{"id":1040,"date":"2022-09-19T09:06:38","date_gmt":"2022-09-19T13:06:38","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/timing-and-frequency-of-screening-for-and-assessment-of-pain\/"},"modified":"2024-05-03T15:22:24","modified_gmt":"2024-05-03T19:22:24","slug":"timing-and-frequency-of-screening-for-and-assessment-of-pain","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/timing-and-frequency-of-screening-for-and-assessment-of-pain\/","title":{"raw":"Timing and Frequency of Screening for and Assessment of Pain","rendered":"Timing and Frequency of Screening for and Assessment of Pain"},"content":{"raw":"<span style=\"color: #000000\">All clients should be <strong>screened for the presence of pain<\/strong>. If pain is present, then you should <strong>assess the pain<\/strong>.<\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Timing <\/strong>and <strong>frequency<\/strong> of screening for and assessment of pain depends on <strong>several factors<\/strong>. It can be useful to check with the unit\/institution where you work about pain assessment frequency. You should perform routine screening for and assessment of pain at specific times and during certain situations such as:<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Admission<\/strong> to a healthcare setting.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Primary<\/strong> healthcare visit.\u00a0<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Start of shift<\/strong> when first assessing a client.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Change<\/strong> in the client\u2019s condition (e.g., change in vital signs) or other potential physiological or behavioural signs of pain. Oftentimes, pain is assessed with each set of vital signs.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Prior to<\/strong> a procedure or activity to establish a [pb_glossary id=\"1304\"]baseline[\/pb_glossary] (e.g., walking for the first time postoperatively) as well as during and after a procedure or activity.\u00a0<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>After<\/strong> treatment (e.g., after the provision of pain medication such as [pb_glossary id=\"1306\"]analgesics[\/pb_glossary]) and continued reassessment until treatment takes effect. Reassessment is often based on the medication\u2019s onset of action (how long the medication takes to begin taking effect), peak effectiveness (how long it takes for the medication to be at its maximum concentration in the body, thus its greatest therapeutic effect) and duration (length of time that a medication produces a therapeutic effect) (Chippewa Valley Technical College, n.d.). Continued reassessment of pain may be needed so that you can determine whether additional treatment is required.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">When there is a <strong>written order<\/strong> for pain assessment. For example, physicians and nurse practitioners sometimes provide written orders for pain assessments (e.g., pain assessment every four hours or pain assessment every eight hours).<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">Pain assessments are often <strong>repeated to evaluate the effectiveness<\/strong> of treatment and medication. First, you should assess the client\u2019s baseline and review the client\u2019s chart to get a full picture of the client\u2019s pain. The timing of repeat pain assessments will depend on several factors (see<strong> Table 2<\/strong>). Always <strong>compare your findings to the client\u2019s baseline<\/strong>.<\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Table 2:<\/strong> Pain reassessment.<\/span>\r\n<table class=\"grid\" style=\"height: 209px\">\r\n<tbody>\r\n<tr class=\"shaded\" style=\"height: 29px\">\r\n<td style=\"height: 29px;width: 284.988px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Factor<\/strong><\/span><\/td>\r\n<td style=\"height: 29px;width: 564.988px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Consideration<\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 90px\">\r\n<td style=\"width: 284.988px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Time for the medication to take effect.<\/span><\/td>\r\n<td style=\"width: 564.988px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Some over-the-counter oral pain medications can start taking effect in 15\u201330 minutes, but peak effectiveness usually takes one hour and up to two hours. Typically, pain is reassessed between <strong>30\u201360 minutes after oral medication<\/strong> is given.<\/span>\r\n\r\n<span style=\"color: #000000\">Intravenous quick acting opioid pain relievers (e.g., morphine) can take effect within 1\u20132 minutes with peak effects between 5\u201315 minutes. Opioids may have even quicker peak effects, e.g., 2\u20135 minutes for fentanyl (Vahedi et al., 2019).<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 90px\">\r\n<td style=\"width: 284.988px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Specific situation<\/span><\/td>\r\n<td style=\"width: 564.988px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">In acute situations where you are attempting to control the pain quickly with an intravenous medication, you may reassess within <strong>2\u20135 minutes<\/strong>. Additionally, you should assess for adverse effects such as respiratory depression with opioid administration. Do not assume that a client is not in pain because their eyes are closed, or because they are smiling or talking.<\/span>\r\n\r\n<span style=\"color: #000000\">In other situations, a client may be given an oral pain medication at bedtime; thus, you may not reassess until they wake up or in the morning. You might ask the client to ring their call bell if the pain has not subsided in an hour.