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Andrew Pollack-Gray

Nursing Notes

Pain Assessment

3 min read

What Am I Assessing?

Recognize and report pain that may affect a resident’s comfort, mobility, sleep, and daily activities.
Pain is subjective: The resident’s self-report is the primary source of information when they can communicate reliably.
Types of Pain:

  • Acute: Recent onset, often associated with injury or illness.
  • Chronic: Persistent or recurring pain, commonly lasting longer than 3 months.

What Should I Look For?

Resident-Reported Pain

Ask questions appropriate to the resident’s communication abilities:

  • Location: Where does it hurt?
  • Intensity: How much does it hurt?
  • Quality: Is it sharp, dull, aching, burning, or throbbing?
  • Timing: When did it start? Is it constant or intermittent?
  • Triggers: What makes it better or worse?
  • Impact: Does it interfere with moving, sleeping, or eating?

Pain Scale

Numeric Rating Scale (0–10):

  • 0: No pain.
  • 10: Worst pain imaginable.
  • Ask the resident to choose the number that best describes their pain.
  • Use the communication method or pain scale specified in the care plan.

Nonverbal Signs

  • Facial grimacing or frowning.
  • Guarding or protecting an area.
  • Crying, moaning, or restlessness.
  • Withdrawal from activities.
  • Changes in movement or appetite.
  • New agitation or resistance during care.
    Important: Behavioral signs can indicate discomfort but do not establish its cause. Absence of visible distress does not mean absence of pain.

What Could It Mean?

Pain may be associated with:

  • Injury or illness.
  • Pressure injuries or skin breakdown.
  • Immobility or poor positioning.
  • Infection or inflammation.
  • Other underlying conditions.
    New, severe, or worsening pain may require urgent nursing evaluation.

What Should I Do?

  1. Ask about pain before activities that may worsen discomfort.
  2. Observe verbal and nonverbal responses during care.
  3. Stop or modify activities that cause unexpected pain when safe.
  4. Help with approved comfort measures, such as repositioning.
  5. Report new, worsening, or uncontrolled pain to the nurse promptly.
  6. Document observations and the resident’s statements according to facility policy.
  7. Observe and report the response to prescribed comfort measures.
    Urgent Reporting:
  • Sudden severe pain.
  • Chest pain or pressure.
  • Severe abdominal pain.
  • Pain accompanied by breathing difficulty, fainting, or sudden neurological changes.

Sources

  • CNA clinical observations and reporting principles
  • MedlinePlus — Pain
  • Facility pain-assessment and reporting procedures

Flashcards

Whose report is the primary source for pain intensity when communication is reliable?03-application / assessment
Answer

The resident's own report.

What does 0 mean on the numeric pain scale?01-foundations / assessment
Answer

No pain.

Name three nonverbal pain cues.01-foundations / assessment
Answer

Grimacing, guarding, and moaning or restlessness.

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