•Attempting to keep to normal day-and-night rhythm, finding a balance between activity and rest, planning periods of respite, possibly a midday nap, shifting activities to times of less tiredness

•No excessive demands, but neither being negligent

19.2.8.4Treatment

•The treatment of fatigue is always guided by its causes. For this reason a detailed history is most important. Discussion with psycho-oncologists

•Appropriate packed red blood cell transfusions

Significance of Fatigue Nursing Care

Nurses cannot, as with nausea and vomiting, resort to a wealth of established methods of action or reserve medication. Detailed knowledge of the relationship between illness, treatment, and fatigue is most important.

19.2.9Pain

•Pain in children occurs often at establishment of diagnosis or after painful interventions

•To enable pain relief through medication, an appropriate assessment is critical

19.2.9.1 Causes

• Due to malignancy

• Caused by treatment, for example, with tests such as bone marrow aspiration or biopsy and intrathecal drug delivery; headache as side effect of drugs

• Following surgical procedures

• Enhanced sensation of pain through stress and anxiety

19.2.9.2 Symptoms

•The way in which a person perceives pain and expresses it is individual.

•Pain can be: pulsating, burning, stinging, nagging, excruciating, mild, strong, radiating, spasmodic, etc.

•Pain assessment is achieved through conversation, observation, evaluation, a good relationship between patient and nurse

•Pain can be scaled from 1 to 10: 1 equaling no pain and 10, the strongest imaginable pain

•Assessment of pain: localization, type, intensity, concomitant factors, psychosocial factors, sequelae, mental processing, behavior of patient, risk groups

19.2.9.3Prophylactic Care

•In cases of chronic pain, it is of particular importance that analgesics are applied regularly, not only once pain has set in, and follow staged priority of medication, according to the WHO analgesic ladder: nonopioid analgesics, weak opioids, strong opioids, according to the following scaled plan:

–By mouth

–By the clock: at regular intervals

–By the ladder: following the WHO analgesic ladder with targeted use of adjuvants