1. Pain Assessment and Management
Nursing

2. Learning Objectives Upon completion of this module, you will
Verbalize the definition of pain
States who is responsible for the management pain
Utilizes appropriate pain scale for the type of patient being assessed
Understands methods to relieve pain
Discuss the assessment procedure
Discuss the appropriate documentation procedure
Discuss the importance of patient/family teaching

3. Definition of Pain
Pain is defined as the unpleasant sensory or /or emotional experience. Pain is subjective - stated by the patient. Hence, all employees will accept the patients report of pain as stated.
CHSB policy states “It is the responsibility of all staff to follow the established guidelines for effective pain management and promote comfort for the patient.

4. Staff Responsibility
CHSB will aggressively respond to the patients complaint of pain All patients pain will be managed utilizing a variety of treatment modalities The individual pain will be assessed/reassessed utilizing the appropriate scale Upon admission, an established goal will be identify an acceptable level of pain.

5. Let’s get started on assessment of pain…

6. Pain Assessment
Obtain any significant history upon admission or pre/post procedure
Previous/Ongoing pain and the effects on the patient
Previous method for pain control that was effective/non effective
Patient/family attitude toward the use of pain medications
Any history of substance abuse
Patient typical coping style
Expectation/beliefs concerning pain and identification of pain goal
Describe how the patient demonstrate pain
Inventory the current medications
Over the counter
Prescription
Herbal./Vitamins

7. Pain Assessment Location Quality
Point to the area on body or use a diagram
Intensity – Use appropriate pain scale
Numeric Intensity Scale
FLACC
Wong Baker
CRIES
CPOT
Quality
Stabbing
Throbbing
Cramping
Vise like
Searing/Burning
Superficial
Deep

8. Pain Assessment Factors Associated with Pain Precipitating Factors
Motion/Position changes
Fear and emotional distress
Fatigue
Environmental stressors
Inadequate pain relief measure
Factors Associated with Pain
Nausea/Vomiting
Bradycardia/Tachycardia
Hypertension/Hypotension
Perspiration
Apprehension/Anxiety
Non verbal indicators of pain
Withdrawal
Grimacing
Crying
Inactivity
Family/Significant other/ Caregivers alert of clues from patient

9. Pain Scales Wong – Baker Pain Scale
Use for children ages 3 years of age or older
Numeric Pain Intensity Scale
Commonly used with adult patients

10. Pain Scales FLACC Faces, Legs, Activity, Cries, Consolability
CRIES - Crying, Requires oxygen, Increased vital signs, Expression, Sleeplessness
Use for 2 months – 7 year olds without developmental delay
Use on infants less than 6 months of age

11. Use this scale for nonverbal or critically ill patients
Pain Scales
CPOT – Critical Care Pain Observation tool
Pain assessment shall be completed at a minimum of every 4 hours with vital signs
Use this scale for nonverbal or critically ill patients

12. Pain Relief Options/Interventions
Drug
Oral
Intramuscularly
Intravenous
PCA
Epidural/Intrathecal
Non – Drug
Relaxation/Imagery
Distraction
Education biofeedback
Heat/Ice
Massage
Exercise
Immobilization

13. Documentation – Assessment
Pasero Opioid‐induced Sedation Scale (POSS)
S = Sleep, easy to arouse
Acceptable; no action necessary; may increase opioid dose if needed
1. Awake and alert
2. Slightly drowsy, easily aroused
3. Frequently drowsy, arousable, drifts off to sleep during conversation
Unacceptable; monitor respiratory status and sedation level closely until sedation level is stable at less than 3 and respiratory status is satisfactory; decrease opioid dose 25% to 50% or notify prescriber or anesthesiologist for orders; consider administering a non‐sedating, opioid‐sparing nonopioid, such as acetaminophen or an NSAID, if not contraindicated.
4. Somnolent, minimal or no response to verbal or physical stimulation
Unacceptable; stop opioid; consider administering naloxone; notify prescriber or anesthesiologist; monitor respiratory status and sedation level closely until sedation level is stable at less than 3 and respiratory status is satisfactory.
Document
Initial assessment
Utilize appropriate pain scale
Intervention used
Nursing Order
Physician Order
Reassessment
Utilize same pain scale
Within 60 Minutes PO
Within 30 minutes IV/PCA
Use the POSS – sedation level
Evaluation of effectiveness
Mobility

14. Documentation – Patient/Family Teaching
Patient/Family should have active involvement in pain prevention and treatment.
Teach the use of the pain scale appropriate for their age and condition.
Include demonstration and/or discussion of the options available
Non – Drug
Drug
Review/Reassess pain management plan
Educate with respect their beliefs:
Personal
Cultural
Spiritual
Ethnic

15. Special Considerations
Infants/Children Use appropriate pain scale for age and development Use toys/stuffed animal for location of pain Elderly Differentiate between acute and chronic type pain Observe for interaction response due to OTC medications observe for signs of dementia, cognitive impairment, or delirium observe for signs of over/under medication response Substance Abusers History may predispose them to re abusive behavior May require high doses due to past tolerance of substance abuse End of life/palliative Care Ensure a dignified, peaceful, and comfortable death Consult the Palliative Coordinator Complicated pain management related to multiple disease processes

16. Congrats you have completed the pain module...
...Now take the test

17. Thank You