Question

You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of three or so. You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patient's pain?

1) Treat the patient on the basis of objective signs of pain and reassess him frequently.
2) Call the physician for new orders because it is apparent that the pain medicine is not working.
3) Believe what the patient says, reinforce education, and reassess often.
4) Ask the family what they think and treat the patient accordingly.

Answer 1

Option 1 is the best approach: treat the patient based on objective signs of pain and reassess frequently, given the stoic demeanor and potential underreporting of pain on the scale. It is essential to respect the patient's self-report but also consider objective signs and use PRN medication orders appropriately while monitoring for changes.

Step-by-step explanation:

In the scenario where an 86-year-old postoperative patient shows objective signs of pain such as elevated vital signs and is diaphoretic but reports a pain level of only three on a 0-to-10 scale, it is important to consider both objective and subjective assessments of pain. The patient's stoic demeanor may result in an underreport of pain. In this case, option 1, to treat the patient based on objective signs of pain and reassess frequently, seems to be the best approach. It is imperative to monitor the patient's vital signs, observe for other signs of discomfort, and provide pain relief as per the PRN medication orders. Continuously reassessing the patient's pain will help to manage it effectively while also respecting the patient's self-report. It is also important to consider that pain assessment tools, like the Wong-Baker Faces pain-rating scale, may not always capture the true extent of pain in certain populations, including older adults or those with cognitive impairments.