Pain AssessmentPain comes in many forms. Remarkably, patients may not report pain unless a provider askswhether it is present. Pain is an important symptom for alerting providers to problems thatrequire further investigation and treatment. Pain is also a problem in and of itself for the patientand requires specific management, regardless of its underlying etiology.Pain assessment logically begins with location. Providers should ask, “Where does it hurt?” “Whatother pains do you have?” A list of all the pains helps the provider organize an approach toassessment.Possible pains in children and adolescents include the following:• Headache• Stomach Ache or Abdominal Pain• Chest Pain• Back Pain• Ear Ache, Sore Throat, Mouth Pain, or Tooth Pain• Extremity PainKnowing when a child has multiple pains helps the provider address each type of pain withappropriate modalities and allows specific reassessment to assure the patient’s optimal responseto each intervention.The severity or intensity of the pain can be assessed using the behavioral rating scale, FACESscale, or the 1-10 scale. (See Figures 4-2 to 4-5 in Chapter 4: Pain.) Pain rating scales helpproviders to determine when a patient’s pain is getting worse and when interventions are providingrelief.The character of the pain may be more difficult to elicit. Some children are able to use adultdescriptors that suggest an etiology of the pain, such as aching versus shooting pain. However,many children will simply say it hurts. Some can describe onset and frequency, but others willonly be able to tell the provider if the pain is present now and whether it is sometimes not there.Colicky pain may require adult observation of the exacerbation/remission cycle of the pain.Physical Examination and Verbal Questioningof Children to Assess SymptomsPhysical examination begins with the careful observation of the patient’s position, spontaneousmovements, and level of arousal/interaction. This phase of the exam is particularly importantwith children. Children become frightened and start crying even in anticipation of an exam thatmay cause them further pain. Once a child reaches this state, it is nearly impossible to discriminateareas of tenderness or to complete an adequate exam.274U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 12: The Care of Children and AdolescentsSimple preparation before touching the patient and respect for a patient’s request to stop aportion of the exam will achieve a more informative evaluation than wrestling with a screamingchild. Visual inspection (without touching!) of the skin reveals lesions or wounds. Palpation andmanipulation26 picashelps to discriminate the presence and location of tenderness as well as otheraggravating factors. Asking a child to help the examiner by telling him or her as soon as somethinghurts, so that further hurt can be minimized, helps include the child in the evaluation andpromotes cooperation and improved feedback about symptoms.Neuropathic pains may have associated motor and sensory changes. Sensory neuropathy causeshyperesthetic areas that cannot tolerate even light touch. The pain of nerve root compressionmay feel deep and aching but not be made worse by direct palpation in the area of referred pain.The assessment of symptoms other than pain in children is less well studied. We rely on directobservation by parents and health care professionals and the subjective reports of the patients.Behavioral observations can make us suspicious that a child is experiencing a symptom, but maynot indicate specifically which symptom. For this, providers need the child’s feedback. However,the child’s capacity to provide this feedback is limited by his or her developmental level. Adultproxies may not provide an accurate assessment. In addition, we have few reliable severity measures,inhibiting our ability to detect changes in severity over time other than by behavioralimprovements in response to specific interventions. Sometimes the provider can only determinethe presence or absence of a symptom. (See Table 12-4).Table 12-4: Sources of Information about Symptoms in ChildrenXIISymptom Presence SeverityPain O, R RVomiting O, R O, RNausea R RDiarrhea O, R O, RConstipation O, R RFatigue O, R O, RAnxiety O, R O, RDepression O, R RSkin lesions O, R O, RAnorexia O, R O, RInsomnia O, R O, RDyspnea O, R O, RFever O, R OCough O, R O, RBleeding O, R O, RSeizures O OO = Direct observation by caregiver or health professional; R = Patient reportU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 275
