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Nursing lessons / Pain assessment / Intermediate

Fill the gaps in the sentences using these words from the text.
______________________ is the amount of time something lasts.
A pain is ______________________ when you cannot bear it.
A description is ______________________ when it is based on the individuals experience or perceptions.
A patient who is ______________________ is able to explain things very well.
The ______________________ of a pain is when it begins.
A pain ______________________ when it spreads out from a central point.
The ______________________ of a pain describes the degree to which the patient feels it.
In order to ______________________ a patients pain, a nurse needs to know its characteristics.
Being ______________________ means relying on facts, rather than personal beliefs or feelings.
______________________ on part of the body is when it is sore or uncomfortable to touch.
Think about how you describe pain in your own language. What sort of words and expressions do
you use?
subjective
intensity
duration
evaluate
objective
articulate
onset
radiates
excruciating
tenderness
NursiNg lessoNs WorksheeT
Pain assessment
Worksheet: Intermediate
Pre-reading
A key words
B
Pain assessment
Assessing pain can be complicated as the physical and physiological
aspects of the patient all need to be considered. Because the experience
of pain is very subjective, the nurse needs to be able to use some
objective criteria to evaluate the location, nature and intensity of the pain
so a diagnosis can be made. One of the most widely accepted definitions
of pain was put forward by McCaffery (1979, p.18), who suggests that
pain is whatever the experiencing person says it is and exists whenever
he says it does.
Assessments of the patients pain experience
When identifying the characteristics of the patients pain it is essential the nurse considers
the following:
The type of pain
: is it crampy, stabbing, sharp? The patients description of the pain may help
in diagnosing its cause. Myocardial (heart) pain is often described as stabbing, but liver pain as
cramping or aching.
Its intensity
: is it mild, severe or excruciating? This can be described by using a pain
assessment scale. The nurse asks the patients to rate the pain on a scale of 0 to 10; zero
being no pain and 10 being excruciating pain. With children, a range of pictures showing a child
changing from happy to sad can be used. Colour charts with a series of colours from black
through grey to yellow and orange can be used, especially with patients who have difficulty
grasping numbers or articulating exactly what their pain is like.
The onset
: was it sudden or gradual? Find out when it started and in what circumstances. What
makes it worse? What makes it better? What was the patient doing immediately before
it happened?
Its duration

: is it persistent, constant or intermittent?


Its location
: ask the patient to be as specific as possible, for example, indicating the site
by pointing.
Changes in the site
: there may be tenderness, swelling, discolouration, firmness or rigidity. With
appendicitis, a classic sign is the movement of pain to the right and downwards. In a myocardial
infarction (a heart attack), pain classically radiates down the arm, and with liver pain it can
radiate to the shoulder.
Any associated symptoms
: Some of the common symptoms of disease that can influence the
response to pain are anorexia, constipation, cough, inflammation, anxiety and fear, dryness of
the mouth.
Signs such as redness, swelling or heat.
read the text below and write
T (true) or F (false) next to each of the statements.
Assessing pain is a straightforward process.
Pain is an objective experience.
It is important for a nurse to use objective criteria to measure the level of pain.
Colour mood charts are only useful for children.
The first step for a nurse is to identify characteristics of the patients pain.
1.
2.
3.
4.
5.
1a.
on the line below there are some words which describe the effect of pain on a patient. group the words in the word
wheels under the appropriate headings.
1b. Match the following expressions of duration with the equivalent phrase.
2.
s
ome words which describe pain also have a more general meaning in
e
nglish. Match the adjectives to
the pictures.
dull
excruciating
intense
intolerable
stabbing mild
tolerable
constant
not often
frequent
all the time
intermittent
keeps coming back
persistent
often
infrequent
from time to time
shooting
gnawing
stabbing
burning
stinging
1
2
3
4
5

Nursi
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g lesso
N
s
W
orkshee
T
Pain assessment
by Marie McCullagh &
r
os Wright
Worksheet: Intermediate
Comprehension check
C
Vocabulary development
D
bearable
________________
________________
________________
unbearable
________________
________________
________________
________________
1b. Match the following expressions of duration with the equivalent phrase.
2.
s
ome words which describe pain also have a more general meaning in
e
nglish. Match the adjectives to
the pictures.
dull
excruciating
intense
intolerable
stabbing mild
tolerable
constant
not often
frequent
all the time
intermittent
keeps coming back
persistent
often
infrequent
from time to tim
Nursing lessons / Pain assessment / Intermediate

