What do you document if your patient is unconscious and you need to put what their pain is from a scale of 1-10? there is not a place to put "unobserved".
taz628, BSN, RN 90 Posts Specializes in ER, Step-Down. Has 2 years experience. Apr 4, 2009 at our facility we have the option "unable to assign a number" and then we can choose "behavioral cues" and leave a comment or NVPS (non-verbal, paralyzed, sedated) as the scale type if we can't assign a number. This is, of course, with electronic charting (Epic to be exact).
CABG patch kid, BSN, RN 546 Posts Specializes in Telemetry, CCU. Apr 4, 2009 There are different pain scales that you can use for the unconscious patient, such as FLACC and Wong-Baker FACES. These scales use non-verbal cues such as grimacing, moaning, restlessness, etc. If the patient is sedated with something that doesn't have analgesic properties, such as Diprivan, but the patient is assumed to be in pain (post op for example), it is okay to document it as such, presume the pt to be in pain, and medicate him.
vashtee, RN 1,065 Posts Specializes in DOU. Apr 4, 2009 We use the FLACC scale which assigns a numeric value to various physical cues such as frowns, grimaces, legs restless, crying, etc. Like the numeric scale, 10 is the highest number possible.
Havin' A Party!, ASN, RN 2,721 Posts Specializes in ICU, CM, Geriatrics, Management. Has 17 years experience. Apr 4, 2009 Ditto above.