Page 4 and 5:
DedicationA Clinical Guide to Suppo
Page 6 and 7:
Lynn A Jansen, RN, PhDAssistant Res
Page 9 and 10:
TABLE OF CONTENTSPart IChapter 1Cha
Page 11 and 12:
IChapter 1.26 picasHIV and Palliati
Page 13:
IA Clinical Guide to Supportive and
Page 16 and 17:
A Clinical Guide to Supportive and
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 47 and 48:
IIIChapter 3.Assessment of Physical
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 145 and 146:
Chapter 6.26 picasPulmonary Symptom
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165:
Page 168 and 169:
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 177 and 178:
Chapter 8.26 picasOral ProblemsDavi
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Chapter 9.26 picasDermatologic Prob
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Chapter 10.26 picasPsychiatric Prob
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234: A Clinical Guide to Supportive and
Page 263 and 264: Chapter 11.26 picas Substance Use P
Page 275: A Clinical Guide to Supportive and
Page 311 and 312: Chapter 14.26 picasCulture and Care
Page 325 and 326: Chapter 15.26 picasSpecial Populati
Page 335 and 336:
Page 337:
Page 340 and 341:
Page 342 and 343:
Page 344 and 345:
Page 346 and 347:
Page 348 and 349:
Page 350 and 351:
Page 352 and 353:
Page 354 and 355:
Page 356 and 357:
Page 359 and 360:
Chapter 17.26 picasEthical IssuesLy
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Chapter 18.26 picasLegal and Financ
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Page 387 and 388:
Page 389 and 390:
Page 391 and 392:
Page 393 and 394:
Page 395 and 396:
Page 397 and 398:
Chapter 19.Palliative 26 picas Care
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417:
Page 420 and 421:
Page 422 and 423:
Page 424 and 425:
Page 426 and 427:
Page 428 and 429:
Page 430 and 431:
Page 432 and 433:
Page 434 and 435:
Page 436 and 437:
Page 438 and 439:
Page 441 and 442:
Chapter 21.26 picas Patient-Clinici
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455:
Page 458 and 459:
Page 460 and 461:
Page 462 and 463:
Page 464 and 465:
Page 466 and 467:
Page 468 and 469:
Page 470 and 471:
Page 472 and 473:
Page 474 and 475:
Page 476 and 477:
Page 478 and 479:
Page 480 and 481:
Page 482 and 483:
Page 484 and 485:
Page 486 and 487:
Page 489 and 490:
Chapter 23.26 picas Medical Care in
Page 491 and 492:
Page 493 and 494:
Page 495 and 496:
Page 497 and 498:
Page 499 and 500:
Page 501:
Page 504 and 505:
Page 506 and 507:
Page 508 and 509:
Page 510 and 511:
Page 512 and 513:
Page 515 and 516:
Chapter 25.26 picas Prevention of S
Page 517 and 518:
Page 519 and 520:
Page 521 and 522:
Page 523 and 524:
Page 525 and 526:
Chapter 26.26 picasResourcesMagda B
Page 527 and 528:
Page 529 and 530:
Page 531 and 532:
Page 533 and 534:
Page 535 and 536:
Page 537 and 538:
Page 539 and 540:
Page 541 and 542:
Page 543 and 544:
Page 545 and 546:
Page 547 and 548:
Page 549 and 550:
Page 551 and 552:
Page 553 and 554:
Page 555 and 556:
Page 557:
Page 560 and 561:
Page 562 and 563:
Page 564 and 565:
Page 566 and 567:
Page 568 and 569:
Page 570 and 571:
Page 572 and 573:
Page 574 and 575:
Page 576 and 577:
Page 578 and 579:
Page 580 and 581:
Page 582 and 583:
Page 584 and 585:
Page 586 and 587:
Page 588 and 589:
Page 590 and 591:
Page 592 and 593:
Page 594 and 595:
Page 596 and 597:
Page 598 and 599:
Page 600 and 601:
Page 602 and 603:
Page 604 and 605:
Page 606 and 607:
DRUGS AND THERAPIES INDEXNOTES: Ent
Page 608 and 609:
Page 610 and 611:
Page 612:
show all

The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?