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r
ead the text below and write
T
(true) or
F
(false) next to each of the statements.
Assessing pain is a strai

ghtforward process.
Pain is an objective experience.
It is important for a nurse to use objective criteria to measure the level of pain.
Colour mood charts are only useful for children.
The first step for a nurse is to identify characteristics of the patient
s pain.
1.
2.
3.
4.
5.
1a.
o
n the line below there are some words which describe the effect of pain on a patient.
g
roup the
words in the word wheels under the appropriate headings.
1b. Match the following expressions of duration with the equivalent phrase.
2.
s
ome words which describe pain also have a more general meaning in
e
nglish. Match the adjectives to
the pictures.
dull
excruciating
intense
intolerable
stabbing mild
tolerable
constant
not often
frequent
all the time
intermittent
keeps coming back
persistent
often
infrequent
from time to time
shooting
gnawing
stabbing
burning
stinging

E. Discussion
Can you see any similarities and differences between the description of pain in your own language and descriptions in
english you have seen here?
F use a search engine or a reference book to look up the symptoms of the following conditions. Make a note
of the kind of pain associated with each of them. keep a record of where you have found the information.

Heart attack (Myocardial Infarction)

Cystitis

Migraine

Pleurisy
Nursing lessons / Pain assessment / Intermediate

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Mrs Miller has come to see her local nurse about the recent headaches shes
been having.

Transcript
Mrs Miller:
I seem to be getting a lot more migraines recently.
Nurse:
Right. When you say migraines, do you mean you get bad
headaches or do you mean a doctor has diagnosed you as suffering
from migraines?
Mrs Miller:
I get very bad headaches. But I know what the symptoms of migraine
are and I get a lot of them.
Nurse:
So what youre saying is that its different to bad headaches?
Mrs Miller:
Yes.
Nurse:
So, what happens when you get a migraine?
Mrs Miller:
Well, it usually starts off with me feeling slightly off when I wake up in the
morning. Im very
sensitive to strong smells and bright lights. Then, as the day goes on, the
headache develops.
Nurse:
How would you describe the pain?
Mrs Miller:
At first its pretty mild, like a scraping pain over my left eye and I get a pain in
my neck also.
Nurse:
Is that on the left side also?
Mrs Miller:
Yes. Its a really tight pain, like my neck is being gripped. After a while the pain
over my left
eye gets more and more intense and its very persistent.
Nurse:
So, it starts off as a scraping pain over your left eye, extends down your neck
and gets more
intense after a while?
Mrs Miller:
Yes.
Nurse:
How long does it last?
Mrs Miller:
Well, if I catch it in time, about 12 hours, but sometimes they can last for at
least three days if
I dont.
Nurse:
What do you mean
catch it in time

?
Mrs Miller:
Well, I take some very strong pain killers and they seem to stop it from getting
worse. But only
if I take them very early on. The only thing is that they tend to make me feel
quite drowsy.
Nurse:
Are the painkillers on prescription?
Mrs Miller:
No. They are tablets that the pharmacist recommended.
Nurse:
And how often do you get these pains?
Mrs Miller:
Practically every week at the moment.
Nurse:
They must be really difficult to cope with.
Mrs Miller:
Yes, they really get me down.
Nurse:
When did you start getting them?
Mrs Miller:
They started about five years ago, but at first I just got the odd one.
Nursing lessons / Pain assessment / Intermediate

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Nurse:
Do you have any idea what triggers them?
Mrs Miller:
Not really. Ive been keeping a record but I cant pinpoint what sets them off.
Nurse:
Well, as you probably know, there are different triggers for migraine: dietary,
environmental
and behavioural. In terms of food, the main culprits are wine, chocolate, cheese
as well as
coffee, so maybe you need to look at whether that might be a factor.
Also strong smells and bright lights can set it off, as you seem to be
experiencing.
Mrs Miller:
They definitely can trigger it.
Nurse:
And you might want to think about any changes in your day-to-day routine,
such as getting
less sleep or working more. These can cause stress, which can also be a factor
in bringing it
on. Ill give you a leaflet on techniques to help you relax and also a leaflet on
migraine which
tells you which foods to avoid.
Mrs Miller:
Thanks. That sounds useful.

