Pain Assessment And Management: 87-Year-Old Woman With Dementia

Pain is considered a highly subjective assessment that should be managed promptly and appropriately. Pain assessment and management can be quite challenging. It is extremely important for nurses to develop a good rapport with the patient initially to gain their trust that he or she will respond to the needs of their pain. It is also important that the nurse believe that the patients who report pain as well as those who deny it or can not verbal express that they are in pain. A nurse that suspects pain should explore the suspected pain such as painful procedures or disorders.

This article identifies an 87-year-old woman with dementia who was brought to the emergency due to abnormal behavior observed by the nursing home staff. Certain

abnormal behavior identified was pulling out feeding tubing, tugging at urinary catheter and striking nursing staff. It is very important for the nursing staff to monitor verbal and nonverbal responses to pain. The woman abnormal behavioral patterns is a reliable indication of pain. Even though the patient was conscious, she was unable to answer questions coherently.

Patient may also show physiological responses to pain, such as increased blood pressure and heart rate, pallor, sweating profusely, increased muscle tone and tachypnea. In this article, it was noted that the patient exhibited increased heart rate and respiratory rate. It was important for the ED nurses to use these clues as a suggestion that the patient may be in pain.

In order to manage pain effectively, the nurse must perform a pain assessment. After the ED nurse completed the pain assessment, she administered a small dose of morphine. Shortly afterwards, the patient returned to her “normal’ self. She no longer presented abnormal vital signs or behavior. Patients with dementia will eventually lose their ability to self-report pain. Once the patient loses language capabilities, good observation of pain related behaviors are imperative. (insert)

The American Geriatric Society Panel on Persistent Pain in Older Person identified body movements, activity patterns or routines, mental status, vocalizations, and changes of facial expressions as behavioral changes that typically found in cognitively impaired older adults. Thus, it is up to the nurse to recognize these behaviors as soon as possible to treat or manage the pain to help the patient to be more comfortable.