Nursing Component Task
Nursing procedures & clinical learning

Pain Management (PM)

MANAGEMENT OF A PATIENT WITH CHRONIC PAIN (ADULTS NONVERBAL)

This is the process of managing chronic pain by the nurse/midwife in a nonverbal adult patient using observation, physiologic assessment and reliance on subjective account of caregivers. Chronic pain is managed with nonpharmacological and pharmacological interventions.

Purpose

  • Use appropriate tools to assess pain in nonverbal patients
  • Effectively manage pain in nonverbal patients to ensure optimum pain relieve
  • Effectively assess chronic pain in patients who can indicate their pain using the appropriate scale
  • Relieve the patient of chronic pain, discomfort and suffering
  • Promote the dignity of the patient
  • Promote early ambulation and discharge of patient
  • Reduce pain with minimal adverse effect
  • Prevent abuse and addiction
  • Counsel patient on adverse effects of pain relieving medications
  • Prevent medication resistance

Indications

  • Nonpharmacological interventions
  • Pharmacological interventions

Equipment

  • Patient Treatment chart (Electronic or Manual)
  • A tray containing the following
  • Spoon
  • A cup
  • A saucer
  • A jug/bottle/sachet of water
  • A pair of scissors
  • Tissue paper/napkin
  • Prescribed pain medication and other adjuvant
  • Pulse oximeter

Procedure steps

  • Practice the five moments of hand hygiene
  • Review patients record to look for information on disease condition and previous pain history
  • Check previous report of pain onset, duration, location, quality and intensity from records or significant other(s)
  • Touch patient and communicate warmth with facial expression if conscious and communicate your intention and expectation as applicable
  • Assess the level of consciousness using the Glasgow coma scale
  • Observe facial expression for grimacing, frowning, extreme sadness, rapid blinking or tearing
  • Observe body movement noting whether patient is relaxed, tense, guarding, pacing or fidgeting. Look out for clenching of the fist, pulled-up knee, rubbing or touching of body parts suggestive of pain
  • Observe if patient is restless, pulling sheets and looks unsettled or agitated
  • Listen for patient sounds such as moaning, groaning, grunting or crying
  • Listen for noisy or observe laboured respiration
  • Inspect patient’s body regionally and look for swellings, scaring, discolouration, lesions, ulceration, atrophy or hypertrophy
  • Asses patient’s response to touch prior to palpating for any areas of tenderness
  • Palpate lymph nodes for swelling, lesions or masses and if present, check for pulsation, and observe patient’s reactions such as guarding, grimacing or groaning.
  • Palpate for tenderness over areas where pain is suspected (conduct a systematic regional palpation if pain is generalised)
  • Check patients pulse noting rhythm, amplitude, equality and rate
  • Percuss for collection of fluid, air or rigidity in regions or structure of tenderness
  • Conduct passive range of motion assessment according to the patient’s activity tolerance level (flexion, abduction, adduction, external and internal rotation) and observe for patient’s responses suggesting pain
  • Assess for increase or decrease in muscle tone as observed with level of resistance during range of motion assessment
  • Check for sensory reaction by pinching patient, pricking with needle and passing cotton wool balls gently over specific spots and observe patient’s response
  • Assess for Achilles, patellar, bicep and triceps reflexes while observing patient’s reaction that suggest decrease or increase pain.
  • Offer pen and paper to patients who are literate to note their pain (onset, duration, location, quality and intensity)
  • Develop pain management goal with the health team and patient family
  • Adopt the most appropriate nonpharmacological intervention that addresses pain
  • Massage areas of pain to facilitate release of endorphins to decrease pain transmission
  • Apply cold compress for 20 to 30 minutes/hour to relieve pain associated with inflammation
  • Use heat application if increasing blood supply to the area of pain will decrease pain reflexes. Do not exceed 20minutes and take precautions to prevent burns or scalds

Precautions

  • Pain assessment is part of vital signs
  • Provide patient and family with adequate information and education on pain management
  • Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
  • Treat each patient as an individual and involve the patient and family in the pain management
  • Employ evidence-based contemporary recommendations for pain management such as:
  • Pre-emptive analgesia (analgesic given before a painful stimulus)
  • Multi-modal analgesia (using two or more forms of analgesic concurrently)
  • Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
  • Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

Open Component Task app