Assessment Of Pain
Assessment – Pain assessment is a broad concept involving clinical judgment based on observation of the type, significance and context of the individual’s pain experience. There are challenges in assessing paediatric pain, none more so than in the pre-verbal and developmentally disabled child.
Therefore physiological and behavioural tools are used in place of the self-report of pain. However in children with developmental disabilities there can be incorrect assumptions and there is a risk of under-treating pain. It is important to take behavioral cues identified by parents and caregivers to improve pain assessment in these children.
Pain assessment in infants and children is also challenging due to the subjectivity and multidimensional nature of pain. The dependence on others to assess pain, limited language, comprehension and perception of pain expressed contextually. In some children it can be difficult to distinguish between pain, anxiety and distress.
cognitive ability environment (hospital) anxiety cause of pain (eg: post-operative)
Pain measurement quantifies pain intensity and enables the nurse to determine the efficacy of interventions aimed at reducing pain. A pain assessment should be conducted during a patient’s admission. (link to Nursing Assessment nursing clinical guideline) Points to consider:
pain historylocation of painintensity of paincognitive development and understanding of pain
Contents
What are the 4 P’s in pain assessment?
The mnemonic presented for assessment is the ‘4Ps’ ( pain, other pathology/past medical history, performance/function and psychological/psychiatric status ).
What are the three P’s of pain?
The 3Ps of pain management are a mix of psychological, physical and pharmacological strategies, or methods, to treat and manage pain. Helpful psychological strategies include distraction, guided imagery and breathing exercises. Physical approaches include heat and cold packs, rest, raising the injured area and massage.
What is a pain assessment model?
MAP NOMENCLATURE AND POSTULATES – MAP classifies the experience of pain and the observable attributes related to this experience within the following 3 components: pain experience, pain expression, and pain measures. Pain experience is defined as an unpleasant sensory and emotional experience, 1 and is understood to be a function of the whole person.
Pain expression is the broad collection of qualitative words and behaviors that communicate pain and is divided into 2 subcomponents—pain narrative, representing the words used to describe pain, and pain behavior, representing pain-related nonverbal and para-verbal behaviors. Pain measures are the quantitative tools used to assess pain and are subcategorized into self-report measures and non–self-report measures.
The environment is understood to include everything surrounding the person in pain and influences all MAP components. Examples of environmental factors include the characteristics of the people around the person in pain, such as their visual appearance, demeanor, and relationship to the person reporting pain, as well as the characteristics of the physical environment, such as lighting, physical objects, and familiarity to the person in pain.
What are the 6 Ps of pain?
Diagnosis – Diagnosis of ACS is based largely on physical examination and six cardinal clinical manifestations described as the six P’s.1 – 3, 6, 8 The six P’s include: (1) Pain, (2) Poikilothermia, (3) Paresthesia, (4) Paralysis, (5) Pulselessness, and (6) Pallor.1 – 3, 8 The earliest indicator of developing ACS is severe pain.
- Pulselessness, paresthesia, and complete paralysis are found in the late stage of ACS.
- Additionally, serial measurement of ICP is critical in confirming and determine progression of ACS.1 – 3, 9 Accurate ICP measurement is especially important when assessing for ACS in patients who are incapacitated or unable to provide reliable answers.
Vigilant monitoring of ICP is also critical in patients where epidural anesthesia is in use as motor and sensory symptoms of ACS can be easily masked.10, 14, 15 Other diagnostic considerations including the use of ancillary testing such as laboratory testing or imaging is briefly discussed below.
What is the most important part of a pain assessment?
The most important factor in pain assessment is the self-report of the patient. However, some patients may be reluctant to trigger the assessment so it is vital for nurses to prompt discussion of pain with patients.
What is the 10 point pain scale?
What Is a Pain Scale? – A pain scale is simply a way of rating or quantifying your pain so you can talk about it with your doctor, other health care professionals, or even your friends and family. There are many different kinds of pain scales, but a common one is a numerical scale from 0 to 10.
Here, 0 means you have no pain; one to three means mild pain; four to seven is considered moderate pain; eight and above is severe pain. Pain scales are based on self-reported data — that means from you, the patient — so they are admittedly subjective. Your version of a seven could be someone else’s idea of a three.
But the idea is that they can help compare your own ratings over time. Is your pain improving or getting worse? Using a pain scale can also help you and your doctor analyze which factors — a change in physical activity, say, or a new medication regimen — could be responsible for those changes.
What is the Wong Baker pain scale?
Is the scale suitable for everyone? – The scale is unsuitable for assessing pain in unresponsive people. It is also not suitable for those under 3 years of age. Furthermore, as a person must understand how to use the scale, older research suggests it may not be appropriate for those with severe cognitive impairments.
What are indicators of pain?
Behavioral – Another method for pain assessment is behavioral observation–based, which is the best practice for noncommunicative patients. The following are common pain behaviors:
Facial expressions: Frowning, grimacing, distorted expression, rapid blinking Verbalizations/vocalizations: Sighing, moaning, calling out, asking for help, verbal abuse Body movements: Rigid, tense, guarding, fidgeting, increased pacing/rocking, mobility changes such as inactivity or motor restlessness Changes in interpersonal interactions: Aggressive, resisting care, disruptive, withdrawn Changes in activity patterns: Appetite change, sleep change, sudden cessation of common routines Mental status change: Crying, increased confusion, irritability, distress
What are 3 subjective indications of pain?
Assessing Non-Verbal Signs – It can be difficult to assess someone’s pain if they are unable to verbalize it and/or unable to point to the FACES scale. You can also try to notice behaviors that are indicative of pain and discomfort. Signs and symptoms that a person may exhibit if they are in pain:
Facial grimacing or a frownWrithing or constant shifting in bedMoaning, groaning, or whimperingRestlessness and agitationAppearing uneasy and tense, perhaps drawing their legs up or kickingGuarding the area of pain or withdrawing from touch to that area
The more symptoms a person has, and the more intense they appear to be, the more you will get a grasp of the degree of pain they are experiencing. You can use these clues to record their pain as “mild”, “moderate”, or “severe.”
What does 3 mean on pain scale?
3 = Noticeable pain. It may distract you, but you can get used to it.4 = Moderate pain. If you are involved in an activity, you’re able to ignore the pain for a while.
