Nursing · Adult clinical nursing
Ask what somebody is experiencing, believe the answer, and do something about it today
In the exams: Japan National Nursing Examination: Adult and geriatric nursing (Heavily represented, reflecting Japan's age structure)
More people come to healthcare because something hurts than for any other reason, and a large majority of those who need strong pain relief at the end of life cannot obtain it — tens of millions die in avoidable severe pain each year, because of restrictive regulation, cost, supply and untrained staff rather than for any clinical reason. Pain is invisible, has no test, and exists only as what the patient reports and what their body shows, which makes the person who asks, believes, records and reassesses a nurse: without that, nothing happens. Untreated pain also causes physical harm, preventing breathing deeply, coughing, moving, eating and sleeping, and therefore producing chest infections, clots, pressure damage, delirium and delayed healing. And most people die of conditions whose course is known in advance, which means most dying can be prepared for and palliative care is ordinary clinical work rather than a specialty for the last week.
More people come to healthcare because something hurts than for any other reason, and chronic pain affects a very large share of adults. There is no specialty in which this knowledge is optional.
A large majority of people who need strong pain relief at the end of life cannot obtain it, because of restrictive regulation, cost, supply and untrained staff. Tens of millions die in avoidable severe pain each year.
Pain is invisible, has no test, and exists only as what the patient reports and what their body shows. The person who asks, believes, records and reassesses is a nurse, and without that nothing happens.
It prevents breathing deeply, coughing, moving, eating and sleeping, which produces chest infections, clots, pressure damage, delirium and delayed healing. Treating pain is a means of preventing complications, not only of being kind.
Most people die of conditions whose course is known in advance, which means most dying can be prepared for. Palliative care is therefore ordinary clinical work rather than a specialty reserved for the last week.
Pain evolved to warn of damage and make you stop, which is useful for an acute injury and useless when the system continues signalling long after healing. Acute and chronic pain are therefore different problems.
Pain is produced by the nervous system interpreting signals, and that interpretation is modified by attention, mood, fear, sleep, previous experience and meaning. That is not the same as saying pain is imaginary.
Two people with the same operation experience quite different pain, and neither is exaggerating. Expecting a standard amount of pain for a standard injury is one of the commonest sources of under-treatment.
Persistent pain changes the nervous system so that it amplifies signals and responds to things that should not hurt. This is a physical change, it explains chronic pain that outlasts any injury, and explaining it to patients helps them.
Poor sleep lowers pain tolerance measurably, and fear of what the pain means increases it. Treating the fear and protecting sleep reduces pain without any change in analgesia.
Pain from injured tissue is usually well localised, described as aching, throbbing or sharp, and it responds predictably to ordinary analgesia. Most post-operative and injury pain is of this kind.
Organ pain is poorly localised, felt deep, may be referred to a distant site, and is frequently accompanied by nausea and sweating. Pain felt at the shoulder tip from the diaphragm is the classic example.
Damage to nerves themselves produces burning, shooting, electric or stabbing pain with numbness, tingling or extreme sensitivity of the skin. It responds poorly to ordinary analgesia and needs an entirely different approach.
Pain from bone, particularly from tumour deposits, is constant, present at rest, worse at night and not relieved by position. That description distinguishes it from mechanical pain and directs treatment specifically.
Most real patients have more than one type at once — a surgical wound plus nerve injury, or bone deposits plus organ pressure. A plan addressing only one type explains a great deal of apparently treatment-resistant pain.
Pain is subjective and the patient's report is the measurement. There is no test that overrides it, and treating the report as one input among several to be corroborated is how under-treatment begins.
Where, what kind, since when, what makes it better or worse, does it move, does it wake them, what does it stop them doing. A number alone cannot be treated, because it does not indicate which treatment.
Whether they can sleep, walk, cough, get out of bed, eat, or hold a grandchild describes the pain's impact and whether treatment is working. In chronic pain especially, function improves before scores do.
A score taken before treatment and never after measures nothing. The second measurement is the one that says whether what you did worked, and it is the one most often omitted.
People minimise pain to avoid being a nuisance, to avoid injections, to avoid being thought weak, or because they believe it is inevitable. Asking more than once, and observing, finds what a single question misses.
Sedated, ventilated, unconscious, delirious, severely disabled and very young patients all feel pain and cannot report it. Under-treatment in these groups is the norm rather than the exception.
Grimacing, frowning, a tightened brow, closed eyes, a fearful expression. Facial expression is the most reliable behavioural indicator of pain across almost every group who cannot speak.
Guarding, rigidity, restlessness, resisting care, fighting a ventilator, moaning, calling out, crying, rocking, or becoming unusually still. Both agitation and withdrawal can mean pain.
A rising pulse and blood pressure may indicate pain and may not, and they are absent in many patients who are nevertheless in pain. They support a behavioural assessment rather than replacing it.
Where pain is plausible and cannot be confirmed, giving analgesia and observing whether behaviour improves is both a treatment and a diagnostic test. Withholding it pending certainty is the wrong way round.
People from ethnic minorities, women, people with sickle cell disease, people who use drugs, people with mental illness, people with learning disability and the very old all receive less analgesia for the same conditions. This is documented across many studies.
A patient who names the analgesia that works for them, having lived with a condition for thirty years, is suspected of seeking drugs. Competence about one's own disease is not a warning sign.
Somebody with an opioid dependence who breaks a leg has the same injury and frequently needs more, not less, analgesia. Undertreating them is both cruel and clinically wrong, and it is extremely common.
