Pain and Mobility
10.4 Clinical Reasoning and Decision-Making for Pain and Mobility
Clinical reasoning is a way that nurses think and process our knowledge, including what we have read or learned in the past, and apply it to the current practice context of what we are seeing right now. [1] Nurses make decisions all the time but making decisions requires a complex thinking process. There are many tools that are useful and found online that can support your thinking through to clinical judgments. This book uses the nursing process and clinical judgment language to help you understand the application of medication to your clinical practice.
After reviewing basic concepts related to pain and several disorders requiring analgesic or musculoskeletal medication, it is time to consider how to make decisions about these types of medications.
Assessment
Although there are numerous details to consider when administering medications, it is always important to first think about what you are giving and why.
First, let’s think of why? Recognizing Cues
Prior to administration of any medication, nurses should perform an assessment and gather cues to analyze and prioritize a hypothesis.[2]
See Figure 10.4a[3] for common nursing mnemonics for pain assessment.
If administering a medication related to mobility or the musculoskeletal system, you will first want to collect data such as strength and stability.https://wtcs.pressbooks.pub/nursingskills/chapter/13-4-musculoskeletal-assessment/
Additional baseline information to collect prior to administration of any analgesic or musculoskeletal medication includes any history of allergy or a previous adverse response.
Lifespan Considerations
A majority of medications are calculated specifically based on the client’s size, weight, and renal function. Client age and size are especially vital in pediatric clients. A child’s stage of development and the size of their internal organs will greatly impact how the body absorbs, digests, metabolizes and eliminates medications.
Visual pain scales have been developed as a tool of communication about pain with children through clients at end of life. See Figure 10.4b for the FACES Pain Rating Scale.[4] To use this scale, use the following evidence-based instructions.
- Explain to the client that each face represents a person who has no pain (hurt), some, or a lot of pain.
- Explain, “Face 0 doesn’t hurt at all. Face 2 hurts just a little. Face 4 hurts a little more. Face 6 hurts even more. Face 8 hurts a whole lot. Face 10 hurts as much as you can imagine, although you don’t have to be crying to have this worst pain.”
- Ask the client to choose the face that best represents the pain they are feeling.
Determinants of Health and Cultural Safety
There are several considerations for nurses when working with clients who have conditions related to pain and mobility. It is important that you engage in client care that is culturally safe, remember that pain is what the client says it is, and