🩺 Fundamentals, Fast · Lesson 2 of 5 · 5 min
Pain Is What the Client Says It Is
😐 A client is laughing with visitors and rates pain 8/10. A nursing student charts 'appears comfortable, pain unlikely.' That chart note is wrong, and the exam will make sure you know why.
💡 Key idea
The client's self-report wins over your observation. Pick the scale that matches the client's age and ability, and always reassess after treating.
🧠 Why it matters
Pain is SUBJECTIVE: the client's report is the most reliable indicator, and behavior or vital signs can be normal in real pain, especially chronic pain. Assess with a structured approach such as PQRST (provoking factors, quality, region and radiation, severity, timing) or OLDCARTS. Choose the scale for the client: the 0 to 10 NUMERIC scale for adults who can self-report, the WONG-BAKER FACES scale from about age 3, the FLACC scale (face, legs, activity, cry, consolability) for infants and non-verbal clients, and PAINAD for advanced dementia. Reassess after every intervention, roughly 30 to 60 minutes after an oral medication and 15 to 30 minutes after an IV dose. Combine non-pharmacological measures such as repositioning, ice or heat, distraction and relaxation with medication rather than instead of it.
🏥 In the real world
👶 A six-month-old in the post-anesthesia unit cannot say anything. The nurse scores FLACC: face grimacing, legs drawn up, inconsolable crying. Score 8. That number justifies the analgesic, documents the response, and lets the next nurse compare. Without the tool, 'fussy baby' becomes an argument instead of an assessment.
📌 Takeaways
- Self-report is the gold standard; normal vital signs do not rule out pain
- Numeric for adults, FACES from age 3, FLACC for non-verbal, PAINAD for dementia
- Reassess after every intervention and chart the response
📖 Terms in this lesson
Opioids (morphine, hydromorphone, fentanyl, oxycodone): Relieve severe pain but depress breathing and consciousness; assess sedation and respiratory rate before each dose and hold for a rate under 12 or a client who is hard to rouse, treat the constipation that never goes away, and keep naloxone available.
NSAIDs (ibuprofen, naproxen, ketorolac): Relieve pain and inflammation at the cost of stomach bleeding, kidney injury and heart attack or stroke risk; take them with food, avoid them with anticoagulants, in kidney disease and late pregnancy, and limit ketorolac to 5 days total by any route.
✅ Test yourself
A client with chronic back pain rates it 7/10 while calmly watching television. What should the nurse do?
- Document that the client is not in pain because behavior does not match
- Wait until the client shows grimacing
- Accept the report and treat the pain
- Reduce the dose because the client looks comfortable
Answer: C · Accept the report and treat the pain
Pain is what the client says it is. Chronic pain often produces no visible behavioral or vital sign changes.
Which pain scale is most appropriate for a 4-year-old?
- 0–10 numeric rating scale
- Wong-Baker FACES scale
- PAINAD
- Visual analog scale (VAS)
Answer: B · Wong-Baker FACES scale
The FACES scale works for children from about age 3. Numeric scales require abstract understanding most preschoolers lack.
When should the nurse reassess pain after giving an IV opioid?
- At the next scheduled vital signs
- Only if the client calls
- Within about 15 to 30 minutes
- After 2 hours
Answer: C · Within about 15 to 30 minutes
IV opioids act fast; reassess at roughly 15 to 30 minutes for effect and for sedation or respiratory depression.
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