Preparation
physical xam can help you understand nature of pain; pain should not be discounted when objective evidence is not found; make every effort to reduce or eliminate pain w/appropriate analgesic and nonpharma intervention
The Joints
Note size and contour of joint; measure circumference of involved joint for compairison w/baseline; check active/passive ROM; joint motion normally causes not tenderness, pain or crepitation; ABN-swelling, inflammation, injury, deformiy, deminishin ROM, i
The Muscles and Skin
insect skin and tissue for color, swelling and any masses or deformity; assess changes insensation, ask pt to close eyes and test ability to perceive sensation of sharp and dull and to identify location; ABN-bruising, leigions, open wounds, tissue damage,
The Abdomen
observe for contour and symmetry; palpate for muscle guarding and organ size; Note any referred pain; ABN - swelling, bulging, herniation, inflammation, organ enlargement
Nonverval Behaviors of Pain
behaviors are influenced by wide variety of factorys, including nature of pain (acute/chronic), age, culture and gender expectations
Behaviors - Acute Pain
acute pain involves autonomic responses and has protective purpose, pts experiencing moderate to intense levels may exhibit the following: gaurding, grimicing, vocalization (moaning), agitation, restlessness, stillness, diaphoresis, or change in vital sig
Behaviors - Persistent (Chronic) Pain
pt w/persistent pain often live w/experience for months and years and cant function in repetitive states of behaviors such as grimicing, guarding, ect; pt adapts over time and you can't look for or anticipate same acute pain behaviors to exist; Pt w/chron
Developmental Competence - Infants
most research focused on acute procedural pain; limited understanding on chronic pain; use mulitdemensional approach for whole infant; changes in facial activity/body movements my help assess pain; Use CRIES tool w/preterm and term neonates; For chronic p
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
Developmental Competence - Aging Adult
pain should NOT be considered "normal" but it is prevalent; will often deny pain for fear of dependency, further testing or invasive procedures, costs and fear of pain meds; look for behavior cures: changes in functional status, dressing, walking, toileti
Developmental Competence - Aging Adult - Dementia
people w/dementia become less able to identify and describe pain over time although pain is still present and destructive; communcate pain through behavior: agitation, pacing, repetitve yelling may indicate pain, not worsening in dementia; Use PAINAD scal
Tools - PAINAD Scale
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
Documentation