Nursing assessment Pain – Flashcards
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is whatever the patient says it is, existing whenever the person says it is
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Pain
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meaningful, linear, reversible, well defined, recent onset, observable signs
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Acute pain
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meaningless, cyclical, irreversible, longer than 6 months, patient physiologically adjusts
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chronic pain
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sensory, affective, behavioral, cognitive
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Pain Experience Factors
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8 Dimensions (OLDCARTM) Document
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Subjective Assessment of Pain
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0-10 scale, Wong-Baker faces Scale, Verbal Scale
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Adult pain assessment tools
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NIPS, CRIES, FLACC, Wong-Baker
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Children Pain Assessment scales
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Vital signs, Observation (facial expression, movement, ability to do ADLS), physical exam
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Objective Data-Pain Assessment
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History (current & prior pain) Assessment Pharmacological Interventions Non-Pharmacological Interventions Reassessment
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5 steps in ensuring effective Pain management
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match initial drug of choice to intensity & type of pain; give drugs orally whenever possible; drugs should be given around the clock when pain is continous & on PRN basis if pain is intermittent; assess response to analgesic regimen use equianalgesic dosing principles
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Principles of Pharmacologic Management of Pain
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1.nonpharm & acetaminophen 2.low dose ibuprofin &/or nonacetylated salicytes 3.Full dose NSAIDs 4."Weak" opoids 5. Strong opoids
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treatment of noncancer pain
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constipation-always ask sedation nausea & vomiting respiratory depression-check RR if patient asleep Itching "from underneath skin"-try diff route
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Side Effects of Opoids
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Narcan & romazicon blocks opoid receptors; short acting; re-assess
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Reversal Agents-Opoid
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positioning & hygiene cutaneous stimulation:massage anticipatory guidance distraction guided imagery relaxation meditation
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Nonpharm Pain Treatments
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pre-op education-will use pain meds timing-activities at drug peak instruct patient to medicate before severe avoid constipation when to seek assistance
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Patient Education-Pain
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agitation is often a sign of pain observe: facial movement, body movement, behavioral changes, daily activity changes
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Assessment of cognitively impaired
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ask parents about child's past pain experiences; observe physiologic variables, behavioral indicators--eating,lethargy, agitation ask child, parent & caregivers
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Assess Pain in Children
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drugs; use words kids understand; positioning;comfort boxes (distractions); EMLA-numb skin for any procedure
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Pain treatment of children
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physical, psychological, social, spiritual
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Pain Perception Components
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meds; smooth bedding; anatomical positioning; lift don't pull; keep dry; position tubing correctly; prevent constipation
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Post-Op Comfort
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has comfort been maximized? If no: thorough history, assessment accurate, meds effective, non-meds effective? What else can I do?
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Re-Assess Patient's Pain
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patient must be given information staff must be educated on pain management Patients must have pain assessments throughout stay quality assurance tracking-1 hour after intervention MUST DOCUMENT
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JCAHO Pain Standards
