Assessing Anxiety, SOB, nausea in patients that can not rate the symptom

Specialties Hospice

Published

I recently did an audit and found that nurses were not using the scales in our EMR to assign a number to a symptom.

The rationale I received was "well they can't tell me a number so I cannot complete a numerical scale.

In all my years of nursing I have never heard this. I have always used the objective data of what I see during the pt assessment and document the number I feel bst describes the symptom.

I have looked for scales and other than the PAINAD, I do not see many 1-10 tools to assist.

Thoughts? Suggestions?

Thank you

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Specializes in Trauma Surgical ICU.

It is not required to reassess those you mentioned at my hospital or previous hospitals I've worked at. Medicating for pain is the only one we reassess for. SOB is rated? I can't see how rating that is helpful much less on a nonverbal pt. Can you please explain

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Specializes in ICU.

You really can't just pick a number that you "feel" best fits the symptoms the patient describes. That's called guessing. There are several tools such as the FLACC and Faces pain scales that take observed or stated symptoms and assign numbers based on that.

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Specializes in School Nursing.

We use FLACC for non-verbal patients.

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Specializes in ICU.

I just realized the last paragraph of my reply was missing.

It would be very uncommon and probably not very useful to use a number scale to rate symptoms such as SOB or nausea. Anxiety, maybe. Typically those symptoms would be described as mild, moderate, or severe.

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Specializes in Trauma Surgical ICU.

Are you using It for pain or as the OP asked are you using it to reassess SOB and nausea too? I'm interested in knowing ?

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Specializes in Trauma Surgical ICU.

Thanks for the clarification ICU. That was my thinking also. Waiting on others to see what their experience has been if they use a tool.

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The EMR we use only has other scales for Pain (PAINAD, FLACC) Does anyone know of other scales? People say yes there are, but I am looking for evidenced based practice.

If a person cannot verbalize a number, then there should be tools that can be used if nurses are just not going to assign a rated number of 1-10.

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Specializes in School Nursing.

Perhaps 0-3 mild, 4-6 Moderate, 7-10 Severe? That is generally the scale in our EMR. I haven't seen any scales like FLACC for SOB and nausea, but I'm going to look now that you've asked, I'm curious. :)

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The charting software my company uses just has a scale of mild to severe for these symptoms which I find utterly useless due to its subjectivity. When charting SOB, I'll chart how many words the patient can speak in one breath as a way to illustrate the severity of the symptom. 3-word dyspnea being worse than 5 word, etc. If patient is non-verbal, you're dependent upon respiratory rate and "character" description of the patient's respirations.

We are limited by our EMR systems, but we always have space to draw the picture in our narratives.

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I believe that CMS Hospice Quality Reporting Measures require that each hospice provide quantification of how well and quickly it addresses dyspnea in newly admitted patients. This is what led to the inclusion of a numeric dyspnea score on nursing documentation a few years back. There has been a lot of confusion in my hospice about how this is used; it is only used if the patient can rate his dyspnea from 0-10 himself. Otherwise, dyspnea is just included as part of PAIN-AD. We use the BORG dyspnea scale, which asks patients to identify their dyspnea from 0-10.

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Specializes in LTC, Hospice.

Yes CMS requires quantitive documentation. It's all really silly IMO.

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