LESSON 4

LESSON 4

Pain Assessment

A.    PRE READING

Think about how you describe pain in your own language. What sort of words and expressions do you use?

B.    READ THE TEXT BELOW

                                                 Pain Assesment

                                                   By Marie McCullagh & Ros Wrigth

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’.

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 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.


Adapted from Foundations of Nursing Practice (3rd Edition), edited by Richard Hogston and Barbara A. Marjoram: Palgrave Macmillan (2008). Reproduced with permission from Palgrave Macmillan. 


C.    EXERCISES

     EXERCISE 1

Fill the gaps in the sentences using these words from the text.


1.    _____________________ is the amount of time something lasts.
2.    A pain is ______________________ when you cannot bear it.
3.    A description is ______________________ when it is based on the individual’s experience or perceptions.
4.    A patient who is ______________________ is able to explain things very well.
5.    The ______________________ of a pain is when it begins.
6.    A pain ______________________ when it spreads out from a central point.
7.    The ______________________ of a pain describes the degree to which the patient feels it.
8.    In order to ______________________ a patient’s pain, a nurse needs to know its characteristics.
9.    Being ______________________ means relying on facts, rather than personal beliefs or feelings.
10.    ______________________ on part of the body is when it is sore or uncomfortable to touch.


     EXERCISE 2

Comprehension check

Read the text below and write T (true) or F (false) next to each of the statements.

1.    Assessing pain is a straightforward process.
2.    Pain is an objective experience.
3.    It is important for a nurse to use objective criteria to measure the level of pain.
4.    Colour ‘mood’ charts are only useful for children.
5.    The first step for a nurse is to identify characteristics of the patient’s pain.