Materi View (9)

CHAPTER 7:

ASSESSING (3): PAIN

Learning Objectives  Student can understand what is paint assesment  Student can identifying the characteristics of the patient‘s pain Assessing Pain 1. Pain assessment Assessing pain can be complicated as the physical and physiological aspects of the patient all need to be considered. Because the experience of pain is very subjective, the nurse needs to be able to use some objective criteria to evaluate the location, nature and intensity of the pain so a diagnosis can be made. One of the most widely accepted definitions of pain was put forward by McCaffery (1979, p.18), who suggests that pain is ‗whatever the experiencing person says it is and exists whenever he says it does‘. 2. Assessments of the patient‘s pain experience When identifying the characteristics of the patient‘s pain it is essential the nurse considers the following:  The type of pain: is it crampy, stabbing, sharp? The patient‘s description of the pain may help in diagnosing its cause. Myocardial (heart) pain is often described as stabbing, but liver pain as cramping or aching.  Its intensity: is it mild, severe or excruciating? This can be described by using a pain assessment scale. The nurse asks the patients to rate the pain on a scale of 0 to 10; zero being no pain and 10 being excruciating pain. With children, a range of pictures showing a child changing from happy to sad can be used. Colour charts with a series

21

of colours from black through grey to yellow and orange can be used, especially with patients who have difficulty grasping numbers or articulating exactly what their pain is like.  The onset: was it sudden or gradual? Find out when it started and in what circumstances. What makes it worse? What makes it better? What was the patient doing immediately before it happened?  Its duration: is it persistent, constant or intermittent?  Its location: ask the patient to be as specific as possible, for example, indicating the site by pointing.  Changes in the site: there may be tenderness, swelling, discolouration, firmness or rigidity. With appendicitis, a classic sign is the movement of pain to the right and downwards. In a myocardial infarction (a heart attack), pain classically radiates down the arm, and with liver pain it can radiate to the shoulder.  Any associated symptoms: Some of the common symptoms of disease that can influence the response to pain are anorexia, constipation, cough, inflammation, anxiety and fear, dryness of the mouth.  Signs such as redness, swelling or heat. Task 1 ReAD the text below ANd write T (true) or F (fALse) next to eACH of the stATEments. 1. Assessing pain is straightforward process 2. Pain is an object experience 3. It is important for a nurse to use objective criteria to measure the level of pain

22

4. Colour ‗mood‘ chart are only useful for children 5. The first step for a nurse is to identify characteristics of the patient‘s pain. MATCH the ADJective to the picture, mAKe the line to the right ADJective.

shooting

gnawing

stabbing

burning

stinging

Task 2 MAKE the description of PAin in your own lANguAGe.

23