Pain Assessment (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 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.

    00:09 Now each one starts with P, Q, R, S, and T.

    00:14 Let's go through and break that down.

    00:16 Now, just to be clear, this isn't the only way to do that.

    00:20 We're just showing you one example of a tool that you can use to help you remember to ask thorough questions.

    00:27 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.

    00:36 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.

    01:10 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.

    01:30 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.

    01:53 So just give them give them some cues that help recognize what type of pain it is.

    01:59 Surgical pain is going to feel different than a muscle pain and incisional pain.

    02:03 It can all be different, now those are obvious things.

    02:07 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.

    02:17 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.

    02:42 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.

    03:00 That's not going to work with all of your clients.

    03:03 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.

    03:10 We ask them to assign a number and remember, this is subjective.

    03:15 Pain is what the patient reports it.

    03:18 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' No.

    03:31 Pain is what the patient says it is, and we work through the treatment plan based on their report.

    03:38 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.

    03:56 But it still needs treatment and assessment.

    03:59 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.

    04:16 Here's a listing of a type of scale that you would use with a client with dementia.

    04:21 Look at the observations, it's called pain, add scale.

    04:25 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.

    04:37 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.

    05:16 Now, I went through them pretty quickly with you because I knew you could follow, right? Because we were following, talking through it.

    05:23 But for a patient, you ask one question, listen to their answer.

    05:30 Then ask another question and listen to their answer and work really hard.

    05:35 No matter how busy you are, how distracted you are, how bored you might be feeling, you got to be head in the game.

    05:43 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'.

    05:58 So I can get the best information about your care.

    06:01 So keep that in mind.

    06:03 And you shouldn't have to memorize these questions.

    06:06 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.

    06:15 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.

    06:23 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.

    06:31 As long as you explain, I'm using this to cue me so that I get the best assessment of what your complaint is.

    06:38 They're really generous and being flexible about that.

    About the Lecture

    The lecture Pain Assessment (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Gastrointestinal System (Nursing).

    Included Quiz Questions

    1. “How often does the pain occur?”
    2. “What caused the pain?”
    3. “What makes the pain worse?”
    4. “Does the pain move?”
    1. Quality
    2. Provocation
    3. Radiation
    4. Severity
    1. PAINAD scale
    2. Numerical scale
    3. Faces pain scale
    4. Self-report pain scale

    Author of lecture Pain Assessment (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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