<\/span><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n<div class=\"textbox shaded\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><span style=\"color: #000000\">Contextualizing Inclusivity<\/span><\/h2>\r\n<span style=\"color: #000000\">Consider forms of pain management other than traditional Western medications when making decisions regarding pain reassessment. For example, <strong>cannabis<\/strong> is now legal in Canada, and prescription of medical cannabis has become more common, particularly for cancer pain and neurological conditions such as multiple sclerosis (Health Canada, 2016). Cannabis may be taken alone or in conjunction with other medications and can be taken through inhalation or oral ingestion (foods\/oils\/capsules). Based on the onset of action (Health Canada, 2016), reassessment may be appropriate within 15 minutes, or within 30 minutes with oral ingestion. As a nurse, you will need to assess the many other forms of pain management that a client may choose to use (e.g., mindfulness meditation, acupuncture, play for children) and assess effectiveness as needed.<\/span>\r\n\r\n<span style=\"color: #000000\">An <strong>open-ended and inclusive question<\/strong> to ask clients is: Tell me about the ways you manage your pain?<\/span>\r\n\r\n<span style=\"color: #000000\">Some Indigenous clients may choose to utilize <strong>traditional medicines<\/strong> instead of, or along with, Western medications. To learn more about treating Indigenous clients using traditional medicines, see<\/span> <a href=\"https:\/\/www.fnha.ca\/about\/news-and-events\/news\/pain-pain-killers-and-indigenous-peoples-choose-the-right-medicine-for-you-in-partnership-with-your-physician\" target=\"_blank\" rel=\"noopener\">Pain, Pain Killers and Indigenous Peoples: Choose the right medicine for you in partnership with your physician<\/a>.\r\n\r\n<\/div>\r\n<h2><span style=\"color: #000000\"><strong>Activity: Check Your Understanding<\/strong><\/span><\/h2>\r\n[h5p id=\"70\"]\r\n<h2><span style=\"color: #000000\">References<\/span><\/h2>\r\n<span style=\"color: #000000\">Chippewa Valley Technical College (n.d.). Nursing pharmacology. <\/span><a href=\"https:\/\/wtcs.pressbooks.pub\/pharmacology\/\" target=\"_blank\" rel=\"noopener\">https:\/\/wtcs.pressbooks.pub\/pharmacology\/<\/a>\r\n\r\n<span style=\"color: #000000\">Health Canada (2016). Consumer information - Cannabis (Marihuana, marijuana). <\/span><a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/licensed-producers\/consumer-information-cannabis.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/licensed-producers\/consumer-information-cannabis.html<\/a>\r\n\r\n<span style=\"color: #000000\">Vahedi, H., Hajebi, H., Vahidi, E., Nejati, A., &amp; Saeedi, M. (2019). Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury. World J Emerg Med, 10(1), 27-32. <\/span><a href=\"https:\/\/doi.org\/10.5847\/wjem.j.1920-8642.2019.01.004\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.5847\/wjem.j.1920-8642.2019.01.004<\/a>","rendered":"<p><span style=\"color: #000000\">All clients should be <strong>screened for the presence of pain<\/strong>. If pain is present, then you should <strong>assess the pain<\/strong>.<\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Timing <\/strong>and <strong>frequency<\/strong> of screening for and assessment of pain depends on <strong>several factors<\/strong>. It can be useful to check with the unit\/institution where you work about pain assessment frequency. You should perform routine screening for and assessment of pain at specific times and during certain situations such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Admission<\/strong> to a healthcare setting.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Primary<\/strong> healthcare visit.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Start of shift<\/strong> when first assessing a client.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Change<\/strong> in the client\u2019s condition (e.g., change in vital signs) or other potential physiological or behavioural signs of pain. Oftentimes, pain is assessed with each set of vital signs.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Prior to<\/strong> a procedure or activity to establish a <button class=\"glossary-term\" aria-describedby=\"1040-1304\">baseline<\/button> (e.g., walking for the first time postoperatively) as well as during and after a procedure or activity.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>After<\/strong> treatment (e.g., after the provision of pain medication such as <button class=\"glossary-term\" aria-describedby=\"1040-1306\">analgesics<\/button>) and continued reassessment until treatment takes effect. Reassessment is often based on the medication\u2019s onset of action (how long the medication takes to begin taking effect), peak effectiveness (how long it takes for the medication to be at its maximum concentration in the body, thus its greatest therapeutic effect) and duration (length of time that a medication produces a therapeutic effect) (Chippewa Valley Technical College, n.d.). Continued reassessment of pain may be needed so that you can determine whether additional treatment is required.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">When there is a <strong>written order<\/strong> for pain assessment. For example, physicians and nurse practitioners sometimes provide written orders for pain assessments (e.g., pain assessment every four hours or pain assessment every eight hours).<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">Pain assessments are often <strong>repeated to evaluate the effectiveness<\/strong> of treatment and medication. First, you should assess the client\u2019s baseline and review the client\u2019s chart to get a full picture of the client\u2019s pain. The timing of repeat pain assessments will depend on several factors (see<strong> Table 2<\/strong>). Always <strong>compare your findings to the client\u2019s baseline<\/strong>.<\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Table 2:<\/strong> Pain reassessment.<\/span><\/p>\n<table class=\"grid\" style=\"height: 209px\">\n<tbody>\n<tr class=\"shaded\" style=\"height: 29px\">\n<td style=\"height: 29px;width: 284.988px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Factor<\/strong><\/span><\/td>\n<td style=\"height: 29px;width: 564.988px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Consideration<\/strong><\/span><\/td>\n<\/tr>\n<tr style=\"height: 90px\">\n<td style=\"width: 284.988px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Time for the medication to take effect.