Pain assessment hcm


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Pain assessment hcm

  2. 2. REV : SOURCES OF PAIN Cutaneous Pain Somatic Pain Visceral Pain Referred Pain Neuropathic Pain Breaktrhough pain Phantom limb sensation Psychogenic Pain
  3. 3. REV : FACTORS AFFECTING PAIN Perception of Pain Socio Cultural Factors Age Gender Meaning of Pain Anxiety Past experience with Pain
  4. 4. INTRODUCTION Pain is both a physical and a psychological phenomenon The pain experience is subjective Meaningful evaluation and successful treatment of a patient with pain requires quantification of the patient’s pain 5th Vital Sign: Doctors’ training module: Pain
  5. 5. WHY MEASURE PAIN? For documentation Produces a baseline to assess therapeutic interventions e.g. administration of analgesic drugs Facilitates communication between staff looking after the patient 5th Vital Sign: Doctors’ training module: Pain
  6. 6. CLINICAL TECHNIQUES FORMEASUREMENT OF PAIN Self reporting by the patient (best method) Observer assessment  Observation of behaviour and vital signs  Functional assessment 5th Vital Sign: Doctors’ training module: Pain
  7. 7. PAIN MEASUREMENT Unidimensional scales  Numerical Rating Scale (NRS)  Verbal Analogue Score (VAS)  Categorical Scale or Verbal rating scale Multidimensional scales  Brief Pain Inventory (BPI)  McGill Pain Questionnaire (MPQ)  Memorial Pain Assessment Card 5th Vital Sign: Doctors’ training module: Pain
  8. 8. PAIN MEASUREMENT Scales used in children / infants and in cognitively impaired patients  Wong Baker Faces Scale  FLACC scale  Observational scale  Functional scale 5th Vital Sign: Doctors’ training module: Pain
  9. 9. Combination Rating Scale (NRS & VAS)*Recommended for Ministry of Health*“On a scale of ‘0’ – ‘I0’ (show the pain scale), if‘0’ = no pain and ‘10’ = worst pain you can imagine,what is your pain score now?”•Patient is asked to slide the indicator along the scale to showthe severity of his/her pain.•Nurse records the number on the scale (zero to 10) 5th Vital Sign: Doctors’ training module: Pain
  10. 10. WHEN SHOULD PAIN BE MEASURED? At Rest Movement, coughing and deep breathing Frequency of assessment should be increased if the pain is poorly controlled or if the pain stimulus or treatment interventions are changing 5th Vital Sign: Doctors’ training module: Pain
  11. 11. HOW TO ASSESS PAIN: Important to :  listen and believe the patient Take a pain history :  “Tell me about your pain…” 5th Vital Sign: Doctors’ training module: Pain
  12. 12. HOW TO ASSESS PAIN IN ADULT P : Place or site of pain  “Where does it hurt?” (a body chart might help describe their pain) A : Aggravating factors  “What makes the pain worse?” I : Intensity (NRS or VAR)  “How bad is the pain?” N : Nature and neutralizing factors  “What does it feel like” “What makes the pain better?” 5th Vital Sign: Doctors’ training module: Pain
  13. 13. DETAILED HISTORY Goal is to characterize pain by location, intensity, and etiology Listen to descriptive words about quality, location, radiation Evaluate intensity or severity, aggravating factors (have patient keep a log) Impact on activity, mood, mentation, sleep, functioning in daily activities
  14. 14. DETAILED HISTORY (CONT’D) Previous episodes, relation to physical or stress-related etiological factors Previous diagnostics and findings Previous treatment and its effects Concurrent medical problems (cardiac, respiratory, anxiety, depression)
  15. 15. ASSESSING PAIN IN CHILDREN Q Question the child U Use pain rating scales Evaluate behavioural and E physiological changes S Secure the parents’ involvement Take the cause of pain into T account T Take action and evaluate results
  16. 16. WHEN SHOULD PAIN BEASSESSED ?1. At regular intervals – as the 5th vital sign during routine observation of BP, heart rate, respiratory rate and temperature). This can be 4 hourly, 6 hourly or 8 hourly2. On admission of patient3. On transfer-in of patient 5th Vital Sign: Doctors’ training module: Pain
  17. 17. WHEN SHOULD PAIN BEASSESSED ?4. At other times apart from scheduled observations:- Half to one hour after administration of analgesics and nursing intervention for pain relief- During and after any painful procedure in the ward e.g. wound dressing- Whenever the patient complains of pain 5th Vital Sign: Doctors’ training module: Pain
