ALERTNever use physiologic responses alone to determine pain therapy. A patient’s self-report is the gold standard. Show
Use only evidence-based pain assessment tools in the population in which the instrument has been tested. Identify patients at high risk for adverse opioid-related outcomes (e.g., patients with sleep apnea, receiving continuous IV opioids, or on supplemental oxygen).undefined#ref5">5 OVERVIEWPain is a subjective experience for the patient and can be characterized in many ways: sharp or dull, burning or tingling, or generalized aching. Unrelieved pain has been associated with negative outcomes and physiologic alterations, such as increased peripheral vascular resistance and cardiac oxygen consumption, hypercoagulability, and compromised immune function.8 Pain management is an important component of comprehensive patient care.1 The assessment and management of pain should be a top priority,4 and alleviating pain is a major nursing responsibility. Through comprehensive pain assessment, the nurse begins to understand the impact of pain on the patient’s life. A comprehensive pain assessment elicits the patient’s subjective report of pain, including the sensory, psychologic, cultural, and emotional experiences of pain.3 When performing a pain assessment, the nurse uses the appropriate organization-approved pain-intensity scale (e.g., visual analog scale, Numeric Rating Scale, colors, Wong-Baker FACES® Pain Rating Scale) (Figure 1) based on the patient’s preference, age, developmental level, and comprehension. Special assessment scales are available for sedated critical care patients and patients with dementia. The same scale should be used consistently with the patient. Pain-intensity scales also help evaluate the effectiveness of pain interventions. The use of opioid medication for pain management comes with risk.1 Health care team members should be involved in pain assessment and management to identify patients at high risk for opioid dependence and to establish criteria for safe opioid prescribing.4 Collaboration among health care team members helps achieve the best possible plan of care for pain relief. The inability of a patient to communicate pain intensity (e.g., patients with cognitive impairment or an inability to communicate) is a barrier to effective pain control. The input of family members helps evaluate the patient’s response to medications and nonpharmacologic interventions but should not be the only assessment. Physiologic responses to acute pain (e.g., tachycardia, hypertension) have a short duration. With persistent pain, a patient does not typically exhibit such physiologic responses. A valid pain assessment method for patients with cognitive impairment or an inability to communicate should be used. The patient should be actively involved in a pain management treatment plan.4 Effectively managing a patient’s pain does not mean eliminating it. Pain management collaboration with the patient and family helps identify an acceptable intensity of pain that allows maximum patient functioning. Asking the patient baseline questions about the pain helps formulate pain-intensity goals to help the patient cope with the discomfort. The nursing process offers a systematic method of pain management that results in improved pain relief for most patients. Using this process, the nurse recognizes distinct differences in patient perceptions and responses to pain. Nonpharmacologic complimentary modalities for pain relief should be incorporated into the patient’s care.1 An individualized plan of care that stabilizes the patient’s pain at an acceptable intensity is the goal of pain assessment and management. EDUCATION
ASSESSMENT AND PREPARATIONAssessment
Rationale: In some cultures, expressing pain is unacceptable; the nurse must assess nonverbal and physiologic signs of pain. When examining the abdomen, auscultate first; then inspect and palpate. Factors other than pain may influence patient behavior and cause distress. Rationale: Pain intensity often changes with movement. Preparation
Rationale: Temperature extremes alter a patient’s responses to pain. Rationale: Bright or very dim lighting aggravates pain sensation. Rationale: Loud or irritating sounds aggravate pain. Rationale: Fatigue accentuates the perception of pain. Rationale: Privacy reduces stimuli that increase pain. PROCEDURE
MONITORING AND CARE
Use the same pain-intensity scale that was used before implementing pain interventions. Rationale: Adverse effects of analgesics may be controlled by reducing the dose, increasing the time intervals, or administering other medications (e.g., stimulant laxative for opioid-induced constipation). EXPECTED OUTCOMES
UNEXPECTED OUTCOMES
DOCUMENTATION
PEDIATRIC CONSIDERATIONS
OLDER ADULT CONSIDERATIONS
HOME CARE CONSIDERATIONS
REFERENCES
ADDITIONAL READINGSSimpson, M.H., Ignatavicius, D.D. (2018). Chapter 4: Assessment and care of patients with pain. In D.D. Ignatavicius, M.L. Workman, C.R. Rebar (Eds.), Medical-surgical nursing: Concepts for interprofessional collaborative care (9th ed., pp. 45-70). St. Louis: Elsevier. Tick, H. and others. (2018). Evidence-based nonpharmacologic strategies for comprehensive pain care: The Consortium Pain Task Force white paper. Explore, 14(3), 177-211. doi:10.1016/j.explore.2018.02.001 Adapted from Perry, A.G. and others. (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier. Elsevier Skills Levels of Evidence
Which important action would the nurse perform when communicating with a hearing impaired patient?Avoid facing the patient while speaking. Speak clearly and slowly. Check for the patient's hearing aids. Make the patient aware while talking.
Which intervention would help the nurse communicate with patients with varying degrees of hearing loss quizlet?The nurse works in a nursing home and understands that most of the elderly patients have varying degrees of hearing loss. Which interventions would help the nurse to communicate with these patients? Speaking clearly and slowly gives the patient time to comprehend what the nurse is saying.
Which action would the nurse perform for easy communication with a patient who has aphasia quizlet?Which action would the nurse perform for easy communication with a patient who has aphasia? aphasia has difficulty speaking. The nurse would encourage the patient to converse and collaborate with a speech therapist as needed; the nurse would not tell the patient to remain silent.
Which action would the nurse take when communicating with a patient with aphasia?Give them time to speak. Resist the urge to finish sentences or offer words. Communicate with drawings, gestures, writing and facial expressions in addition to speech. Confirm that you are communicating successfully with “yes” and “no” questions.
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