Reply to classmates post , at least 125 words for each and 1 scholarly reference for each within last 5 years
The patient’s self-report remains the gold standard for pain assessment. Obtaining a patient’s self-report should be validated, if the patient is in pain ten out of ten even if it is unrelated to the diagnosis, it should be treated. More than 50% have significant pain during procedures or routine care (e.g. turning, repositioning, headache.) Even a dressing change can cause pain. Untreated pain can result in negative consequences such as tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea and the development of chronic pain (Critical Care Nurses, 2018.)
Proper assessment include:
Attempt to obtain the patient’s self-report of pain using validated pain assessment tools or simple questions.
Assess and document pain using appropriate and validated tools such as numerical rating scales
Teach patients to use self-report pain scales and communicate in verbal and nonverbal ways, such as numerical and faces rating scales, pointing, and head nodding.
Perform and document pain assessments routinely, including a baseline evaluation at the beginning of shifts, evaluations during activities or procedures known to be painful, and before and after administration of analgesics
Communicate pain assessment findings during patient handoffs.
Assess and document pain for critically ill adults who are unable to self-report, using a validated behavioral pain scale
Use changes in vital signs as cues (ie, tachycardia/bradycardia, hypertension/ hypotension, desaturation, and bradypnea) that the patient might be having pain and assess using validated pain tools
Consider asking someone who knows the patient well to identify behaviors that may indicate pain
Complaints of chest pain or chest discomfort raise concerns about the heart; however, other structures need to be assessed such as the thorax and lungs. To assess this symptom, you must pursue a dual investigation of both thoracic and cardiac causes.
Sources of Chest Pain and Related Causes include:
The myocardium- Angina pectoris, myocardial infarction, myocarditis
The pericardium- Pericarditis
The aorta- Aortic dissection
The trachea and large bronchi- Bronchitis
The parietal pleura- Pericarditis, pneumonia, pneumothorax, pleural eﬀusion, pulmonary embolus
The chest wall, including the musculoskeletal and neurologic systems- Costochondritis, herpes zoster
The esophagus- Gastroesophageal reﬂux disease, esophageal spasm, esophageal tear
Extra-thoracic structures such as the neck, gallbladder, and stomach- Cervical arthritis, biliary colic, gastritis
Initial questions should be as open-ended as possible such as:
Do you have any discomfort or unpleasant feelings in your chest?
Where is the pain located?
Do you have history of panic and anxiety disorders?
Does the pain occur with climbing stairs?
How many ﬂights? How many steps?
How about with walking—50 feet, one block, more?
What about carrying groceries, making beds, or vacuuming?
How does this compare with these activities in the past?
When did the symptoms appear or change?
How intense is the pain, on a scale of 1 to 10?
Does it radiate into the neck, shoulder, back, or down your arm?
Are there any associated symptoms like shortness of breath, sweating, palpitations, or nausea?
Does it ever wake you up at night?
What do you do to make it better?
Have you had any swelling anywhere?
When does it occur? Is it worse in the morning or at night?
Do your shoes get tight?
For chest symptoms, the clinician requires to be as systematic as possible through the range of possible cardiac, pulmonary, and extra-thoracic etiologies. Chest pain, dyspnea, wheezing, cough, and even hemoptysis can be cardiac as well as pulmonary in origin. A clenched fist over the sternum suggests angina pectoris; a finger pointing to a tender spot on the chest wall suggests musculoskeletal pain; a hand moving from the neck to the epigastrium suggests heartburn. Chest pain is reported in one in four patients with panic, anxiety and hyperthyroid disorders-manifestations include chest pain, diaphoresis, and palpitations.
For more information on Pulmonary Embolus read this:https://en.wikipedia.org/wiki/Pulmonary_embolism#:~:text=Pulmonary%20embolism%20(PE)%20is%20a,in%2C%20and%20coughing%20up%20blood.
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