  18. 18. WHO SHOULD BE ASSESSED? All inpatients  Including patients in labour room, recovery room (OT), High dependency units, Coronary Care Units All patients in Emergency department Ambulatory care units Exclusion  Patients in NICU 5th Vital Sign: Doctors’ training module: Pain
  19. 19. Who does Pain Assessment?- All nurses- All Doctors- All Student nurses- All medical students….. Everyone! 5th Vital Sign: Doctors’ training module: Pain
  20. 20. WHICH TOOL TO USETO MEASURE PAIN? Usethe standard tool for pain assessment as recommended by Ministry of Health, Malaysia  For adult patients, use the combined NRS / VAS scale  For paediatric patients 1 month to 3 years old, use the FLACC  For paediatric patients > 3-7 years, use the Wong- Baker FACES scale  For paediatric patients >7 years, use the combined NRS/VAS scale (same as for adults) *Always use the same tool for the same patient 5th Vital Sign: Doctors’ training module: Pain
  21. 21. SUMMARY OF ASSESSMENT TOOLS FORPAEDIATRICS0-1 month 1 mth – 3 yrs 3-7 years > 7 yearsOPS OPS OPS Coloured analogueNFCS COMFORT COMFORT scaleCRIES CHEOPS CHEOPS HorizontalNIPS TPPPS TPPPS linearCOMFORT Nurse FACES analogueCHEOPS observation Poker chip Adjective selfLIDS Parental Colour scales reportPIPP observation OUCHER APPT FLACC Horizontal Ladder scale linear analogue VAS CAS FLACC
  22. 22. IS IT POSSIBLE TO GET A PAIN SCORE IN ALL PATIENTS?? Some groups where pain score may be difficult to elicit may be  Adult cognitively impaired patients  Use FLACC score where possible  Patients with severe head injury  Patients with language barriers  Use the visual analogue scale if possible “Unable to score” may be recorded if all efforts to get a pain score have failed 5th Vital Sign: Doctors’ training module: Pain
  23. 23. Observation ChartPatient’s Name : RN : DOA :Age :Ward : DATE TIME BP PULSE RESP TEMP PAIN ACTION COMMENTS RATE SCORE TAKEN 5th Vital Sign: Doctors’ training module: Pain
  24. 24. WONG-BAKER FACES PAINRATING SCALE This scale can be used with young children (sometimes as young as 3 years of age). It also works well for many older children and adults as well as for those who speak a different language. Explain that each face represents a person who may have no pain, some pain, or as much pain as imaginable. Point to the appropriate face and say: (0) "This face is happy and does not hurt at all." (2) "This face hurts just a little bit." (4) "This face hurts a little more." (6) "This face hurts even more." (8) "This face hurts a whole lot." (10) "This face hurts as much as you can imagine, but you dont have to be crying to feel this bad."
  25. 25. FACES FOR 3-7YEARS Wong-Baker FACES pain rating scale This is a self report tool consisting of 6 cartoon faces. Ask the child to choose a face which best describes his/her pain ? Multiply the score below the face by 2 , to get a maximum total score of 10. Be careful as some children might confuse the faces as a measure of happiness
  26. 26. FLACC Scale This is a behavior scale that has been tested with children age 3 months to 7 years. Each of the five categories (Faces, Legs, Activity, Cry, Consolability) is scored from 0-2 and the scores are added to get a total from 0-10. Behavioral pain scores need to be considered within the context of the childs psychological status, anxiety and other environment factors.
  27. 27. 2 0 1 Frequent to No particular Occasional grimace orFace constant frown, expression or frown, withdrawn clenched jaw, smile disinterested quivering chin 0 2 1Legs Normal position Kicking, or legs Uneasy, restless, tense or relaxed drawn up 0 1 2 Lying quietly,Activity Squirming, shifting back Arched, rigid, or normal position, and forth, tense jerking moves easily 2 0 1 Crying steadily,Cry No cry Moans or whimpers, screams or sobs, (awake or asleep) occasional complaint frequent complaints 1 2Consola 0 Reassured by occasional Difficult to consolebility Content, relaxed touching, hugging or or comfort "talking to, distractible
  28. 28. PAIN SIGNS IN COGNITIVELYIMPAIRED Facial expressions Verbalizations Body Movement Change in Interaction Change in Activity or Routine Mental Status Changes