Pain, Assessment Techniques, Validation & Documentation

Question 1

What is pain?

Answer 1

–5th vital sign
–what pt. says it is (subjective)
–assessed w/ other vitals
–age & culture impact response and assessment
–pain hinders healing & well-being
-there are JCAHO standards for pain
(see p.149)

Question 2

A thorough pain assessment includes QUESTIONS about …

Answer 2

(health hx&raquo_space; subjective data&raquo_space; COLDSPA)

• location
• intensity
• quality
• pattern
• precipitating factors
• pain relief
• effect on daily activities
• coping strategies
• emotional responses
  (p. 149, and Box 9-5 on p.150)

Question 3

When assessing pain, OBJECTIVE data should include…

Answer 3

> > general impression«

• Posture
• Facial expression
• Joints & muscles (tension)
• Skin (bruising, edema, wounds)

> > vitals«

• Heart rate
• Respiratory rate
• Blood pressure
  (p. 156)

Question 4

What techniques are used for nonverbal pts. or those w/ cognitive impairments?

Answer 4

The Hierarchy of Pain Assessment Techniques:
1) self-report

2) search for potential causes of pain
3) observe pt. behaviors
4) surrogate reporting (family, caregivers)

5) attempt analgesic trial (pain killers)
(p. 150)

Question 5

What is considered when choosing a pain assessment tool?

Answer 5

Age & cognitive ability

• -some specific to special types of pain
• -be sure tool is reliable & valid
• -clear & easily understood by pt.; req. little effort
  (p. 150)

Question 6

What are the 3 most common pain assessment tools?

Answer 6

–Numeric Pain Intensity Scale (NRS) (Fig 9-5, p.151)

–Faces Pain Scale

–FLACC Behavioral Scale (Tool 9-2, p.152)