Chap 9: assessing pain
A nurse begins to assess pain in a client admitted to the hospital for new onset of severe nausea and vomiting. What question should the nurse ask the client to assess the pattern of pain? "Where is the pain located?" "When did your pain start?" "What therapies have you tried to control the pain?" "How often do you experience the pain?"
"How often do you experience the pain?" The nurse uses a mnemonic device including but not limited to OLD CART or COLDSPA to elicit information from a client about the pain. The nurse should assess for patterns by asking questions that elicit information about what makes the pain better or worse. Asking the client how often the pain occurs will help the nurse understand the course of the pain and if there is any pattern that may help identify the source of the pain. Asking about onset of the pain is essential to determine the severity of the situation. Therapies alert the nurse to the effect of treatment modalities that have or have not been successful in alleviating the pain. Location helps to identify the underlying cause.
A male client with a history of a back injury 2 months ago has been taking daily doses of narcotic pain medication. He is currently hospitalized with a leg fracture after falling down the stairs. He complains of 10/10 pain in his back and leg after taking pain medication one hour ago. What is the nurse's best action?
Consult with the healthcare provider about increasing the dose of medication.
Which of the following is not released during the stress response? Cortisol Dopamine Norepinephrine Epinephrine
Dopamine
A nurse assesses a cognitively impaired adult client who grimaces and points to the right knee following a motor vehicle accident. Which pain scale would be most appropriate for the nurse to use to assess the client's pain?
FACES. also used for adolescents.
Pain scale for infants
FLACC (think skinny, small baby) faces, legs, activity, cry, consolability
The nurse is caring for a 4-week-old postoperative patient. The most appropriate pain assessment tool would be the:
FLACC. faces, legs, activity, cries, and consolability
A client on a medical-surgical unit reports pain of 10 on a scale of 0 to 10 and wants more pain medication. The nurse does not think the pain is as bad as the client says. The physician left orders for prn morphine for breakthrough pain. What is the priority nursing action? Give the prn morphine Document the client's pain rating on a scale of 0 to 10 Call the physician to check the order Hold the medication and wait 30 minutes
Give the prn morphine
A client complains of pain in several areas of the body. How should the nurse assess this client's pain?
Have the patient rate each site seperately, NOT just rate the site with the highest pain.
A 12-year-old boy has reported to the emergency department after having fallen off his bicycle and sustained what appear to be minor injuries. The nurse is assessing him for pain. Which of the following objective findings would most tend to indicate pain? Nodding up and down in response to questions Maintaining a consistent position and posture Sustained eye contact with the nurse Upright posture while sittin
Nodding up and down or saying, "yeah, yeah," may not indicate a client's positive response to questions, but rather may indicate just listening or not wanting to be negative, as responding verbally or in detail would require too much effort while the client is in pain. The other findings listed would all tend to indicate a lack of pain: upright posture, sustained eye contact, and maintaining a consistent position and posture.
The Seven Dimensions of Pain
Physical dimension refers to the physiologic effects just described. This dimension includes the patient's perception of the pain and the body's reaction to the stimulus. Sensory dimension concerns the quality of the pain and how severe the pain is perceived to be. This dimension includes the patient's perception of the pain's location, intensity, and quality. Behavioral dimension refers to the verbal and nonverbal behaviors that the patient demonstrates in response to the pain. Sociocultural dimension concerns the influences of the patient's social context and cultural background on the patient's pain experience. Cognitive dimension concerns "beliefs, attitudes, intentions, and motivations related to the pain and its management" (p. 14). Of course, beliefs, attitudes, intentions, and motivations are affected by all of the dimensions mentioned, but can be associated with the management part of the pain experience, which is dependent on cognition. Affective dimension concerns feelings, sentiments, and emotions related to the pain experience. The pain can affect the emotions and the emotions can affect the perception of pain. Spiritual dimension refers to the meaning and purpose that the person "attributes to the pain, self, others, and the divine" (p. 15). For some suggested questions to assess each dimension, see Assessment Guide 9-1.
