Pain assessment
Encyclopedia
Pain
is often regarded as the fifth vital sign in regards to healthcare because it is accepted now in healthcare that pain, like other vital signs, is an objective sensation rather than subjective. As a result nurses are trained and expected to assess pain.
s or pain management
is regulated in healthcare facilities by accreditation
bodies, like the Joint Commission. The Joint Commission began setting standards for pain assessment in 2001 stating that the route of analgesic administration dictates the times for pain reassessment, as different routes require different amounts of time for the medication
to have a therapeutic effect.
Oral: 45–69 minutes.
Intramuscular: 30 minutes.
Intravascular: 15 minutes.
and they give a score. A rating is taken before administering any medication and after the specified time frame to rate the efficacy
of treatment.
s are assessed with different types of scales.
The scores are added together to achieve a 0-10 pain score.
s, analgesic
s, benzodiazepine
s, stimulant
s, barbiturate
s, and sedative-hypnotics have the potential to become addicted
.
Many people with chronic illnesses, injury
, and history of mental illness
are prescribed these drugs.
As a nurse it is difficult to assess whether the pain is real or whether the patient is seeking the narcotic
.
Adult patients display pain and emotions differently.
Many patient's become dependent physically and mentally on these drugs.
and rheumatoid arthritis
are chronic condition and can be very painful.
In long-term care facilities three non-drug interventions need to be attempted before administering anti-anxiety or anti-psychotic medications. These interventions can be giving the patient food, drinks, one on one care, back rub
, changing the patient's position in bed, adjusting the temperature, and redirecting the patient's mental focus. Many times these interventions work, but many times the medication may still need to be administered.
The patient's history and diagnosis are helpful in deciding whether or not the patient is developing a substance abuse problem. A patient having social or relationship problems may need to meet with a crisis counselor.
Every shift that a nurse is on duty, they must do an assessment on the patient. If they suspects the patient is becoming addicted, they must notify the physician.
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
is often regarded as the fifth vital sign in regards to healthcare because it is accepted now in healthcare that pain, like other vital signs, is an objective sensation rather than subjective. As a result nurses are trained and expected to assess pain.
Regulation
Pain assessment and re-assessment after administration of analgesicAnalgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s or pain management
Pain management
Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists,...
is regulated in healthcare facilities by accreditation
Accreditation
Accreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...
bodies, like the Joint Commission. The Joint Commission began setting standards for pain assessment in 2001 stating that the route of analgesic administration dictates the times for pain reassessment, as different routes require different amounts of time for the medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
to have a therapeutic effect.
Oral: 45–69 minutes.
Intramuscular: 30 minutes.
Intravascular: 15 minutes.
Types of Assessment
Most pain assessments are done with in the form of a scale. The scale is explained to the patientPatient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
and they give a score. A rating is taken before administering any medication and after the specified time frame to rate the efficacy
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
of treatment.
Number Scale
Patients rate pain on a scale from 0-10, 0 being no pain and 10 being the worst pain imaginable.Faces Scale
A scale with corresponding faces depicting various levels of pain is shown to the patient and they select one.Special Considerations
Patients whom cannot verbalize/comprehend pain scalePain scale
A pain scale measures a patient's pain intensity or other features. Pain scales are based on self-report, observational , or physiological data. Self-report is considered primary and should be obtained if possible. Pain scales are available for neonates, infants, children, adolescents, adults,...
s are assessed with different types of scales.
FLACC
Used for neonates/infants:| Assessment | 0 | 1 | 2 |
|---|---|---|---|
| Face | Smiling/expressionless | Frowning | Clenched jaw/Anguish |
| Legs | Normal movement/Relaxed | Restless/Tense | Legs drawn up/Kicking |
| Activity | None/Lying quietly | Squirming/Tense movements | Arched back/Rigid/Jerking |
| Cry | None | Occasional whimper | Crying constantly/Screaming |
| Consolability | Relaxed | Easily distracted or reassured | Difficult to distract/reassure |
The scores are added together to achieve a 0-10 pain score.
Addiction
Many patient's who use drugs and are on opioidOpioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
s, analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s, benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s, stimulant
Stimulant
Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
s, barbiturate
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
s, and sedative-hypnotics have the potential to become addicted
Addiction
Historically, addiction has been defined as physical and psychological dependence on psychoactive substances which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain.Addiction can also be viewed as a continued involvement with a substance or activity...
.
Many people with chronic illnesses, injury
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...
, and history of mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
are prescribed these drugs.
As a nurse it is difficult to assess whether the pain is real or whether the patient is seeking the narcotic
Narcotic
The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...
.
Adult patients display pain and emotions differently.
Many patient's become dependent physically and mentally on these drugs.
Patient's History
- One way to assess whether the patient is drug seeking or in true pain is to look at their history:
- Does the patient have a history of drug abuseDrug abuseSubstance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts...
? - What is the patient's illness?
- What is the patient's medical historyMedical historyThe medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
? - Does the patient have a mental illness?
- Does the patient have a history of anxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
or depression? - Is the patient going into surgerySurgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
? - Has the patient just came out of surgery?
- What medical condition would cause the patient to have severe pain?
Nurses Assessment
- Does the patient show nonverbal signs of pain such as crying or grimacing?
- Does the patient watch the clock and ask for the pain medication or sedativeSedativeA sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
at the exact time its due? - Does the patient continually ask for the medication?
- Does the patient continually ask the physicianPhysicianA physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
to increase pain medication? - What is the dose of the medication and how often does the patient ask for it?
- How long has the patient been taking the drug?
- Does the patient have a change in mood and behavior if they don't receive the medication at the exact time?
- Have a conversation with patient. Do they want the medication because they are in pain or because they can't sleep?
- Do they want the medication because they are anxious?
- What is going on in the patient's life?
- What are their social circumstances?
- Is the nursing staff performing three non-drug interventions before administering a sedative, hypnotic or anti anxiety medication?
- How many different medications is the patient on?
- Is the patient gradually asking for less medication as time goes on or are the asking for more?
Assessment Findings
If the patient is continually asking for the physican to increase their pain medication or increase the frequency then they need further evaluation by both a nurse and a physican. There is a good possibility the patient is in pain. There is also a possibility that they are becoming addicted to prescribed medication. The patient's history must be taken into account as well. Medical conditions such as cancerCancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
and rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
are chronic condition and can be very painful.
In long-term care facilities three non-drug interventions need to be attempted before administering anti-anxiety or anti-psychotic medications. These interventions can be giving the patient food, drinks, one on one care, back rub
Massage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
, changing the patient's position in bed, adjusting the temperature, and redirecting the patient's mental focus. Many times these interventions work, but many times the medication may still need to be administered.
The patient's history and diagnosis are helpful in deciding whether or not the patient is developing a substance abuse problem. A patient having social or relationship problems may need to meet with a crisis counselor.
Every shift that a nurse is on duty, they must do an assessment on the patient. If they suspects the patient is becoming addicted, they must notify the physician.