pain assessment. objectives: at the end of this lecture, the students will be able: 1.identify the...
TRANSCRIPT
Pain assessmentPain assessment
Objectives:
At the end of this lecture, the students will be able:
1.identify the purpose of pain assessment.2.recognize form of pain.
3.list factors affecting pain sensitivity.4.discuss behavioral of responses to pain.
5.follow and use pain assessment chart.
Definition of pain:
Pain is not a simple sensation but a complex phenomenon which have both a cognitive (physical) and
an affective ( emotional) component.
''pain is whatever the experiencing person says it is ,existing whenever the experiencing person says it
does.“
Purpose:
The purpose of pain assessment is to identify all the factors affecting the patient perception of pain.
Types of pain:
There are various ways of classifying the types of pain
-onset of occurrence ,such as postoperative pain
-duration , such as acute or chronic pain
-severity or intensity ,such as severe or mild or 0 to 10 on a scale
-mode of transmission , such as normal pain pathways or referral pain
-location or source, such as superficial , deep , or central pain
-causation , such as receptor stimulation , or psycho physiological pain
Factors affecting pain sensitivityIncreased by:
-Discomfort
-Insomnia
-Fatigue
-Anxiety
-Fear
-Anger
-sadness
-Depression
-Boredom
Relief of symptomsLowered by:
-Sleep
-Rest
-Sympathy
-Understanding
-Companionship
-Diversional activities
-Reduction in anxiety
-Elevation of mood
Pain assessment tools:
1/pain assessment charts
2/pain intensity assessment chart
3/key to pain intensity
:Behavioral responses to pain
Verbal description Behavioral response Age groupCries cries
Generalized body movements.
Chin quivaring , fucial grimacing.
Reflex withdrawal to stimulus,facial grimacing , disturbed sleep, irritability, restlessness
Infants<6 months
6-12 months
Cries and screams, cannot describe intensity or type of pain.
Localized withdrawal , resistance of entire bodyAggressive behavior , disturbed sleep
Toddlers1-3 years
Behavioral responses and verbal descriptions of pain by children of different developmental stages:
Can identify location of pain , denies pain , may believe his or her pain is obvious to others.
Active physical resistance Directed aggressive behaviorStrikes out physically and verbally when hurt, low frustration level
Preschoolers3-6 years
Can specify location of pain and describe its physical characteristics
Able to describe intensity and location with more characteristics , able to describe psychologic pain
Passive resistance, clenches fiats , holds body rigidly still , suffers emotional withdrawal , engages in plea bargaining
May pretend comfort to project bravery , may regress with atressAnd anxity
School age children7-9 years
10-12
More sophisticated description as experience is gained
Want to behave in a socially acceptable manner (like adults) show acontrolled behavioral response
Adolescents12-18 years
Guidelines for pain assessment:
A:initial assessment:
Rationale Action
To obtain the patients and cooperation. 1.Explain the purpose of using the chart to the patient.
To encourage patients participations. 2 .When appropriate, encourage the
patient to complete the pain chart himself/herself.
To reduce the risk of misrepresentation. 3.Where the nurse completes chart, record the patients own description of his/her pain.
Continue…
Ascertaining how and when the patient experiences pain, enables the nurse to plan realistic goals.For example, relieving the patients pain during the night and while he /she is at rest is usually easier to achieve than relieving pain on movement.
4(.a) Record any factors
which influence the
, . . intensity of the pain e g
activities or
interventions which
reduce or increase the
, , pain such as
distractions or heat pad.(b) Record whether or not
the patient is pain freeat
, night at rest or on
movement.
B:pain sites:Rationale action
The body outline is ideally a vehicle for the patient to describe own pain experience.
1.Encourage the patient, when appropriate to identify pain himself/herself.
This enables individuals pain sites to be located.
2.Index each site(A to H)in whatever way seems most appropriate, e.g. shading or coloring of areas or arrows to indicate shooting pain.
C:monitoring pain intensity:Rationale Action
To indicate the intensity of the pain at each site.
1 .Give each pain site a numerical value according to the key of pain intensity or the pain scale and note time recorded.
To monitor the efficacy of prescribed analgesia.
2.Record any analgesia given and note route and dose.
Extra pharmacological or non- pharmacological interventions
might be indicated.
3.Record any significant activities, which are likely to influence the patients pain.
Note: fixed times for reviewing the pain have been omitted intentionally to allow for flexibility. It is suggested that , initially, the patients pain has to be reviewed every four hours.When patients level of pain has stabilized, recording may be made less frequently,e.g. 12-hourly or daily. The chart should be discontinued if patients pain
becomes totally controlled .
Thank you