During an admission assessment of a patient with dementia, the ...

[sammy]

During an admission assessment of a patient with dementia, the nurse assesses for pain because the patient has recently had several falls. Which of these are appropriate for the nurse to assess in a patient with dementia? Select all that apply.
 
  a. Ask the patient, Do you have pain?
  b. Assess the patient's breathing independent of vocalization.
  c. Note whether the patient is calling out, groaning, or crying.
  d. Have the patient rate pain on a 1-to-10 scale.
  e. Observe the patient's body language for pacing and agitation.

Question 2

A patient is complaining of severe knee pain after twisting it during a basketball game and is requesting pain medication. Which action by the nurse is appropriate?
 
  a. Completing the physical examination first and then giving the pain medication
  b. Telling the patient that the pain medication must wait until after the x-ray images are completed
  c. Evaluating the full range of motion of the knee and then medicating for pain
  d. Administering pain medication and then proceeding with the assessment

[Liddy]

Answer to Question 1

ANS: B, C, E
Patients with dementia may say no when, in reality, they are very uncomfortable because words have lost their meaning. Patients with dementia become less able to identify and describe pain over time, although pain is still present. People with dementia communicate pain through their behaviors. Agitation, pacing, and repetitive yelling may indicate pain and not a worsening of the dementia. (See Figure 10-10 for the Pain Assessment in Advanced Dementia PAINAD scale, which may also be used to assess pain in persons with dementia.)

Answer to Question 2

ANS: D
According to the American Pain Society (1992), In cases in which the cause of acute pain is uncertain, establishing a diagnosis is a priority, but symptomatic treatment of pain should be given while the investigation is proceeding. With occasional exceptions, (e.g., the initial examination of the patient with an acute condition of the abdomen), it is rarely justified to defer analgesia until a diagnosis is made. In fact, a comfortable patient is better able to cooperate with diagnostic procedures.