If the client responds with a yes
to any type of pain assessment,
here's a quick and easy tool to help you keep
in mind the types of questions you should ask.
Now each one starts with P, Q, R, S, and T.
Let's go through and break that down.
Now, just to be clear, this
isn't the only way to do that.
We're just showing you one
example of a tool that you can use
to help you remember to ask thorough questions.
Now when it comes to provocation, or palliation,
Hhre's some additional questions you could ask
so you can recognize those cues and have
the information you need to analyze them.
You would ask What were you
doing when the pain started?
What caused it? What makes it better or worse?
What do you think seems to trigger it?
Do stress make it worse? Is there a certain
position that relieves it or makes it worse?
What about activities?
So when you're asking about what relieves it, you
want to say what do you do, is it medications?
Do you massage it, you try heat or cold?
When you're changing positions
being active or resting,
What is it that can help relieve
your pain in your experience?
And ask them about what aggravates it.
So is it moving a certain way, Is it bending?
Does it get worse when you lie
down, or maybe when you stand up?
What about when you're walking?
So these are just all examples that
you can get the best information
to get a more complete picture
about what is causing the pain
and what helps to relieve the
pain in the patient's experience.
Now quality and quantity, that's
like, what does it feel like?
Ask them to use words to describe
the pain such as, is it sharp?
Is it dull? Is it stabbing? Is it
burning? Is it crushing? Is it throbbing,
nauseating, shooting, twisting or stretching?
People are usually pretty descriptive,
but sometimes when they're uncomfortable,
or when they're in pain, they
can't think of the words.
So just give them give them some cues that
help recognize what type of pain it is.
Surgical pain is going to feel different
than a muscle pain and incisional pain.
It can all be different, now
those are obvious things.
So when we have someone coming,
and we're assessing their pain,
these questions will help us recognize
what could be a possible cause of the pain.
Now R is for region or radiation,
so where is the pain located?
Does the pain radiate or move? Where does it go?
Does it feel like it travels and moves around?
Did it start elsewhere and now
it's localized to one spot?
We're asking you about where are all the
places that our client is experiencing pain?
Now what about a severity scale?
Now that's what the S stands for.
How severe is the pain?
So say on a scale of 0 to 10, with 0 being
no pain and 10 being the worst pain ever,
the most excruciating pain, what number
would the patient assign to this?
Now I'm showing you an
example of a numerical scale.
That's not going to work with all of your clients.
So first, let's walk through the example if
the patient was able to use a scale like this,
so we ask them 0 to 10.
We ask them to assign a number
and remember, this is subjective.
Pain is what the patient reports it.
If you're using Your scale that has been
validated, if they tell you they're feeling an 8,
you don't get to look at them and
say, 'Yeah, not really sold on that,
I don't know for sure if that's an 8'
Pain is what the patient says it is,
and we work through the treatment plan
based on their report.
So you're thinking about things like
does it interfere with their activities?
How bad is it when it's at its worst?
How is it right now? Does it force you to
have to sit down or lie down or slow down?
And how long does an episode last?
Because patients may experience
pain when they're not with you.
But it still needs treatment and assessment.
Now, back to our example, if
a numerical scale didn't work,
what if the patient had dementia?
Well, there's actually a way to look and observe
a patient only if the patient has dementia,
and is not able to communicate
using the numerical scale.
Here's a listing of a type of scale that
you would use with a client with dementia.
Look at the observations,
it's called pain, add scale.
So you look at each one of those
observations and do your best to determine
if the patient is experiencing pain, if
they're unable to communicate it with you,
and using a numerical scale.
Now, last timing, look, there's a
lot of questions we want to ask,
what time did the pain start? How long
did it last? How often does it occur?
Hourly, daily, weekly, monthly? Is it sudden? Or
is it gradual? Can you kind of feel it coming on?
What were you doing when you first experienced it?
When do you usually experience it, is it
the daytime? the nighttime, early morning?
Are you ever awakened by it?
Does it lead to anything else?
Is it accompanied by other signs and symptoms? And
does it ever occur before, during or after meals?
And does it occur seasonally?
That is a long list of questions.
Now, I went through them pretty quickly
with you because I knew you could follow,
right? Because we were
following, talking through it.
But for a patient, you ask one
question, listen to their answer.
Then ask another question and listen
to their answer and work really hard.
No matter how busy you are, how distracted
you are, how bored you might be feeling,
you got to be head in the game.
So you want to make sure that you're
making that eye contact with your patient,
and you give no indication that there's
anywhere else you would like to be, right?
You help them know 'I'm not in a hurry,
I am here for you for whatever you need'.
So I can get the best information about your care.
So keep that in mind.
And you shouldn't have to
memorize these questions.
This just gives you a feel of what you
would ask, and if you think through these
in a P, Q, R, S, T - just use
those headings to cue you.
You can also have them on a slip of
paper and say, 'Hey, Jose, do you mind?
I've got a list of questions because I
really want to learn more about this pain.
To make sure that I don't forget anything,
would you mind if I use this sheet as a guide?
Most patients will say, absolutely.
As long as you explain, I'm using this to
cue me so that I get the best assessment of
what your complaint is.
They're really generous and
being flexible about that.