Assessing Pain In Nursing

Sample Solution

     

Assessing Pain in a 72-Year-Old Patient with Osteoarthritis

Scenario:

I am an Advanced Nurse Practitioner (ANP) and I am seeing a 72-year-old female patient named Mrs. Jones in my clinic. She reports increasing pain in her right knee for the past six months, worsening with activity and alleviating somewhat with rest and ice. She describes the pain as a dull ache, sometimes sharp with sudden movements.

Assessing Pain:

1. PQRST: I will use the PQRST pain assessment tool to gather a comprehensive picture of her pain:

   • P - Provocation: Ask what activities worsen or trigger the pain (e.g., walking, stairs), and what alleviates it (e.g., rest, ice).
   • Q - Quality: Describe the pain characteristics (e.g., dull ache, sharp, burning).
   • R - Region: Identify the location and radiation of the pain (e.g., right knee, radiating to thigh).
   • S - Severity: Use a validated pain scale to rate the intensity (e.g., 0-10 Numeric Rating Scale, Wong-Baker Faces Pain Scale).
   • T - Time: Ask about the onset, duration, and frequency of the pain (e.g., constant, intermittent, worse in the morning).

Full Answer Section

       

1. Age-Specific Considerations: Older adults may have difficulty expressing their pain or may underreport it due to fear of medication side effects or being seen as a burden. I will use open-ended questions, be patient, and offer reassurance to encourage honest communication.
2. Condition-Specific Considerations: Osteoarthritis is a common cause of knee pain in older adults. I will assess for joint stiffness, swelling, and limitations in range of motion.
3. Treatment-Related Considerations: Depending on Mrs. Jones's pain severity and individual factors, I will consider various evidence-based treatment options, such as:
   • Non-pharmacological interventions: Weight management, exercise therapy, physical therapy, heat/cold therapy, and patient education.
   • Pharmacological interventions: Topical pain relievers, oral nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or opioids (as a last resort and with caution due to potential side effects in older adults).

Pain Scale Selection: For Mrs. Jones, I would likely use the Numeric Rating Scale (NRS) due to its simplicity and effectiveness in older adults. The NRS uses a 0-10 scale with descriptors at each point (e.g., 0 = no pain, 10 = worst pain imaginable). Evidence-Based Approach: The American Academy of Orthopaedic Surgeons (AAOS) recommends a non-pharmacological approach as the first line of treatment for osteoarthritis knee pain. This includes weight management, exercise therapy, and patient education. Pharmacological interventions are only considered if non-pharmacological measures are inadequate. I will monitor Mrs. Jones's pain closely and adjust the treatment plan as needed. Regular follow-up appointments are crucial to ensure optimal pain management and prevent complications. This scenario demonstrates how a comprehensive pain assessment, considering age, condition, and evidence-based treatment options, is essential for effective pain management in older adults.