Pain Assessment

Pain Assessment Pain assessment Pain is often considered a fifth vital sign, assessed along with temperature, pulse, respiration, and blood pressure. Because pain can affect patients’ physical, emotional, and mental well-being, it must be managed immediately and effectively so that they can perform daily activities. Pain can be acute pain or chronic. Acute pain is often severe with a rapid onset and a short duration. It generally resolves with healing. Chronic pain continues beyond the point of healing, often for more than 6 months. Cancer pain is in a category of its own. It can be acute, chronic, or intermittent and is caused by tumor growth and tissue necrosis. Various tools are available for assessing pain. Tool selection is based on the patient’s age and cognitive abilities. The CRIES pain assessment tool is used for assessing postoperative pain in preterm and term neonates. Behavioral and physiologic indicators are measured on a 3-point scale. The FACES pain scale or the OUCHER pain scale is commonly used with pediatric patients. Both assessment tools require patients to point to the face that best matches how they feel about their pain. A numeric rating scale is the most common pain assessment tool used for teens and adults. This type of pain scale requires patients to rate their pain on a scale of 0 to 10, with 0 reflecting no pain and 10 indicating the worst possible pain. For older adults, a descriptor scale is often used. This type of scale lists words that describe different levels of pain intensity. For patients whose cognitive abilities are impaired or for those who cannot respond verbally, it is essential to assess nonverbal cues such as facial expressions, behavior, vocal sounds (moaning), and unusual movements. For whichever pain-assessment tool you use, teach the patient how to use the scale and make sure the same one is used each time the patient’s pain is assessed. Managing pain involves implementing both pharmacological and nonpharmacological interventions. To provide the most effective pain relief when using pharmacological agents, the medication should be prescribed and administered on a regular schedule rather than on an as-needed basis. Because each patient experiences pain differently, it is important to manage it on an individual basis. For more information about pain management, both pharmacological and non-pharmacological, see the painmanagement skills module. Oxygen Saturation Pulse oximetry is a quick and noninvasive way to measure a patient’s oxygen saturation. The pulse oximeter works by reading the light reflected from hemoglobin molecules. It consists of a sensor with a light-emitting diode (LED) that is connected to the oximeter by a cable. Normal oxygen saturation for a healthy adult is between 95% and 100%. To obtain the best reading, place the oximeter sensor on a vascular area of the body. The fingers, toes, earlobes, and bridge of the nose are the most common sites. If you use a patient’s finger, make sure nail polish and artificial nails are removed because they can interfere with obtaining an accurate reading. Patient movement, hypothermia, medications that cause vasoconstriction, peripheral edema, hypotension, and an abnormal hemoglobin level can also affect pulse-oximetry readings. Pulse oximetry is rarely part of a general examination. It is most often indicated for patients whose oxygen status is unstable and for those who are at risk for respiratory problems that reduce oxygen saturation.