Pain

Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. It is shaped by biological, psychological, and social factors, so the same injury can produce very different experiences in different people. Pain and nociception are not synonymous: activity in sensory neurons does not prove that a person is or is not in pain. The first assessment decision is whether the client can communicate a reliable self-report. If so, the report is the reference standard for pain intensity; a normal heart rate or a calm appearance does not overrule it. If self-report is not currently possible, the nurse does not simply assume that pain is absent. The nurse attempts communication, looks for a painful disease process or procedure, observes behavior with a validated tool, asks caregivers about the client's usual pain behaviors, and may evaluate response to a carefully ordered analgesic trial. Tool selection must match the population in which the instrument was validated. The Numeric Rating Scale is appropriate for many communicative adults and older children. The Faces Pain Scale–Revised...