The nurse enters an older client's room to assess for pain and discovers the client is hard of hearing. What is the nurse's best action?
Speak face to face with patient. Do not speak in high voice as this infantilizes patient.
The nurse is explaining the difference between acute pain and chronic pain to the patient. Which should the nurse include in the explanation? The duration of chronic pain is short. Chronic pain is caused by damage to nerves. Acute pain lasts longer than 3 to 6 months. The cause of acute pain can be identified.
The cause of acute pain can be identified (more easily)
The nurse is explaining the difference between acute pain and chronic pain to the patient. Which should the nurse include in the explanation? The duration of chronic pain is short. Acute pain lasts longer than 3 to 6 months. The cause of acute pain can be identified. Chronic pain is caused by damage to nerves.
The cause of acute pain can be identified.Acute pain is of short duration and has an identifiable cause.
T or F. Acute pain can be as intense as chronic
True. terms are differentiated by time, not intesity.
sites of visceral pain
abdomendal, thorax, cranium (ICP)
A post-operative client is observed breathing 24 breaths/minute while complaining of 10/10 abdominal pain. The client's oxygen saturation is 90% on 2 liters nasal cannula. What is the nurse's priority action?
administer analgesic. the patient is hyperventilating due to pain.
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following? Relaxation techniques Cutaneous stimulation Surgery Analgesics
analgesics
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following?
analgesics are still the #1 even though alternative therapies have grown.
What is the last resort in pain hierarchy with disabled patients?
ask family. not before observing.
Which dimension of pain involves grimicing?
behavioral
A patient reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort?
endorphins
The nursing student asks the nurse what would be an example of visceral pain. What would be the correct response by the nurse? Arthritic pain Cardiac pain Burn pain Gallbladder pain
gallbladder
A nurse is using the FLACC (Face, Legs, Activity, Cry, Consolability) scale for pediatric pain assessment to assess for pain in a 6-month-old client. Which of the following findings on this assessment tool would indicate the strongest pain in the client?
kicking. whimpering only gets 1 point while crying would get 2 points.
A student nurse learns that especially in the very young and very old pain can be inadequately treated. What else would the student learn about inadequate pain treatment in the very young?
neurodevelopmental problems
shingles involves which kind of pain
neurologic pain
When patients report pain, it is important to find the source. When patients describe pain as "burning, painful numbness, or tingling," the source is more than likely: Referred Visceral Somatic Neuropathic
neuropathic
A patient recovering from a stroke complains of pain. The nurse suspects this patient is most likely experiencing which type of pain?
neuropic
MI is which type of pain
nociceptive (or somatic pain)
FACES pain scale is used for which two groups?
older adults (without cognitive impairment) and toddlers
Chronic pain is defined as
pain that is present for 6+months
The nurse is assessing the pain of an older adult client who is recovering from a right hip open reduction procedure. What element would the nurse know it is important to review to best understand the patient's pain? Genetic history Family history Sleep patterns Elimination pattern
sleep patterns
A client who suffers from arthritis complains of sharp pain in her knees and elbows. The nurse recognizes this is what type of pain? Somatic Visceral Referred Cutaneou
somatic
A patient recovering from abdominal surgery is complaining of pain. The nurse realizes that the patient is most likely experiencing which type of pain? Somatic Psychogenic Neuropathic Idiopathic
somatic pain results from tissue damage and damage to joints, tendons
cutaneous pain
superficial skin pain
the site of referred pain is usually ___ to the origin site above the diaphragm and ___ to the origin site below the diaphragm except liver
superior; inferior. lungs, heart and stomach superior while kidneys, bladder,
somatic pain is assoicated with
tendons, ligaments, bones, blood vessels.
how often should pain be assessed after giving meds IV and oral
usually 1 hour oral and 30 min IV
A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing? Cutaneous pain Neuropathic pain Somatic pain Visceral pain
visceral
Mark is a 20-year-old college student who has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is Mark most likely experiencing?
visceral pain
