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Pain Test > Assessment and reassessment of pain > Flashcards

Assessment and reassessment of pain Flashcards

1
Q

Hierarchy of pain assessment***

A
  1. Self report.(gold standard)
  2. if patient unable to self report, search for potential causes of pain, observe, patient behaviors, proxy, reporting, response to analgesic trial.
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2
Q

Single, most reliable indicator of pain

A

Self-report

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3
Q

Component of pain assessment

A

Pain:
Location
Type (acute, chronic, persistent, bk through
description (quality)
intensity
duration

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4
Q

Component of pain assessment:
Effects of pain on individual

A

Alleviating factors
Aggravating factors
Effect on function, ADLs

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5
Q

Cues for assessment: WILDA

A

Words
Intensity
Location
Duration
Aggravating/alleviating

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6
Q

Cues for assessment: COLDERR

A

Character
Onset
Location
duration
Exacerbating
Relieving
Radiation

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7
Q

Superficial, raw, sharp
Burning (if cold or burned)
Aching, deep, dull, gnawing

A

Words suggesting somatic (nociceptive) pain

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8
Q

Cramping
Colicky
Squeezing, pressure
Throbbing

A

Words suggesting visceral (nociceptive) pain

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9
Q

Burning “on fire”
Numbness, tingling
shooting
Stabbing
Electrical shock
Strange vibrations
Raw skin
Crawling ants
Bag of worms

A

Words suggesting neuropathic pain

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10
Q

Things to consider for Additional Assessment

A
  • 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
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11
Q

Complete depression assessment

A
  1. Mood/irritability/frustration
  2. Sleep patterns, appetite/weight changes
  3. Changes in daily life or ability to manage, decreased interest in activities
  4. Decreased libido
  5. Isolation/hopelessness
  6. Suicidal/homicidal thoughts
  7. Medications (antidepressants, anxiolytics)
  8. PTSD, anxiety disorder
  9. Use depression scale
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12
Q

To ask regarding depression

A
  1. Over the past 2 weeks, have you felt down, depressed or hopeless?
  2. Over the past 2 weeks, have you felt little interest or pleasure in doing things?”
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13
Q

What pain scale is used for patient with advanced dementia

A

PAINAD

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14
Q

Tool developed to provide simple clinical tool that can be used to identify pain of predominantly neuropathic origin - distinguishing between neuropathic and nociceptive pain.

A

Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)

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15
Q

What is most appropriate pain scale to use for an 89yo with severe cognitive impairment that has fallen and fractured their elbow

A

PAINAD

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16
Q

Things to include in spiritual assessment

A
  • 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
17
Q

Things to including in coping assessment

A
  • 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
18
Q

Things to consider regarding cultural/spiritual impact on pain

A
  1. Perception & response to pain influenced by
    • cultural factors
    • spiritual factors
    • individual values and beliefs
  2. 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
19
Q

Questions to ask to gain insight about spiritual needs & strengths

A

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

20
Q

Evaluating impact of pain on physical function, quality of life, and ability to perform ADLs

A

Part of functional pain assessment

21
Q

Questions to ask regarding function

A
  1. 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?
  2. Do you require help to do things you once did independently?
  3. Do you avoid doing things you once did?
22
Q

Pain scale validated in age 3 and over

A

Faces pain scale or FPS revised

23
Q

A pain assessment tool that measures only one aspect of pain (intensity) often used to evaluate the effectiveness of pain relieving interventions .

A

Uni-dimensional tools

24
Q

These are examples of what type scale
0-10
Visual analog
Verbal descriptor
Iowa pain thermometer
Faces pain scale revised

A

Intensity rating scale

25
Q

For those unable to self report what scale type is best

A

Behavioral/observational rating scale

26
Q

FLACC and CRIES are examples of what type scale

A

Behavioral/observational rating

27
Q

Examples of behavioral /observational rating scales are:

A
  1. PAINAD - pain in advanced dementia scale
  2. CNPI - checklist of nonverbal pain indicators
  3. CPOT - critical care pain observation tool
  4. FLACC
  5. CRIES
  6. PIPP - premature infant pain profile
28
Q

A tool that assesses more than one pain component

A

Multidimensional tools

29
Q

Examples of multidimensional tools

A
  1. Brief pain inventory
  2. McGill pain assessment tool
30
Q

multidimensional tools for pain assessment address:

A

Nature, location & impact of pain
- physical sensation and functional impact
- cognitive/emotional amplifiers and effects

31
Q

For persistent pain what assessment may provide better indication of treatment effectiveness than intensity rating

A

Multidimensional scale

32
Q

What are tools to evaluate risk of substance misuse, abuse - risk evaluation tools

A
  1. Opioid Risk Tool (ORT)
  2. CAGE-AID (alcohol)
  3. Screener and opioid assessment for people with pain-revised (SOAPP-R)
  4. current opioid misuse measure (COMM) - patients currently on opioid therapy
33
Q

Other than evaluation tools, ways to evaluate risk of substance misuse, abuse

A
  1. Prescription monitoring programs
  2. Urine drug testing - with knowledge of what to order and how to interpret results
34
Q

Pain interview - remember to

A
  1. Review patient chart
  2. Set stage (environmental control/privacy)
  3. Respectful, nonjudgmental, patient focused
  4. Display interest, empathy, and desire to help
  5. Appropriate eye contact
  6. Assure patient comfort.
35
Q

Other factors to consider include pain interview

A
  1. Language that is clear and easy to understand
  2. Ask open ended questions
  3. Clarify unclear responses (tell me more…)
  4. Be aware of non-verbal (yours and patient’s)
  5. Observe patient/family/caregiver interactions
  6. Identify expectations
36
Q

ABCDE Assessment. The E stands for?

A

Examine patient

37
Q

Conditional risk for substance abuse

A

Mental health

Pain Test (12 decks)

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