Rethinking Pain Assessment - Page 2

One of the advantages of being a pedi nurse is you have to learn to make assessments without consideration of patient's verbal input (especially pre-verbal pts). If skin is pale, eyes staring into nothing or closed most of the time, very still or very fidgety---I guess the idea is extremes in behavior. Best of all, give pain med and see what response you get. That should be a clue for that patient.

Has anyone else noticed that older patients with dementia can sometimes "escape" pain, like neonates, by going to sleep? I had a patient last week in her 80's with dementia, who when awake was in obvious pain (rib fx) but would go to sleep between when I assessed her and when I brought back the pain med (and it wasn't that long!!! I know what you're all thinkin'... )

Anyone can use sleep as an escape mechanism when in pain. Being able to sleep does not mean that pain is improved or under control; sedation also does not equal pain relief. It is possible to be quite sedated but still in severe pain.

My problem is more with family members who say patient needs pain meds when patient says "NO". I am running into that so much lately. Anyone else have this problem? If the family feels that the patient is concealing pain I am only to glad to quietly do pain teaching. However, I can kneel on someone's chest and shove it down their throat.

glascow, I must be a very mixed up kind of mutt because sometimes pain tolerance works for me, and sometimes not. If you ever have me for a patient though.......gosh darn it.....JUST BRING ME THE FRIKKIN PAIN MED STAT!!! :chuckle :roll :chuckle

I wonder what gene in me that was that just jumped out here?

I hope no one thinks I medicate my pts based on the generalized statements I made.
Of course, I would never NOT give pain med based on what I said.
I was just sharing my observations over the past 12 yrs.
Regardless of race or sex, I do a thorough pain assessment on all of my patients and medicate accordingly.

:angel2:

Just a few shifts ago I had a man come in the ER with severe (rated 10/10) epigastric and RUQ pain. He was pale and diaphoretic. Really sick looking. Heart rate was 35 in assessment. Needless to say I put him in a room and on a cardiac monitor. To make a long story short - he had gallstones. Once his pain was relieved his heart rate was in the 80's.

I have also had a few women that come in complaining of teeth or jaw pain - and they were having an AMI.

I agree that young white males seem to be the worst whiners.

I also agree with the sleeping issue. But that is a hard one to explain to nurses (especially ER nurses) if they have never been in pain.

One thing I do alway question is the person that comes in complaining of severe abd pain and nausea. But they are out in the waiting room eating Cheetohs and drinking Coke. That one I don't understand.

I realize that pain is perception. But what do you do with people who rate their pain at 25 (on the 0 to 10 scale) everytime they come in.

My Dad was allergic to Lidocaine. He needed a Hickman placed. Dr had the staff ice his chest for 15 minutes, then Demerol 25 IV prior to placing the line. Dad seemed to go into a trance, yet would answer appropriately; became hypotensive and bradycardic. (BP 70/40, P 50) When told it was over, he was a/o and asked Dr. "Did my BP go up or anything?"

I was amazed--it gives insight into the power of the mind over body.