Assessing Pain in the Elderly

Assessing Pain in the Elderly

Course Description

This course discusses assessment and recognition of pain in elderly patients.

Accreditation: KLA Education Services LLC is accredited by the State of California Board of Registered Nursing, Provider # CEP16145.

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Course Objectives

Upon completion of the course the course particpant will be able to:

  • List 3 barriers to recognizing pain.
  • Define pain.
  • Describe multiple pain scales.
  • List 5 methods for assessing pain.


Course Content

Recognizing Pain

The # 1 reason for failure to treat pain in LTC is the failure to detect it.

Resident related barriers

  • Misconception that pain is a normal part of aging

  • Belief that suffering is punishment for past actions

  • Fear that pain means new or worsening disease

  • Concerns about not being a “good patient”

  • Fear of addiction or being thought of as an addict

  • Worries about unmanageable side effects

  • Language and cultural barriers and beliefs

Communication Barriers

  • C.N.A. reports are often ignored, not included in shift reports

  • Nurse does not ask if the resident is having pain, so few PRN medications are given

  • Shift-to-shift conflicts about the treatment plan, based on own personal beliefs

  • Nurse to physician incomplete information, non-specific requests

  • Nurse assessment of pain, verbal and non-verbal in incomplete or insufficient

What is Pain? "Pain is whatever the experiencing person says it is and it exists whenever he/she says it does.”

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Pain screening interviews

  • Do you feel pain anywhere right now?

  • Does pain stop you from doing things you enjoy?

  • Does pain keep from sleeping at night?

  • Do you have pain everyday?

Descriptors of Pain
Agonizing Dull
Aching Excruciating
Abrupt Hot
Burning Heavy
Constant Intermittent
Crushing Pinching
Cramping Prickly
Nauseating Shooting
Pressure Tingling
Sharp Tender
Sore Takes Breath Away
Sudden Throbbing
Stabbing Unbearable
Sickening

Pain Rating Scale

Numeric pain scale

Assessing pain

  • Many residents have more than one source of pain so may require more than one approach to pain management.

  • If pain is identified upon a screening, then a comprehensive pain assessment should be completed.

Pain screening Timing

  • Each time vital signs are taken

  • Each time a treatment is performed

  • Each time pain medication is given (routine or PRN)

  • Each time an invasive procedure is performed

  • Anytime a resident has a non-verbal or verbal sign of pain

  • With any change of condition

  • With any admission or re-admission

  • With any adverse change in behavior

Pain screen Documentation

  • On the back of the MAR
  • On the back of the TAR
  • On the 24 hour shift to shift report
  • In the nurses notes
  • On the vital signs flow record
  • On the monthly summary
  • On the skilled nurses notes
  • On interdisciplinary notes

Type of pain scale

  • When screening for pain it is necessary to document the type of pain scale used and to use the same pain scale consistently.

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Comprehensive Pain assessment

  • Regular intervals for all residents

  • With any new complaint or sign of pain

  • With any increase in pain or

  • With any sign or report of unrelieved pain

  • With any fall incident

  • With new admissions

  • With re-admissions

  • With any change of condition

Communicate!

  • Tell the physician

  • Tell the resident

  • Tell the family

  • The your co-workers

  • Recognize the pain

  • Treat the pain

  • Evaluate the treatment

  • Revise the pain plan

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Re-assess

  • At regular intervals

  • With any complaint of increasing pain

  • Following any change of condition

  • With changes in behavior

  • With decreased physical functioning



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Course Evaluation

Please select the extent to the following was met. (Disagree..Agree)

1. Course met objectives?

(1) (5)

2. Applicability or usability of new information?

(1) (5)

3. Adequacy of the instructor's mastery of subject?

(1) (5)

4. Efficiency of course mechanics?

(1) (5)

Course Evaluation

Please select the extent to the following was met. (Disagree..Agree)

1. Course met objectives?

(1) (5)

2. Applicability or usability of new information?

(1) (5)

3. Adequacy of the instructor's mastery of subject?

(1) (5)

4. Efficiency of course mechanics?

(1) (5)

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Course Exam

Before you receive your certificate, you must complete the exam and achieve a score of % or higher. (You have unlimted attempts).

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