Pain
defined as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of damage. Pain is always subjective.
Subjective Data - Pain
most reliable indicator of pain; because pain occurs on neurochemical level, the diagnosis of pain cannot be made exclusively on physical examination findings, although these findincs can lend support
Initial Pain Assessment
1) Do you have pain, 2) Where is your pain, 3) When did your pain start, 4) What does your pain fell like, 5) How much pain do you have now, 6) What makes your pain better or worse?, 7) How does pain limit your function or activities?, 8) How do you usual
Pain Assessment Tools
multidemential in scope, encompassing physical, affective and functional domains; select pain assessment tool based on purpose, time involved in admistration and pts ability to comprehend and complete tool
How to Use Pain Assessment Tools
1st, teach pt how to use each tool, with practice sessions to strengthen the validity and reliability of response; Enlarge print when appropriate for impaired vision; print correct language; Ask pt to rate and evaluate all pain sites; use pain tool consis
Types of Pain Tools
Overall pain assessment tool: initial pain assessment, the brief pain inventory, short-form McGill pain questionnaire; pain rating scales: numeric rating scales, descriptor scale
Types of Pain Tools - Overall Pain Assessment
more useful for chronic pain conditions or particulary problematic acute pain problems; ex - Initial Pain Assessment, Brief pain inventory, McGill Pain Questionnare
Tools - Initial Pain Assessment
8 questions concerning location, duration, quality, intesity, and aggravating/relieving factors; also adds questions about manner of expressing pain and effects of pain that impair quality of life
Tools - Brief Pain Inventory
pt rates pain within past 24 hrs using graduated scales (0-10) with respect to its impact on areas such as mood, walking ability, and sleep
Tools - Short-form McGill Pain Questionnaire
asks pt to rank a list of descriptors in terms of intensity and to give an overall intensity rating to pain
Types of Pain Tools - Pain Rating Scales
unidimensional and are intended to reflect pain intensity; come in various forms; rating scales can indicate a baseline intensity, track changes, and give some degree of evaluation to a treatment modality; EX - Numeric rating scales, descriptor scale, PAI
Tools - Numeric Rating Scale
ask pt to choose number that rates level of pain for each painful site, with 0 being no pain and the highest 10 indicating the worst pain ever exerienced; can be administered verbally or visually along a vertical or horizontal scale; Older adults find sca
Tools - Descriptor Scale
lists words that describe different levels of pain intensity, such as no pain, mild pain, moderate pain, severe pain; Older adults will often respond to scales in which words are selected
Tools - Dementia
for dementia pts; evaluates 5 common behaviors of breathing, vocalization, facial expression, body language, and consolability; quanitfied from 0-2 w/total 0-10; score of 4 or more indicates need for pain management
Types of Pain Tools - Children/Infants
it is difficult for children to rate pain on a scale of 0-10 or use words to describe. The use of pictures and visual ID help; ex - Faces Pain Scale, Oucher Scale, CRIES
Tools - Faces Pain Scale (FPS) and Revised (FPS-R)
6 drawings of faces that show pain intensity, from "no pain" on left (score 0) to "very much pain" on right (score 10); Numbers not shown to children; Revised drawing has more realistic facial expressions w/furrowed brow and horizontal mouth stretch, avoi
Tools - Oucher Scale
has 6 photos of young boys' faces w/different expressions of pain, ranked on 0-5 scale of increasing intensity; Child points at face that best matches their pain; Variations have pics of girls and diverse ethnic groups
Tools - CRIES
developed for postoperative pain in preterm and term neonates; measures physiologic and behavior indicators on 3-pt scale; sympathetic NS engaged in acute episodes of pain, physiologic changes take place that may indicate presence of pain: sweating, incre
Infants and Children
infants incapable of self-report so pain assess depends on behavioral and physiologic cues; It is important to undersand that infants DO feel pain; Chilren 2yo can report pain and point to location; Can't rate pain intensity yet so FPS-R is good tool to u