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How to Conduct a Pain Assessment

How to Conduct a Pain Assessment

Marijke Durning | NursingLink

Look for these five behavioral clues when making subjective pain assessments:

1- Facial Expressions
Facial expressions are one of the most obvious ways of identifying a patient in pain. Facial expressions may vary from grimacing to a flat affect, which the patient maintains as a way of trying to control what is happening. If the pain is intermittent or changes in quality, it’s likely that the patient’s facial expressions will change in response as well. However, there is one catch: not everyone shows pain on their face, so don’t use facial expressions as the sole means of assessing pain! After all, some patients are taught to keep such feelings to themselves, or are naturally unexpressive.

2- Body Movements
Some people who are in pain move parts of their body, their arms or their legs, in a rhythmic fashion. Repetitive motion is meant to be soothing, like rocking back and forth, for example. This constant motion, sometimes mistakenly interpreted as restlessness, could be a signal that the patient is experiencing pain. When the movements are intense, affecting the whole body, this could be described as writhing in pain.

3- Guarding
Our instinct is to guard our most vulnerable body parts, and this kind of behavior is especially true when we’re in pain. If you have a patient with abdominal pain, you may find them resting their hands along the painful area, as if protecting it from further pain. Be on the lookout for this kind of behavior as an indicator of pain.

4- Verbal Expressions
Nurses can pick up clues from how their patients are verbalizing, even if they aren’t saying “I have pain.” For example, someone in pain may speak in short, clipped words because speaking is too painful. Others may speak very softly or whisper. Patients who can’t or won’t speak, may start involuntarily moaning, accompanied by rocking and/or repetitive motions. We don’t know why moaning happens, but even animals have been heard moaning when in pain.

5- Respirations
Someone who is experiencing pain will often have increased respirations, or breaths per minute, than is normal. In addition to the rapid respirations, the breaths are often shallow, because deeper breaths may cause an increase in pain.

Observing respirations is particularly important if your patient is sleeping a lot. It used to be believed that if a patient was asleep, they couldn’t be having pain. By watching facial expressions and noting respiratory patterns, this may show you that it’s not true: patients who are sleeping may be in quite a bit of pain and still need to be treated.

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