pain management

1. Laxmi thapa
B.sc. Nursing 3rd year
Roll no:29

2. PAIN
“Pain is complex multifactorial phenomenon
which includes an emotional experience
associated with actual as potential”
-MERSKEY & BUGDULK, 1994

3. ASSESSMENT OF PAIN
Assessment of pain includes
SUBJECTIVE
OBJECTIVE

4. A. SUBJECTIVE ASSESSMENT
1. PAIN HISTORY
While taking pain history, nurse must provide an
opportunity for clients to express in their own
words, how they view it and their situation
This will help the nurse to understand means of
pain to client and how the client is coping with
it.

5. 2. ONSET AND DURATION OF OCCURRENCE:
- When did pain begin?
- How long has it lasted?
- Does it occur at same time each day?
- How often does it occurs?

6. 3. LOCATION
- In which area it is felt? Do the area differ
under different circumstances?
- If several parts of body are painful, do pain
occur simultaneously?
- Is pain unilateral / bilateral?
- Ask the individual to point site of discomfort

7. 4. INTENSITY
- Use of pain intensity scale is an easy and
reliable method of determining the clients
pain intensity
- Most scales are either 0 to 5 or 0 to 10
- Currently used scales are:
• Numerical scale
• Descriptive scale
• Visual analog scale

8. PAIN ASSESSMENT SCALE
1. NUMERICAL RATING SCALE
 A numerical rating scale with the range of 0 to
10 is another type of pain scale that is used
 The word “no pain” appear by “0” and “worst
pain possible” is found by “10”
 Patient are asked to choose a number from 0
to 10 that best reflects his/her level of pain

10. 2. VERBAL RATING SCALES
Verbal pain scales as name suggests, use words
to describe pain. Word such as no pain, mild
pain, moderate pain & severe pain are used to
describe pain levels.

11. 3. VISUAL ANALOGUE SCALES:
- VSA use a vertical or horizontal line with
words that convey “no pain” at one end and
“worst pain” at opposite end
- Patient is asked to place a mark along line that
indicates his/her level of pain.

12. WONG-BAKER FACES
PAIN RATING SCALE
With the wong-baker pain scale, six faces are
used that are numbered 0 to 5 underneath
Face 0 is a happy face
Face 2 is still smiling
Face 4 is not smiling or frowning
Face 6 is starting to frown
Face 8 is definitely frowning
Face 10 is crying

14. B. OBJECTIVE ASSESSMENT
1. BEHAVIORAL EFFECTS:
Assess verbalization, vocal response, facial
and body movements & social interaction
Facial expression is often 1st indication of pain
& may be only one manifestation
Vocalization like moaning, groaning, crying,
grunting, screaming are associated with pain.

15. 2. PHYSIOLOGICAL RESPONSES:
 It vary with the origin and duration of pain
 Early in onset of acute pain, the symapthetic
nervous system is stimulated
 Results in increased blood pressure, pulse
rate, respiration, pallor, diaphoresis and pupil
dilation

16. P-Q-R-S-T FORMAT
PROVOCATION: how the injury occurred &
what activities increase or decrease the pain
QUALITY: characteristics of pain
REFERRAL/ RADIATION
 Referred: site distant to damaged tissue that
does not follow course of peripheral nerve
 Radiating: follows peripheral nerve, diffuse
pain

17. QUESTION TO ASK ABOUT PAIN
PATTERN: onset & duration
AREA: location
INTENSITY: level
NATURE: description

18. WHO 3-STEP LADDER

19. NURSING DIAGNOSIS
1. Ineffective airway clearance r/t chest pain
2. Anxiety r/t past experience of poor control of
pain
3. Altered health maintenance r/t chronic pain
4. Impaired physical mobility r/t asthmatic pain
perception
5. Knowledge deficit r/t pain
6. Self-care deficit r/t pain or disease condition

20. NURSING INTERVENTION
Use pain assessment scale to identify intensity
of pain
Assess and record pain & its characteristics,
condition, quality, frequency & duration
Administer analgesics as prescribed to
promote optimal pain
Document severity of patient pain on chart

21. Identify & encourage patient to use strategies
that have been successful with previous pain
Consider cultural influence on response
Eliminate the factors that increase the pain
experienced
Teach the use of non pharmacological therapy
techniques