LECTURE 1: Pain Assessment 💀🤪

Question 1

What is a pain assessment? What to consider?

Answer 1

Why is it important?
- portrays changes in levels of pain
- informs the nurse of patients personal experience
Keep in mind…
- patient’s pain scores are subjective
- OLDCARTSS is relevant

Question 2

Physiology of Pain

Answer 2

Nociceptors (PNS fibers) carry painful stimuli to the CNS
- they are located in various tissues
- activated by chemical, thermal, mechanical stimuli
- starts the pathway of pain

Question 3

Physiology of Pain: Pathway

Answer 3

1. Impulse PNS
2. Spinal cord CNS
3. Pain may be blocked/continue
4. Thalamus
5. Limbic system (emotions to control pain are produced)
6. Cerebral cortex (pain is recognized)

Question 4

4 Components of Pain

Answer 4

1. Sensory/Physical
   - action in pain nerves and effect on physiological status, severity
2. emotional/affective
   - how it makes us feel, fears, knowledge (limbic system)
3. cognitive
   - effect of pain on behaviour, coping strategies
4. social
   - our behaviour, how we react/respond

Question 5

acute pain assessment, RED FLAGS & what u gonna do

Answer 5

Most reliable indicator of the existence of pain and its intensity is the client’s description

1. sudden onset
   - explosive headache
   - painful breathing
   - chest pain
   - abdominal pain
   - severe pain unrelieved by appropriate meds
2. What to do?
   - focused/emergent history
   - involve others, family/witnesses
   - observation of patient and their behaviours

Question 6

Patient’s experience, factors influencing pain

Answer 6

• age
• gender
• culture
• spiritual
• family and social support
• personal meaning of pain
• anxiety level
• coping style
• fatigue
• previous experience of pain

Question 7

Role of the nurse, why nurse is important and what should they be doing

Answer 7

• with patient the most
• best position to observe and monitor changes
• reassessment of pain - follow up is important
• well positioned to document things (responses to pain, assessments of pain, outcomes of treatments), SUBJECTIVE DATA - other clinicians need this data
• make recommendations based on above info

Question 8

effects of poorly managed pain

Answer 8

results in increased circulating stress hormones contributing to…
- reduced cognitive/mental function
- sleeplessness, anxiety, fear
- hyperglycemia (high bp)
- tachycardia (high hr)
- decreased immune response
- increased suffering (by client & loved ones)
- potential development of chronic pain
- decrease in QUALITY OF LIFE

Question 9

ways to assess pain

Answer 9

• OLDCARTSS
• numeric pain severity scale (1-10)
• visual analogue scale (FACES, smiley/grumpy face)
• FLACC (score 0-2, face, legs, activity, cry, consolability)
• brief pain inventory (scale, questionnaire)
• universal pain assessment tool (scale, faces, multiple languages)

Question 10

Different ways to classify pain

Answer 10

1. Duration - fast vs. long-term
2. Frequency - continuous vs. intermittent
3. Form - nociceptive vs. neuropathic
4. Associated with cancer - with cancer or with treatment for cancer

Question 11

Types of pain

Answer 11

• nociceptive
• neuropathic, nerve pain
• visceral, organ pain
• somatic, felt pain?
• cutaneous, superficial (skin)
• referred, pain that is felt as a sign to something else that is wrong
• parietal, lining of the inside of abdomen