Critical care - Pain assessment: Nursing

Pain assessment helps to identify and manage a patient's pain. Pain is commonly experienced by patients in the critical care unit and it can act as a stressor that can worsen their condition.

It can also have long lasting effects on daily functioning quality of life and overall wellbeing. As the nurse caring for critically ill patients, you will provide patient centered care by performing pain assessments to effectively address your patient's pain.

Now, pain is an unpleasant sensory and emotional experience that occurs in response to actual or potential tissue damage.

So you'll start your assessment by obtaining your patient's report of how they perceive and interpret their pain. If your patient is able to verbalize their response, you can begin by asking whether or not they have pain.

If they answer yes, then you should gather more information to better understand their pain, to do this. You can use the PQ RST UV.

Pneumonic P stands for provocation or what provokes or causes the pain like moving or taking a deep breath. It also stands for palliation or what relieves the pain like resting or changing a position.

Q refers to quality or how your patient describes the pain such as sharp achy, burning, stabbing or dull r stands for region or the location of the pain like the arm head or abdomen.

You can also ask if the pain radiates or moves from one area to another like chest pain that wraps around to the back. S refers to severity or how your patient would quantify their pain to determine severity.

You can use a pain scale such as the numeric pain scale, where your patient assigns their pain a number from 0 to 10 with zero being no pain and 10 being the worst pain.

Other pain scales include a visual analog scale where the patient places an X on a horizontal line with one end representing no pain and the other end representing the worst pain and a face scale where the patient assigns a facial expression to their pain.

Intensity T stands for timing and refers to the onset duration and frequency of pain. For example, your patient could report that their pain started two weeks ago, lasts for less than 10 minutes and is intermittent while another patient could report their pain began a few hours ago and occurs continuously.

You refers to understanding and is your patient's perception of their pain? For example, they may say their pain feels like the pain they've previously had from heartburn and lastly V indicates values which are your patient's preferred pain treatments such as medication, heat or cold application or guided imagery.

When assessing your patient's pain. Remember to allow plenty of time for them to answer your questions.

And if they're unable to verbalize their responses, use assistive communication devices as needed. Now, you'll also gather objective data about your patient's pain, which are observable and measurable manifestations of pain that can be identified by assessing your patient's non verbal signs and vital signs.

Non verbal signs include grimacing, moaning, guarding and restlessness. Vital signs that can sometimes indicate pain include an increased heart rate, respiratory rate or BP.

However, keep in mind that vital signs alone should not be used as pain indicators because they're often influenced by many other factors like medications and your patient's clinical condition.

So be sure to use them as cues to prompt a more in depth pain assessment as indicated. Now, objective data is especially important for your critically ill patient who's unable to effectively communicate due to the nature of their condition, presence of sedation or paralytics or being mechanically ventilated to assess their pain.

Select a pain scale that uses behavioral and physiologic indicators such as the behavioral pain scale or the critical care pain observation tool.

The behavioral pain scale evaluates your patient's facial expression and position of upper limbs. Then if they're intubated, you'll also assess their tolerance of mechanical ventilation.

And if they're not intubated, you'll assess their vocalizations. Similarly, the critical care pain observation tool includes assessment of facial expressions, body movements and muscle tension, then compliance with the ventilator is assessed for intubated patients and vocalization is assessed if they're not intubated.

Keep in mind that if your patient is paralyzed, receiving neuromuscular blocking agents or under heavy sedation, they won't be able to express these behavioral signs of pain.

Additionally, if your patient has a brain injury, their behavioral responses can manifest differently. For example, instead of grimacing, they may have facial flushing or tearing of the eyes.

So when selecting a pain assessment tool, be sure to choose the one that's been validated in the same patient population and context in which you'll use it.

All right. As a quick recap, pain assessment helps to identify and manage a patient's pain, which is an unpleasant, sensory and emotional experience that occurs in response to actual tissue damage or potential tissue damage to assess your patient's pain.

Evaluate subjective data such as their verbal report of pain as well as objective data such as nonverbal signs when using a pain scale.

Be sure to select one that's been validated in the same patient population and context in which you'll use it.