Introduction to the assessment of Pain.pptx

Introduction of Pain

1. EXAMINATION POSITIONS

2. SUPINE Areas Assessed: Anterior chest for respiratory, cardiac, and breast exams. Pulses and extremities

3. SITTING Head and Neck Anterior and posterior chest for respiratory, cardiac, and breast exams. Vital signs and upper extremities.

4. DORSAL RECUMBENT Abdomen: Basically supine position with knees slightly flexed to relax abdominal muscles. Female pelvic area if patient is unable to assume lithotomy or Sim’s position. Lithotomy position for female pelvic and rectal areas essentially same as dorsal recumbent but legs and feet I stirrups. Female pelvic and rectal areas: Best alternative if patient is unable to assume lithotomy position.

5. SIM’S Female pelvic and rectal areas: Best alternative if patient is unable to assume lithotomy position.

6. PRONE Muscoloskeletal sytem

7. LEFT LATERAL RECUMBENT Chest: Best for cardiac auscultation, particularly of S3 S4 and some murmurs.

8. KNEE-CHEST Male rectal and prostate areas: Best position for these exams.

9. STANDING Supine and joints (ROM); Best for these musculoskeletal areas; used for both neurological exam and to assess gait and cerebellar function.

10. TYPES OF PAIN

11. Overcoming nervousness Confidence-building strategies

12. PAIN Enhancing your presentation

13. TYPE CAUSE DURATION EXAMPLES ACUTE Injury or pathology self-limiting, resolves with healing trauma, medical or surgical, labor, acute diseases CHRONIC may or may not be associated with pathology persists beyond expected healing time injury, malignant conditions, chronic non-life threatening diseases such as arthritis. CANCER /MALIGNANT associated with underlying malignancy, may be acute or chronic, pain level malignancy and associated diagnostic tests and treatments diagnostic procedure, or disease treatment strongly correlates with the degree of pathology CHRONIC NON- weak connection between cause and extent of prolonged or possibly lifelong osteoarthritis, low back pain, myofascial pain, fibromyalgia CANCER PAIN pain headaches, central pain, chronic abdominal pain, CHRONIC PAIN SYNDROME chronic pain that consumes and incapacitates prolonged, possibly lifelong pain

14. NEUROPATHIC PAIN Mono/Polyneuropathies Deafferentation Sympathetically Maintained Pain Central Pain

15. NOCICEPTIVE/NEUROPATHIC PAIN Nociceptive Pain – results from exposure to noxious (painful) stimuli. The painful stimuli can occur in the viscera, resulting in visceral pain, or tissue, resulting in somatic pain. Visceral pain results from overdistention, spasms, ischemia, inflammation, or traction, of organs such colic, appendicitis peptic ulcer disease, and bladder distention. Referred Pain Radiating Pain Somatic Pain Deep Somatic Pain

16. Performing the pain assessment

17. Precipitating/ palliative/ provocative factors What were you doing when the pain started? Does anything make it better, such as medication or a certain position? Does anything make it worse, such as movement or breathing? This Photo by Unknown Author is licensed under CC BY

18. QUALITY/QUALITY What does it feel like? Superficial somatic pain is sharp, pricking or burning. Deep somatic pan is dull or aching. Visceral pain is dull, aching, or cramping. Neuropathic pain is burning, shocklike , lancing, jabbing, squeezing, or aching. This Photo by Unknown Author is licensed under CC BY

19. REGION/RADIATION/RELATED SYMPTOMS Can you point to where it hurts? Does the pain occur or spread anywhere else? Localized pain is confined to the site of origin, such as cutaneous pain. Referred pain is referred is related to a distant structure such as shoulder pain, with acute cholecystitis or jaw pain associated with angina. Projected (transmitted pain) is transmitted along a nerve, such with herpes zoster. Dermatomal pain as with peripheral neuropathic pain. Nondermatomal pattern as with central neuropathic pain, fibromyalgia. This Photo by Unknown Author is licensed under CC BY

20. REGION/RADIATION/RELATED SYMPTOMS Do you have any other symptoms? (nausea, dizziness, shortness of breath) Visceral pain-related symptoms include sickening feeling, nausea, vomiting, and autonomic symptoms. Neuropathic pain-related symptoms include hyperalgesia and allodynia. Complex regional pain syndrome-related symptoms include hyperalgesia, htyperesthesia , allodynia, autonomic changes, and shin, hair, and nail changes This Photo by Unknown Author is licensed under CC BY

21. SEVERITY Use appropriate pain scale This Photo by Unknown Author is licensed under CC BY

22. TIMING When did the pain begin? How long did it last? Brief flash: Quick pain as with needle stick Rhythmic pulsation – pulsating pain as with migraine or toothache. Long-duration rhythmic: as with intestinal colic Plateau pain: pain that rises then plateaus such as angina Paroxysmal: such as neuropathic pain This Photo by Unknown Author is licensed under CC BY

23. TIMING How often does it occur? Continuous fluctuating pain: as with musculoskeletal pain Do you have times when you are pain free? This Photo by Unknown Author is licensed under CC BY

24. PAIN SCALES for adults Various instruments are available to assess pain. UNIDIMENSIONAL SCALES NUMERIC RATING SCALE VISUAL ANALOGUE SCALE CATEGORICAL SCALE MULTIDIMENSIONAL PAIN SCALES INITIAL PAIN ASSESSMENT INVENTORY BRIEF PAIN INVENTORY MCGILL PAIN QUESTIONNAIRE NEUROPATHIC PAIN SCALE

25. PAIN SCALES for CHILDREN Various instruments are available to assess pain. FACES Pain Rating Scale Oucher Numeric Scale Poker Chip Tool Word-Graphic Rating Scale Visual Analogue Scale Color Tool

26. Thank you Brita Tamm 502-555-0152 [email protected] www.firstupconsultants.com