Pain Management

Pain is now seen as the fifth vital sign and needs to be assessed. You will be assigned pain assessment with vitals if you do not get pain managment as a selected AOC,and to be on the safe side I would not ignore a pt complaints of pain even if it is not your AOC, it shows caring to take care of that physiological need. In the very least pain levels should be reported to the primary nurse. The timing depends on the level of pain and pt distress.
My mneumonic is actually dual part memory tool :LAIRD
Here I think of a Scottish underling calling their leige "lord". I certainly would not want my LAIRD in any pain.
L- Level of Pain (PQRST) This is more extensive than the simple number. Look for behaviors especially in a noncommunicative adult or a child like guarding, moaning,curling into a fetal position,clenching hands , restlessness or quivering jaw.
P- Provoking or precipitating factors..what makes it worse?better?does movement make it flare?This gives you an opportunity to understand the pt experience and it may aide you when planning your care
Q- Quality of Pain- Does it shoot? is it sharp? dull? throbbing?
R- Radiation- Does it start in one area and extend to another site?
S- Severity- Use the appropriate scale 0-10 for adults Faces for children
T- Timing- Intermittent, constant ,rare

A- Administers analgesic/Ask primary to medicate. Check the MAR first so you know when the last time your pt was medicated. It is always good practice to ask the pt be med 30 minutes prior to a potentially painful procedure or ambulation, especially if they are post op ortho

I-Intervenes .Only ONE intervention in addition to analgesic is required . Here you would use the information collected in your assessment of pain phase.The pt may already have given you a big hint as to what will work for them.The choices EC gives us are:heat/cold application. This will be assigned along with the method of delivery,time of treatment. Be sure you put a barrier between the heat/cold and the pt.Back massage is always a favorite among people but it can eat up your time so be mindful .Position change have to be done anyways during the PCS and so it is multi tasking.Relaxation/distration can be as easy as putting the TV on or as extensive as guided imagery. be comfortable in whatever you choose.If you are floundering it will be picked up by your pt and be counter productive.

R- Reassess- within 30 minutes of all interventions using the SAME scale.I read of one failing a PCS because the CE thought she used a different scale to reassess.

D- Document -All of the preceding needs to be recorded