Assessment and reassessment of pain Flashcards
Hierarchy of pain assessment***
- Self report.(gold standard)
- if patient unable to self report, search for potential causes of pain, observe, patient behaviors, proxy, reporting, response to analgesic trial.
Single, most reliable indicator of pain
Self-report
Component of pain assessment
Pain:
Location
Type (acute, chronic, persistent, bk through
description (quality)
intensity
duration
Component of pain assessment:
Effects of pain on individual
Alleviating factors
Aggravating factors
Effect on function, ADLs
Cues for assessment: WILDA
Words
Intensity
Location
Duration
Aggravating/alleviating
Cues for assessment: COLDERR
Character
Onset
Location
duration
Exacerbating
Relieving
Radiation
Superficial, raw, sharp
Burning (if cold or burned)
Aching, deep, dull, gnawing
Words suggesting somatic (nociceptive) pain
Cramping
Colicky
Squeezing, pressure
Throbbing
Words suggesting visceral (nociceptive) pain
Burning “on fire”
Numbness, tingling
shooting
Stabbing
Electrical shock
Strange vibrations
Raw skin
Crawling ants
Bag of worms
Words suggesting neuropathic pain
Things to consider for Additional Assessment
- psychosocial assessment
- personal/family history of
- response to analgesics
- Drug ETOH misuse or addiction
- past or current treatment for substance abuse
- hx sexual abuse
- comorbidities
- anxiety/depression
- spirituality
- resources
- coping
Complete depression assessment
- Mood/irritability/frustration
- Sleep patterns, appetite/weight changes
- Changes in daily life or ability to manage, decreased interest in activities
- Decreased libido
- Isolation/hopelessness
- Suicidal/homicidal thoughts
- Medications (antidepressants, anxiolytics)
- PTSD, anxiety disorder
- Use depression scale
To ask regarding depression
- Over the past 2 weeks, have you felt down, depressed or hopeless?
- Over the past 2 weeks, have you felt little interest or pleasure in doing things?”
What pain scale is used for patient with advanced dementia
PAINAD
Tool developed to provide simple clinical tool that can be used to identify pain of predominantly neuropathic origin - distinguishing between neuropathic and nociceptive pain.
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)
What is most appropriate pain scale to use for an 89yo with severe cognitive impairment that has fallen and fractured their elbow
PAINAD
Things to include in spiritual assessment
- importance of religion/spirtuality
- beliefs (rituals or taboo actions) affecting health
- beliefs related to pain and pain relief
- evidence of spiritual/existential distress
- desire for support or referral
Things to including in coping assessment
- previous experiences
- present attitude
- presence of depression/anxiety/frustration
- perception of stress
- usual coping strategies
- willingness to try new strategies
- preferences and wishes
- role of family - circle of impact
Things to consider regarding cultural/spiritual impact on pain
- Perception & response to pain influenced by
- cultural factors
- spiritual factors
- individual values and beliefs
- Ask about and respect health beliefs and practices
- promote feeling of acceptance (avoid stereotyping)
- respect differences in eye contact, touch, etc
- pain expression differences
- differences in the meaning of pain
Questions to ask to gain insight about spiritual needs & strengths
Ask self-reflective questions
- where to you find your strength?
- what helps you to keep going?
- what brings you comfort?
- Pay attention to verbal /material clues
Evaluating impact of pain on physical function, quality of life, and ability to perform ADLs
Part of functional pain assessment
Questions to ask regarding function
- To what extent does pain interfere with….
- getting up and down from chair or toilet?
- going up and down steps, curbs, etc?
- dressing, grooming, or bathing self?
- your balance. Hav you fallen, almost fallen or feel unsteady?
- attending school, work, place of worship, social events?
- Do you require help to do things you once did independently?
- Do you avoid doing things you once did?
Pain scale validated in age 3 and over
Faces pain scale or FPS revised
A pain assessment tool that measures only one aspect of pain (intensity) often used to evaluate the effectiveness of pain relieving interventions .
Uni-dimensional tools
These are examples of what type scale
0-10
Visual analog
Verbal descriptor
Iowa pain thermometer
Faces pain scale revised
Intensity rating scale
