- Initial Pain Assessment Tool Patient S Name Diagnosis Date Room Age Physician Nurse 1 Location Patient Or Nurse Mark D 1 (116.83 KiB) Viewed 34 times
Initial Pain Assessment Tool Patient's Name Diagnosis Date Room Age Physician Nurse 1. LOCATION. Patient or nurse mark drawing Right . Lot Lot Le Right RIGHT Righ Le Lo Riga 2. INTENSITY Patient rates the pain. Scale used Present pain: Worst pain gets: Best pain gets Comfort-Function goal: 3. IS THIS PAIN CONSTANT? YES NO IF NOT, HOW OFTEN DOES IT OCCUR? QUALITY. (For example: ache, deep, sharp, hot, cold, like sensitive skin, sharp, itchy) 5. ONSET, DURATION, VARIATIONS, RHYTHMS: 6. MANNER OF EXPRESSING PAIN: 7. WHAT RELIEVES THE PAIN? 8. WHAT CAUSES OR INCREASES THE PAIN? 9. EFFECTS OF PAIN (Note decreased function decreased quality of life.) Accompanying symptoms (eg nausea) Sleep Appetite Physical activity Relationship with others (e.g. irritability) Emotions (eg. anger. suicidal crying) Concentration Other 10 OTHER COMMENTS 11. PLAN