Page 112 Complete Your CE Test Online - Click Here FLACC Scale ● ● Face. ● ● Legs. ● ● Activity. ● ● Cry. ● ● Consolability. It requires observation of the child for one to five minutes, at which time the clinician rates the behavior from 0 to 2 based on information given in the scale (Merkel, Voepel-Lewis, & Malviya). The Pain Quality Assessment Scale (PQAS) is a 20-question survey that measures different qualities of pain—dullness, sharpness, piercing, superficial, deep, tenderness, coldness of the pain, numbness, radiating. It asks the patient to quantify the pain on a scale of 0 to 10, with 0 no pain and 10 the most intense pain. It is important to ensure the proper pain scale is used to achieve the most successful treatment of pain and evaluation of pain relief. Tools to aid in assessment are helpful; however, a firsthand description of pain from the patient is optimal. Pain scales can be accessed here: Nursing consideration: For patients unable to verbalize pain, the nurse should be aware of physiological and physical signs and symptoms of pain: • Increased blood pressure. • Increased heart and respiratory rate. • Shallow breathing. • A decrease in oxygen saturation. • Groaning. • Crying. • Frowning. • Guarding of an injured area. • Writhing. Self-assessment question 4 A pain assessment should: a. Be performed every four hours. b. Include a fall risk assessment. c. Use a universal pain scale measurement to ensure consistency throughout the medical institution. d. Include exacerbating and relieving factors. Nursing consideration: Referred pain is a condition in which pain is felt at a site different from where the injured tissue is located (Guyton & Hall, 2006). Nociceptors from different sources converge at the dorsal horn of the spinal cord at the same location, and the brain cannot pinpoint the exact location of the pain, which is usually visceral pain felt as body surface pain (Copstead & Banasik, 2013). Examples of referred pain are jaw pain with myocardial infarction and shoulder pain with pelvic procedures (Copstead & Banasik). When the nurse is assessing pain, she should be aware that pain in certain areas may actually be referred pain. Acute pain Acute pain is caused by injury to tissue that resolves when the injury is healed, typically less than three to six months. Acute pain is an expected physiologic response to noxious stimuli, is usually of sudden onset, is time limited, and can become pathologic (Interagency Pain Research Coordinating Committee [IPRCC], 2015). It is pain that has an endpoint after recovery from injury. Acute pain serves a biological purpose as a protective mechanism to guard against further tissue injury. Headache, abdominal pain, burns, cuts, pain after surgery, labor pains, and dental pain are examples of acute pain . Abdominal pain, chest pain, and headache are among the top reasons patients seek help in emergency rooms (Centers for Disease Control [CDC], 2010). Acute pain can also be recurrent with periods of being pain free, as is the case in some medical conditions, such as migraine, sickle cell disease, and dysmenorrhea (IOM, 2011). This type of pain is known as acute on chronic pain in which there is a flare-up of acute pain of an existing chronic pain condition. In these cases, treatment is aimed at controlling the flare-up of pain. Nursing consideration: Acute pain in the emergency room may be undertreated secondary to fear of masking symptoms, poor communication, a language barrier, lack of documentation and reassessment of pain, and fear of contributing to or causing addiction to pain relievers (Samcam & Papa, 2016). Nurses must ensure that pain is assessed, treated, reassessed, and documented thoroughly. The sympathetic nervous system is stimulated during times of acute pain causing such signs and symptoms as elevated heart and respiratory rate, elevated blood pressure, sweating, pallor, nausea, and vomiting (Copstead & Banasik, 2013). The person experiencing pain may also be anxious or agitated. During acute pain, gastric secretions and blood glucose levels increase. Blood is shifted to the brain, striated muscle, heart, and lungs, and there is a decrease in motility of the gastrointestinal tract and bladder (Copstead & Banasik). EBP alert! In patients experiencing acute abdominal pain, the administration of morphine has been shown to control the pain without compromising the physical signs of acute appendicitis (Yuan, et al., 2010). Despite this information, only 56.8% of nearly 1 million children who received a diagnosis of appendicitis in the ER received any analgesia (Goyal, Kupperman, Cleary, Teach, & Chamberlain, 2015). Self-assessment question 5 Which of the following would most likely NOT be present in the patient experiencing acute pain? a. Tachypnea. b. Tachycardia. c. Bradycardia. d. Nausea. Postsurgical acute pain progression to chronic pain Acute pain secondary to surgery should be managed aggressively, as the intensity of acute pain postoperatively is correlated to the risk of developing chronic pain (Mugabure Bujedo et al., 2015). One in four cases of chronic pain can be attributed to the progression of postsurgical acute pain that evolves into persistent pain (American Pain Society, 2017). Inadequately treated pain in the postoperative period may lead to the development of chronic pain as well as other problems, such as depression, anxiety, and limited coping ability (American Pain Society). Specific surgical procedures carry a greater risk of persistent pain—breast, cardiac, and orthopedic joint replacements (American Pain Society). Nerve injury during surgery can also contribute to the development of chronic pain.