<\/span><\/td>\n<td style=\"width: 564.988px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Some over-the-counter oral pain medications can start taking effect in 15\u201330 minutes, but peak effectiveness usually takes one hour and up to two hours. Typically, pain is reassessed between <strong>30\u201360 minutes after oral medication<\/strong> is given.<\/span><\/p>\n<p><span style=\"color: #000000\">Intravenous quick acting opioid pain relievers (e.g., morphine) can take effect within 1\u20132 minutes with peak effects between 5\u201315 minutes. Opioids may have even quicker peak effects, e.g., 2\u20135 minutes for fentanyl (Vahedi et al., 2019).<\/span><\/td>\n<\/tr>\n<tr style=\"height: 90px\">\n<td style=\"width: 284.988px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Specific situation<\/span><\/td>\n<td style=\"width: 564.988px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">In acute situations where you are attempting to control the pain quickly with an intravenous medication, you may reassess within <strong>2\u20135 minutes<\/strong>. Additionally, you should assess for adverse effects such as respiratory depression with opioid administration. Do not assume that a client is not in pain because their eyes are closed, or because they are smiling or talking.<\/span><\/p>\n<p><span style=\"color: #000000\">In other situations, a client may be given an oral pain medication at bedtime; thus, you may not reassess until they wake up or in the morning. You might ask the client to ring their call bell if the pain has not subsided in an hour.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<div class=\"textbox shaded\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><span style=\"color: #000000\">Contextualizing Inclusivity<\/span><\/h2>\n<p><span style=\"color: #000000\">Consider forms of pain management other than traditional Western medications when making decisions regarding pain reassessment. For example, <strong>cannabis<\/strong> is now legal in Canada, and prescription of medical cannabis has become more common, particularly for cancer pain and neurological conditions such as multiple sclerosis (Health Canada, 2016). Cannabis may be taken alone or in conjunction with other medications and can be taken through inhalation or oral ingestion (foods\/oils\/capsules). Based on the onset of action (Health Canada, 2016), reassessment may be appropriate within 15 minutes, or within 30 minutes with oral ingestion. As a nurse, you will need to assess the many other forms of pain management that a client may choose to use (e.g., mindfulness meditation, acupuncture, play for children) and assess effectiveness as needed.<\/span><\/p>\n<p><span style=\"color: #000000\">An <strong>open-ended and inclusive question<\/strong> to ask clients is: Tell me about the ways you manage your pain?<\/span><\/p>\n<p><span style=\"color: #000000\">Some Indigenous clients may choose to utilize <strong>traditional medicines<\/strong> instead of, or along with, Western medications. To learn more about treating Indigenous clients using traditional medicines, see<\/span> <a href=\"https:\/\/www.fnha.ca\/about\/news-and-events\/news\/pain-pain-killers-and-indigenous-peoples-choose-the-right-medicine-for-you-in-partnership-with-your-physician\" target=\"_blank\" rel=\"noopener\">Pain, Pain Killers and Indigenous Peoples: Choose the right medicine for you in partnership with your physician<\/a>.<\/p>\n<\/div>\n<h2><span style=\"color: #000000\"><strong>Activity: Check Your Understanding<\/strong><\/span><\/h2>\n<div id=\"h5p-70\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-70\" class=\"h5p-iframe\" data-content-id=\"70\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Pain Chapter: Frequency and Assessment of Pain\"><\/iframe><\/div>\n<\/div>\n<h2><span style=\"color: #000000\">References<\/span><\/h2>\n<p><span style=\"color: #000000\">Chippewa Valley Technical College (n.d.). Nursing pharmacology. <\/span><a href=\"https:\/\/wtcs.pressbooks.pub\/pharmacology\/\" target=\"_blank\" rel=\"noopener\">https:\/\/wtcs.pressbooks.pub\/pharmacology\/<\/a><\/p>\n<p><span style=\"color: #000000\">Health Canada (2016). Consumer information &#8211; Cannabis (Marihuana, marijuana). <\/span><a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/licensed-producers\/consumer-information-cannabis.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/licensed-producers\/consumer-information-cannabis.html<\/a><\/p>\n<p><span style=\"color: #000000\">Vahedi, H., Hajebi, H., Vahidi, E., Nejati, A., &amp; Saeedi, M. (2019). Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury. World J Emerg Med, 10(1), 27-32. <\/span><a href=\"https:\/\/doi.org\/10.5847\/wjem.j.1920-8642.2019.01.004\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.5847\/wjem.j.1920-8642.2019.01.004<\/a><\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"1040-1304\" hidden><p>refers to a starting point before any intervention.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"1040-1306\" hidden><p>are medication to relieve pain such as acetaminophen or ibuprofen (commonly known as Tylenol and Advil)<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":8,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[85],"license":[56],"class_list":["post-1040","chapter","type-chapter","status-publish","hentry","contributor-january-2023","license-cc-by-nc"],"part":1022,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1040","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":3,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1040\/revisions"}],"predecessor-version":[{"id":1547,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1040\/revisions\/1547"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/1022"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1040\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=1040"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=1040"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=1040"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=1040"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}