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Assessing Pain in the Critically Ill Adult

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Scope and Impact of the Problem
Many critically ill adult patients experience significant pain during hospitalization. In the intensive care unit (ICU), for example, more than 30% have significant pain at rest, and more than 50% have significant pain during routine care, such as turning, endotracheal suctioning, and wound care.1,2

Untreated pain can result in negative consequences, including multisystemic complications and the development of chronic disabling pain. These results, in turn, may seriously impact the patient’s functioning, quality of life, and well-being.3-5  Furthermore, the absence of pain assessment or an incomplete assessment has been associated with death in the ICU.6

Since pain is multidimensional and subjective,the patient’s self-report is the gold standard for assessment. However, many adult patients in the ICU cannot self-report pain as a result of an altered level of consciousness, the administration of sedative agents, and/or mechanical ventilation.8

The lack of self-reporting makes assessing pain in critically ill patients a challenge for nurses, who should consider use of alternatives such as observational pain assessment tools.9-10

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