Mr Yu's Case

Mr. Yu is a 76-year-old male who retired from his architecture business 10 years ago. Mr. Yu has a history of dementia and repeatedly reports, ""My left knee hurts!"" He is unable to describe the pain's character to you, his nurse. When asked a clarification question, his response remains, ""My left knee hurts!"" Mr. Yu is restless and pacing, and while seated, he frequently rubs his left knee.

a. What behavioral data would the nurse collect in assessing the patient's pain?

b. What other resources does the nurse have to obtain information related to pain?

c. Should the nurse notify the physician and ask for an analgesic trial?

d. What attitude should the nurse have toward the patient who cannot verbally describe pain?"

a.  Data to be Gathered on the Behavioural Factor

 When assessing pain in a patient with dementia who cannot verbally describe their pain, the nurse should focus on the following behavioral data:The following are ways of assessing for pain in a patient with dementia who cannot speak:

 Facial Expressions: Some of the signs of restlessness include; the patient might be in pain or have some form of discomfort.

 Body Language: This can be seen in Mr. Yu who always touching his left knee.

 Vocalizations: Record any and all complaints whether of Client’s utterance or implied, whether clear or ambiguous.

 Activity Level: Further observations of the client includes whether the client has brought any change in the way of living or the carrying out of activities in his or her daily life.

 Sleep Patterns: Search for the alterations in the sleep pattern for example insomnia or other forms of complaints that are related to sleep.

 Changes in Appetite: The changes in the patient’s consumption pattern of food may be brought about by a number of factors including discomfort or pain.

 Interactions: Notice how Mr. Yu will behave and if he will have any change in his behavior towards other people.

 b.   Other ways by which information on pain can be acquired

 The nurse can use the following resources to obtain more information about Mr.   Yu’s pain:The following are some of the sources through which the nurse can be able to get more information about the pain of Mr. Yu:

 Family and Caregivers: This can be done by talking to Mr. Yu’s family or the caregivers as they will be in a position to explain to you on the pain behaviors that Mr. Yu displays or if he has had any seizures in the past.

 Medical History: Take a look in to the patient previous medical record for any history of diagnosed, treated or operated in the past on his knee or for any condition that has potential to cause him knee pain.

 Physical Examination: Assess the knee joint for tenderness, swelling, instability or deformity and assess the range of motion of the joint.

 Pain Scales: For the patients with dementia, the following behavioral pain assessment tools should be used these include the Pain Assessment in Advanced Dementia (PAINAD) or Abbey Pain Scale.

 Diagnostic Tests: It is recommended that in case you deem it necessary and with the intervention of a doctor, you may order for some imaging like an X-ray or an MRI for the knee.

 c. Is it necessary to contact the doctor and ask for a trial of analgesia?

 Yes it was appropriate for the author to have the nurse to report the pain to the doctor and have the patient tried on some analgesics. It also can assist to check if all the measures that have been taken to reduce the pain are working and can also assist in the development of more ways of reducing pain. Some suggestions are that the physician should begin with small amount of analgesic to see the response of the patient and if the pain is still not relieved, then the physician can increase the dosage.

 d. Attitude towards the Patient who Cannot Expressed His/Her Pain Out?

 First of all the nurse should explain this to Mr.  Yu nicely and calmly, for instance, the nurse should try to convince Mr.  Understanding that dementia can affect communication, the nurse should:The nurse should understand that dementia affects communication in that:

 Be Compassionate: It has to be said that Mr Yu is getting pretty impatient and one has to be as tolerant as possible even when he cannot express himself.

 Be Observant: To zoom in the non-verbal cue and behaviours that would suggest that the given patient is in pain.

 Be Persistent: There is/are to attend to and follow up on with and without fail monitor and evaluate Mr. Yu’s response to the care provided, pain response and plan of care.

 Involve Family: It is also important to go to the family members and ask them more on the pain of Mr. Yu and his comfort.