Pain 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.

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