How to use pain as a vital sign?

[maanggohs]

When using pain as a vital sign in the same line of temp, bp, resp, hr

What if the patient only has pain when he/she uses the affected part of their body or only if it's moved. Would that still count as a pain vital sign, meaning it'll go together with the other vital signs temp bp etc? Or would you just note that in your chart "patient report pain upon exertion..."

[MU Nursingstudent]

Not sure what you mean..Pain is still pain.. Anyhow if you're asking about charting it then every place is different a little. The hospital I'm at now has a place were you chart your pain assessment and it is in the same area where the vital signs are charted. Another hospital I was at had teh pain assessment with the physical assessment.

[Elle_Guerira]

I normally assess for pain using the numeric pain scale. I would ask the patient to rate their pain from 0 being no pain to 10 being excruciating pain. If they experience any significant pain, I would assess further by asking where, to describe it for me (stabbing, shooting, dull, etc.) for how long, what alleviates it, etc. etc.

[clinicalteach]

don't forget that when you chart about pain, you should chart when it started, chronic or does it come and go , what type of pain(sharp, stabbing, burning) relieving factors, or factors that exacerbate it and of course define what type of scale you used to determine level.

[nurseprnRN, BSN, RN]

i think your question sounds like it come from, "if i do vital signs at 0700 and my patient is comfortable in bed, and i don't do vital signs again until 1300, and she's all settled in bed again after a busy morning by then, how do i count pain as a vital sign?" please correct me if i misread you.

vital signs are data that you need to establish your nursing diagnoses and interventions. nursing data collection is not limited to the time slot on the chart where shift signs are recorded. if your vs sheet doesn't make room for them there, be sure you mention in your notes.

data collection goes on all day long. every time you're in the same room as your patient is an opportunity to observe what's happening-- is her coordination good, does she tire easily, does she move ok, does she get short of breath when she walks, is it hard for her to pee or poo, can she answer you when you talk to her, does she follow directions prn, is her skin warm or cool or dry or moist or reddened, and does she have pain/when/why/what kind/what happens/makes it better/makes it worse?

[turnforthenurse, MSN, NP]

Pain is pain. You need to adequately assess it. Is the pain acute or chronic? Acute pain typically affects your vitals - elevated HR, BP, RR. Chronic pain typically does not affect your vitals. Is it constant or intermittent (come & go)? What makes the pain worse/what helps alleviate the pain? What is the pain quality (aching, burning, squeezing, sharp, stabbing, etc) and how would they rate their pain on a scale from 1-10.

And if they can't communicate with you, look at other factors. Are they restless/agitated? Are they grimacing? Etc.

[NCRNMDM, ASN, RN]

In the clinical facility I am currently at, we do pain assessments every two to four hours, and we do vitals on the same schedule. We are on a post-surgical/ICU step-down floor, so the patient population tends to be pretty variable. When it comes to vitals, pain included, I don't follow a specific time schedule. If I take a BP and it is high, low, or aberrant from the patient's baseline, I might check it once an hour, or every thirty minutes if it is significant enough. Of course, I would also notify the MD and see what, if anything, he/she wants to do. Pain follows the same principle. If my patient is six hours post-op, I am going to assess their vitals, including pain, more frequently than if they are two days post-op. However, if I enter a patient's room and they are complaining of severe pain, I will administer a pain medication and begin checking their pain level every 30 minutes to an hour.

When using pain as a vital sign, you have to apply it to the rest of the patient's clinical picture. Acute pain is going to (often) elevate the blood pressure, heart rate, and respiratory rate. With chronic pain, you aren't going to expect to see the other vital signs shoot up. If your patient is a chronic pain patient and you find that their heart rate is 130, you aren't going to instantly attribute this to pain. If, however, your patient has presented to the ED with a fractured humerus, then you would probably attribute that heart rate to pain, anxiety, and fear.

Also, when assessing pain, you aren't just asking how much it hurts. You want to know where it hurts, how long the pain has been going on, what it feels like (stabbing, aching, burning, dull, etc), the severity, etc. Keep in mind that sometimes patients are reluctant to report pain, or simply cannot convey their pain to you (for instance, someone who is intubated, mute, etc). In these patients you need to assess for other cues. Agitation, restlessness, grimacing, limiting movement, guarding an area, etc are also signs of pain.