Assessment and Care of Patients in Pain
• Assessment—Location, Intensity, Quality, Onset and Duration, Aggravating and
RelievingFactors, Effects of Pain on QOL
• Best indicator of pain—
o Self-report-the patient is the authority on the pain and the only one who
candescribe the experience.
▪ Elderly, substance abusers, Language barriers**HIGH RISK
GROUP
▪ Pg. 25 table 3-1 Impact of unrelieved pain
• Pain scales—quality descriptive and best for feedback in assessing pain level.
o Numeric Rating Scale (NRS)- 0-10 pain scale verbalized by patient.
o Wong-Baker FACES- 6 cartoon faces with word descriptors
o Face Pain Scale—Revised (FPS-R)- 7 faces, patient picks face that
best depictstheir pain.
o Verbal Descriptor Scale (VDS)—Words or phrases that describe intensity
of
pain.
• Pain Goals—Prevent. Restore/Allow function. Good QOL—
o do not give unrealistic goals, bring goal to a tolerating level.
• Types of Pain—
o Acute- usually temporary, has a sudden onset, and is easily localized.
▪ Patients may experience fight or flight reactions such as—
increasedvital signs, sweating, and dilated pupils (acute pain
model).
o Chronic- persistent pain, often described as pain that lasts of recurs for an
indefinite period, usually for 3 months or more.
▪ Emotional and financial burdens—depression and hopelessness.
▪ The body adapts thus vital signs often will be lower than normal.
• Pg. 25 table 3-2—Characteristics of acute and chronic pain
• Pain challenges—
o Cognitively impaired—come up with a baseline from family or friends.
o Critically ill (intubated, unresponsive)—body behaviors,
withdrawal-physiological signs.
o Comatose
o Imminently Dying
▪ Pg. 33 table 3-5—Hierarchy of Pain Measures
1. Attempt to obtain self-report
2. Consider underlying pathology of pain
3. Observe behaviors
4. Evaluate physiologic indicators
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