Pain Assessment And Reassessment

[Audio] Good day We would like to extend a warm welcome to all of you on behalf of pain management Team . Pain is universal experience , as healthcare professionals, our role in nursing is assessing, managing, and alleviating pain our topic of discussion will be pain assessment, reassessment, and the tools used for pain assessment in SSMC.

[Audio] The planning committee and the presenter declare no conflict of interests in product or company, direct research support, or other form of potential bias..

[Audio] Our learning objectives for this session: Define pain Understand various pain assessment tools Explain pain assessment and reassessment process according SSMC comprehensive pain policy..

[Audio] "Pain is whatever the experiencing person says it is, existing whenever he/she says it does" There is no machine or laboratory test that can tell you whether the patient is experiencing pain or not. It is subjective experience.

[Audio] Classifications of Pain Pathogenesis (The manner of development of a disease) Nociceptive Neuropathic According to the duration: Acute Chronic According to severity : Mild, Moderate, Severe According to the pattern of pain Intermittent pain Persistent pain Breakthrough pain.

[Audio] Acute pain happens suddenly, starts out sharp or intense, and serves as a warning sign of disease or threat to the body. It is caused by injury, surgery, illness, trauma, or painful medical procedures and generally lasts from a few minutes to less than six months Chronic pain lasts months or years and can affect any part of your body. It interferes with daily life and can lead to depression and anxiety..

[Audio] Pain is classified by mode of origin and transmission: Nociceptive pain is due to the stimulation of nerve fibers that transmit signals in a normal way from nerve endings to brain centers. Somatic pain – pain originating from muscle, soft tissue or bone. It is usually well localized and described as deep, aching, or boring. It may be worse with movement. Some examples are bone metastases, osteoarthritis, and muscle/tissue damage. Visceral pain – pain originating from internal organs or viscera surrounding them. It is usually less well localized and can be referred. Often described as deep, cramping, or squeezing. Some examples are bowel obstruction, brain tumor, and appendicitis. Neuropathic pain : Abnormal stimulation of the nerves, which can originate from a dysfunction, i.e. nerve damage, or can be due to continued, sustained stimulation. Patients often describe it as burning, shooting or prickling pain. It is often accompanied by other sensations including pins and needles.

[Audio] Breakthrough or flare-up pain can be described as a transitory increase in pain in someone who has relatively stable and adequately controlled baseline pain. Breakthrough pain may be caused by changes in an underlying disease, including treatment, or involuntary or voluntary physical actions such as coughing or getting up from a chair. It can also be caused by emotions such as increased stress, anxiety, or worry. Breakthrough pain may occur at the end of the scheduled pain medicine dose as well..

[Audio] Why pain assessment is important? It is the first step toward proper management Help in diagnostic process Determine the best treatment Allows to monitor patient response Facilitate effective communication between multidisciplinary team.

[Audio] Numeric Pain Rating Scale: Numeric Rating Scale (NRS) is widely used and acceptable scale for children aged 7 years up to adult Patient will be asked to indicate the intensity of pain levels on a scale of 0 (no pain) to 10 (worst pain imaginable). Wong-Baker Faces  Wong-Baker Faces Pain Rating Scale is used for children aged 3-7 years.  Wong-Baker Faces Pain Rating Scale can be offered as a second option for children aged 7 years up to adult if numeric rating scale is not feasible and if patient faced difficulty with using numbers..

[Audio] Comprehensive pain assessment should be performed and documented at the initial pain assessment and should be repeated at new report of pain or change in the condition; assessment should include the following: Pain score level of consciousness using appropriate sedation scale Location of pain Quality Healthcare providers may ask patients to describe their pain in their own words. For example, the patient may describe their pain as sharp, dull, throbbing, or burningOnset (Gradual, Sudden) Duration (How long does it last?) Radiation: Healthcare providers may ask patients to point to where the pain is located and if it spreads to other areas. For example, a patient may report pain in their left arm that radiates up to their shoulder. Aggravating and Alleviating factors : Healthcare providers may ask patients what triggers their pain or makes it worse and what makes it feel better. For example, the patient may report that certain activities or movements worsen their pain, or that it is alleviated by rest or medication. Associated symptoms Past and current pain history Patient goal (unique for each patient and directs the plan of care)..

[Audio] Critical Care Pain Observation Tool (CPOT) can be used for adults critically ill and/or sedated patients unable to self-report pain severity/intensity..

[Audio] Pain Assessment in Advanced Dementia (PAINAD) scale is valid tool for verbal or non-verbal adult patients with levels of cognitive impairment, confusion, or delirium and unable to self-report.

[Audio] Face, Legs, Activity, Cry, Consolability Scale (FLACC) for children from 1 up to 7 years and nonverbal critical ill and/or sedated pediatrics.

[Audio] Modified Neonatal Infant Pain Scale (NIPS) for infants up to 1 year.

[Audio] Periodic reassessment should include: Pain score Sedation score Functionality Achievement of comfort-function goals Side effect of the drugs.

[Audio] The RN has to reassess pain after administration of pain therapeutics: Within 30 minutes after parenteral drug administration Within 1 hour after oral drug administration With each report of new or changed pain..

[Audio] As part of our nursing role, if patient still complain of pain and still have side effects, we inform the physician or the team who manage the patient's pain to achieve optimal care ..

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