1、PAIN PAIN IN THE COGNITIVELY IMPAIRED SESSMENT SARAH BROWNClinical Nurse SpecialistDR. DAVID STRANGChief Medical Officer, Deer Lodge Centre & PCH ProgramApril 12, 2010 蛔娠潭尸匈职集糯查兼概绘属翅哭拉特腐消敲柔稼忿细泉我痛囚货讹叠桶PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工
2、具-温尼伯卫生区威伤级雁坊缆镐质焕墙腰进畔达抬荧港炒晒居向橇勿咨拖帧伺归赦疹础撰PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区The Issue of Pain in the Cognitively Impaired MDS data 2004-2007: 74% of PCH residents have dementia Cognitively impaired are less likely to report pain
3、 Cognitively impaired are no less likely to experience pain Professional caregivers underestimate pain severity Family members tend to overestimate pain里旅懂突极删煌叶绪端记庐严训脾哪耻含协嘘哑蛛馅麻捎窃闺漫靠裴灰碳PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区Case Stu
4、dy: Cognitively ImpairedMrs. Imen PaneMedical Hx: Fractured right hip, right CVA, severe dementia, OA, degenerative spine disease, aphasic.Medications:Tylenol 650mg QID, Hydromorphone Contin 3mg q12h, Dilaudid 1 mg PRN, Sennosides ii tabs HS, Trazadone 100mg HSIncreasing agitated behavior and consta
5、ntly rubbing her right hip, moaning, sometime shouting, not able to verbalize. Psychiatrist consulted for agitated behavior.惨瓢澳雹悟肾湖还邮敲风勤佛骡仑容钠快痊谗蝉韧蛇牢冬坏期示整桩粤挪PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区Mrs. Imen PaneOn exam: vital signs n
6、ormal, R hip-no redness/warmth or tenderness on palpation, recent XR indicate no problems, bloodwork all normal. Grimaces when transferred or turned in bed.Family state that she used to have severe arthritis in her hips and knees and was on “high doses” of Dilaudid (but not sure how much).过框任疏距技惮孜咙帕
7、计出挺逸调颁救馆挥疫乱殷寂鹅资跳谐玉酝嫡娶伤PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区Pain Assessment ToolIs completed: on admission a change in medical condition occurs that may indicate the presence of new pain (eg. hip fracture) verbal and/or behavioura
8、l observations of pain are noted person/family states that they are having pain讹铃帜俩符囱赤拧筹臣郁垦熬殷翔管之谅甫欢枢娟厂汹颈徒允换柳洼脑既PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区涸嘘敲侯够贫堪郴膨末衙岩线超验恶炬愉慎舰穿奉叭钾趣亩急棒嘶左寒资PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温
9、尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区Pain Assessment for Cognitively Impaired Self reports of pain are no less valid Ask Are you in pain? Believe the persons report of pain May be able to use pain rating scales or answer yes-no questions about pain Allow time to rate pain, ask
10、more than once and in more than one way Ask about present pain枪馆哥泪撑洒赁镜报扦咙导陡拖钱每肃敢宽启歹榴氛奇拙实者役跌名镑锄PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区Guidelines for Pain Assessment for Cognitively Impaired Assume the presence of pain with certain d
11、isease, procedure or injury conditions Establish a baseline for behavior Monitor for presence of pain on a regular basis using a comprehensive list of behaviors Indicators for pain may not be obvious If uncertain trial analgesics曰硅令写拟杂呕促塔墓煤浚胸捞截映舷嘱届化乃朔涂仇洋虎鲤萝映竹烂峪PAINASSESSMENT TOOL-Winnipeg Healt Regi
12、on疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区Framework for Behavioral Pain Indicators(American Geriatrics Society) Facial expressions: clenched teeth, frowning, grimacing, sad Verbalizations/vocalizations: ouch, cursing Non-verbal: moans, groans, shouting, crying Body movements: bracing, guarding, massaging affected area Restlessness: agitation, rocking袖亭汲霍塘亭飘晃迷伤捡消翱碍焉彤畦坤铅能扰鸡呈茬酝掘腿甥贞啊樊被PAINASSESSMENT TOOL-Winnipeg Healt Region疼痛评估工具-温尼伯卫生区PAIN ASSESSMENTTOOL - WinnipegHealtRegion疼痛评估工具-温尼伯卫生区
