Wong on Web Paper
Pain Assessment
Record
Principles: Rationale:
Directions for each column:
- Record date and time of administering analgesic; assess analgesic
effect [______] minutes later and then [______].
- Use a pain rating scale if child understands its use. Name of
scale [______].
Ratings: No pain=[______] Worst
pain=[______]
Acceptable pain rating [______]
- Record analgesic, dose, and route.
- Record possible indications or effects of pain, such as shallow
breathing due to incisional pain, parental requests for pain relief; record
indications or effects of pain relief, such as "moves easily, playing."
- Record level of arousal, using sedation scale in box. Also,
record any other side effects (e.g., nausea, itching).
- Resp.=Respiratory function. Record breaths per minute and/or
other observations of respiratory status (e.g., depth of respiration, change in
color of skin).
- Signature or initials of person recording information.
- SEDATION SCALE
- S=Sleeping, easily aroused.
- Requires no action
- 1=Awake and alert.
- Requires no action
- 2=Occasionally drowsy, easy to arouse.
- Requires no action
- 3=Frequently drowsy, arousable, drifts off to
sleep during conversation.
- Notify practitioner
- 4=Somnolent, minimal or no response to
stimuli.
- Notify practitioner
1
Date/
time |
2
Pain
rating |
3
Analgesic
|
4
Possible
effect/
indications of pain or relief of pain |
5
Arousal/
side
effects |
6
Resp |
7
Signature |
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Click here for a pain FACES rating
scale.
March 15, 2002
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