Health professionals can help clients create an organization system for medications and an accurate list of medications to improve communication with healthcare providers. Often, older clients may be seeing a variety of specialists who are not always
aware of what the other healthcare providers have prescribed. An attentive practitioner can sometimes help mitigate polypharmacy for these clients.
PAIN ASSESSMENT
Unfortunately, there is no laboratory test for pain, and accurate pain assessment is difficult. The most important facets of pain management are serial assessments and the use of good communication skills. Remember that pain is whatever and whenever the client says it is. The attitude of the health professional goes a long way in allowing clients to fully and honestly talk about their pain. Pain scales Many scales are available to help clients describe and locate their pain. Several are 0 to 10 ranking scales, with 0 being no pain, 1 being the least amount of pain, and 10 being unbearable
The first step in assessing pain is to obtain a description from the client of what his or her pain is and what it does. A pain assessment includes a numeric pain rating (0 = no pain, 10 = worst pain), pain characteristics, duration, location(s), pattern, and what makes the pain better or worse.
pain (Figure 2). Even children who are seven or eight years old should have little difficulty using these numeric scales.
Figure 2: Numeric Rating Scale
Note . From Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Academic Emergency Medicine, 17( 1), 50-54. doi:10.1111/j.1553-2712.2009.00620.x.
The Wong-Baker FACES Pain Rating Scale (Figure 3) is a series of images showing a range of facial expressions, from a happy smile to a grimace with tears. This scale may be used with
children to rate pain severity and has been validated outside the emergency department, mostly for chronic pain (Garra et al., 2010).
Figure 3: Wong-Baker FACES Pain Rating Scale
The Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Assessment Scale (Figure 4) measures distress through observation of infants, children, and adults by objectively
assessing facial expression, body movements, or behavior on a standard scale.
Figure 4: FLACC Behavioral Pain Assessment Scale
Categories
0
1
2
Face
No particular expression or smile.
Occasional grimace or frown, withdrawn, disoriented.
Frequent to constant frown, quivering chin, clenched jaw.
Legs
Normal position or relaxed.
Uneasy, restless, tense.
Kicking or legs drawn up.
Activity
Lying quietly, normal position, moves easily.
Squirming, shifting back and forth, tense. Moans or whimpers, occasional complaint. Reassured by occasional touching, hugging, or being talked to, distractible.
Arched, rigid, or jerking.
Cry
No cry (awake or asleep).
Crying steadily, screams or sobs, frequent complaints.
Consolability
Content, relaxed.
Difficult to console or comfort.
Note . From Merkel, S. I., Voepel-Lewis, T., Shayevitz, J. R., & Malviya, S. (1997). The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23 (3), 293-297, p. 293. Copyright 2002, The Regents of the University of Michigan. Used with permission.
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