1. Nursing Assistant Monthly Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012 PAIN The fifth vital sign

2. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign The purpose of pain  Pain is an important survival tool –Warns of a possible threat to health and well-being –Causes us to seek and remove its cause –Without pain signals, even a minor injury could lead to illness or perhaps death  Pain can also work against us

3. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign Types of pain  Acute –Usually comes on rapidly –Time limited –Examples: post-operative pain, a finger cut, tension headache  Chronic –Does not get better with time –Examples: cancer pain, arthritis pain, pain from nerve damage

4. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign Our experience of pain depends on  Past experience with pain  Physical health  Emotional health  Messages/beliefs we learned about pain For example: –“complaining about pain is a sign of weakness” –“pain is punishment for our wrongdoings”

5. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign Untreated or undertreated pain  A common problem in nursing homes –Older adults tend to have conditions that cause pain (arthritis, cancer, diabetes-related circulation problems) –Non-verbal residents may not be able to report their pain to caregivers –Behaviors due to pain may be misinterpreted by staff  Untreated or undertreated pain affects life quality –May impair ability to perform ADLs –Leads to isolation, withdrawal from activities that were once enjoyable

6. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign Pain and dementia  Many residents with dementia cannot report their pain  Behavior is a sign of an unmet need and may mean “I’m hurting!”  Observe behavior, especially watch for CHANGES –Wandering, restlessness, agitation –Angry outbursts –Resisting care (because it hurts!)

7. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign Your role as caregiver  Learn the signs of pain such as: –Restlessness, crying, guarding a body part –Withdrawn, sad, unable to sleep –Change of behavior  Report any signs of pain to the nurse  Follow up to be sure the resident’s needs were addressed

8. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign Comfort measures for pain  Medications are only part of the answer  CNAs can help in other ways, such as: –Proper positioning, frequent position changes –Offering: A soothing warm bath, cup of herbal tea Gentle range of motion Backrub for relaxation To play calming music the resident enjoys

9. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. April 2012Pain: the fifth vital sign Involve the resident and family For residents with chronic pain  If possible, ask the resident what usually helps his or her pain  Ask the family members if they know what helped the resident’s pain in the past  Let the nurse know what you learn