Note taking

c
olloquial language

feeling slightly off


pretty mild
to feel quite drowsy
to pinpoint
the odd one
set it off
bring it on
get me down
1.
2.
3.
4.
5.
6.
7.
8.
to make one miserable
not being your usual self
to trigger
to be sleepy
not intense
cause
occasional
to identify
a.
b.
c.
d.
e.
f.
g.
h.
a
s you listen, write
T
(true) or
F
(false) next to the statements below.
The headaches tend to start in the evening.
The patient is very sensitive to strong smells and bright lights.
The patient also gets a pain in her shoulders.
The headaches always last up to 12 hours.
The painkillers are non-prescription drugs.
The patient is able to identify the cause of the migraines.
l

isten to the dialogue again and make notes under the following headings.
The nurse uses two types of questions in the dialogue, closed and open.
c
losed questions restrict the
possible answers that can be given.
o
pen questions allow any answer to be given.
l
ook at the two
examples below and decide which is the open and which is the closed question.
1 Nurse:
So what youre saying is that its different to bad headaches?
2 Nurse:
So, what happens when you get a migraine?
Listen to the dialogue again and try to find more examples of open and closed
questions. Use the
transcript to check your answers and to identify any others.
1.
a.
b.
c.
d.
e.
f.
2.
3.

Nursi
N
g lesso
N
s
W
or
K

s
H
ee
T

p
ain assessment
by Marie Mc
c
ullagh &
r
os Wright

Podcast: Intermediate

c
haracteristics
Notes
Type of pain
Intensity
Onset (starts, first started, possible triggers)
Duration
Location
1. The patient uses a number of colloquial expressions. Match the phrases to
the definition.

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Nursing lessons / Pain assessment / Intermediate


Macmillan Publishers Ltd 2008

i
n each of the sentences below the nurse is trying to achieve one of the
following objectives:
confirm what the patient is saying
clarify what the patient is saying
summarise what the patient is saying
Match the objective with the sentence.
Nurse: What do you mean
catch it in time
?
Nurse: So, what youre saying is that its different to bad headaches?
Nurse: So, it starts off as a scratching pain over your left eye, extends down
your neck and gets more intense
after a while?
a)
b)
c)

1.
2.
3.
Your teacher will give you a card. You will need to fill in the missing words from
your research on the
follow-up in
p
art
a
.
With a partner, take it in turns to play the part of nurse and patient.
a
s the nurse you will need to ask the
patient what their pain symptoms are and make a note of them.
p
atient 1 (
c
ardiac arrest)
p
atient 2 (
p
leurisy)

c
ommunication focus

Follow-up

c
haracteristics
Patient 1 (Cardiac arrest)
Type of pain
?
Intensity
severe
Onset (first started)
five hours before he/she was admitted
Duration
intermittent lasting 10-15 minutes
Location
?
c
haracteristics
Patient 2 (Pleurisy)
Type of pain
?
Intensity
intense
Onset (first started)
three days before admitted
Duration
persistent
Location

g
roup the following words under the correct word stress pattern.

o
ptional activity:
p
ronunciation

trigger
prescription
drowsy
sensitive
migraine
dietary
symptoms
record pharmacist
scraping
culprits

a
N
s
W
er
K
e
Y
a
p
rofessional usage

F
T
F
F
T
F
Question types
1 Nurse: So what youre saying is
th
at its different to bad headaches? Closed
2 Nurse: So, what happens when you get a migraine? Open

B
c
olloquial language
b

e
d
h
g
c
f
a
1.
a.
b.
c.
d.
e.
f.
2.
3.
1.
2.
3.
4.
5.
6.
7.
8.

haracteristics
Notes

Type of pain
scraping, tightness in neck
Intensity
mild

intense
O
nset (starts, first started,
possible triggers)
starts gradually; first started: 5 years ago; possible triggers: strong smells, bright lights, dietary,
environmental,
behavioural factors
Duration
12 hours

3 days
Location
over left eye, radiates to neck
Right. When you say migraines do you mean you get bad headaches or do you mean a doctor has
diagnosed you as suffering
from migraines?
closed
So what youre saying is that its different to bad headaches?
closed
So, what happens when you get a migraine?
open
How would you describe the pain?
open
Is that on the left side also?
closed

So, it starts off as a scraping pain...


closed
How long does it last?
closed
What do you mean catch it in time?
open
Are the painkillers on prescription?
closed
And how often do you get these pains?
closed
When did you start getting them?
closed
Do you have any idea what triggers them?
open

N
s
W
er
K
e
Y
c
c
ommunication focus
b
a
c

D Handover
e
o
ptional activity

*point out to students that the word


record
when used as a verb has a different word stress. The main s