Patients whose pain was doubted delay seeking care, conceal symptoms, and present later and sicker. The suspicion that felt cautious in the moment produces the crisis that arrives months afterwards.
The useful question is not whether you believe you are fair, but whether the patients you find difficult share characteristics. That is an uncomfortable question and it is the one that changes anything.
Pain treatment is conventionally escalated from simple analgesia through to strong opioids, with additional agents for specific pain types. Simple analgesia is continued alongside stronger treatment rather than replaced by it.
Pain that is present most of the time is treated with regular doses so it does not return, with extra doses available. Waiting until it is severe means chasing it, and patients learn not to ask.
Oral treatment is preferred where the patient can swallow, because it is simpler, less distressing and equally effective. Injections given by default cause unnecessary pain and expense.
Nerve pain, bone pain, muscle spasm, inflammation and organ pain respond to different additional agents. Escalating the dose of an agent that does not suit the pain type increases side effects without relief.
Constipation, nausea and drowsiness from strong analgesia are predictable and are prevented rather than waited for. Constipation in particular is close to universal and is a common reason treatment is abandoned.
Burning, shooting, electric pain responds poorly to standard painkillers, which is why escalating them produces sedation without relief. Recognising the type is the whole of the decision.
The quality of the pain, numbness or tingling in the same area, pain from light touch that should not hurt, and pain in a distribution matching a nerve. Describing quality rather than scoring intensity is what identifies it.
Specific agents, originally developed for other purposes, work for nerve pain. Patients are frequently told nothing can be done, which is untrue and leaves treatable pain untreated for years.
Diabetes, shingles, chemotherapy, spinal problems, amputation, nerve injury and tumour pressing on a nerve. Each is common, and each produces pain regularly dismissed as inevitable.
These treatments take weeks to work, are increased gradually, and reduce rather than abolish pain. Patients not told that conclude they have failed and stop.
Even with good background control, pain breaks through with movement, dressing changes, physiotherapy, coughing or at the end of a dose. A plan without provision for that is an incomplete plan.
Additional doses prescribed and actually accessible, rather than requiring somebody to be found and persuaded. Delay between a patient asking and receiving is where most breakthrough pain lives.
Giving analgesia in time to be working before a turn, a dressing change or physiotherapy determines whether the procedure is bearable and whether it achieves anything. Timing is a nursing decision.
Frequent breakthrough doses indicate the background treatment is inadequate, which is information for review. Giving the extra doses without ever reporting the pattern misses the point.
Pain returning reliably before the next dose is due means the interval or the amount is wrong. Patients endure this for weeks because nobody asked when in the cycle the pain comes back.
A well-supported limb, a pillow under a wound, a change of position, gentle movement. These reduce pain immediately, cost nothing, and are frequently the difference between bearable and not.
Heat for muscle pain and stiffness, cold for acute injury and swelling, and massage or simple touch for a great deal. They are not alternatives to analgesia and they are genuinely effective additions.
Pain occupies attention, and attention amplifies pain. Music, conversation, a task, a screen, a visitor, breathing exercises — all measurably reduce reported pain, particularly during procedures.
Understanding what the pain is, that it is expected, and that it is not a sign of catastrophe reduces its intensity. Fear is an amplifier, and information is the treatment for fear.
Poor sleep lowers pain tolerance, and hospitals destroy sleep systematically. Clustering care, dimming lights, silencing alarms and protecting a period of quiet is analgesia by another route.
Patients, families, nurses and prescribers all fear addiction, and the result is that people in severe pain receive less than they need. This fear causes more measurable harm than the dependence it guards against.
Needing a dose to avoid withdrawal, needing more for the same effect, and compulsive harmful use are three different things, and the first two are expected physiological responses. Conflating them is the root of the fear.
People decline analgesia because they fear becoming addicted or because they believe strong treatment means the end is near. Both beliefs are extremely common and both are addressable in one honest conversation.
Opioid prescribing for long-term non-cancer pain has caused very substantial harm, including dependence and death. Both under-treatment of severe pain and over-prescription for chronic pain are real failures and neither justifies the other.
Explaining what the treatment is for, how long it is likely to be needed, what will be monitored and how it will be reduced treats the fear rather than dismissing it. That conversation is nursing work.
Consumption of strong analgesia is concentrated overwhelmingly in a small number of wealthy countries, while most of the world's population has almost no access. This is a regulatory and distribution failure rather than a clinical one.
Fear of diversion producing restrictive laws, complicated prescribing requirements, cost, unreliable supply, and staff who have never been trained to use it. Each is addressable and none is medical.
Simple analgesia used properly and regularly, positioning, wound care, treating constipation, treating anxiety, presence, explanation and touch. These are not adequate substitutes and they are not nothing.
A patient promised comfort that cannot be delivered loses trust in everything else. Naming honestly what is unavailable, and advocating for it, is more useful than describing a standard of care that cannot be reached.
Nurses who document unrelieved pain, and say plainly that the medicine was unavailable rather than that the patient declined it, build the record that changes policy. That documentation is advocacy.
Pain after surgery or injury is expected, has a predictable course, and resolves. Saying how long it will last, honestly, changes how somebody experiences it.
Poorly controlled acute pain is associated with a higher chance of pain persisting long after healing. Treating it properly at the time is prevention of chronic pain, which is a strong and under-used argument.
Using several approaches together — simple analgesia, a regional block, positioning, ice — achieves better relief with less of any single agent and fewer side effects. A single-drug plan is an incomplete one.
Strong analgesia causes drowsiness before it slows breathing, so conscious level is the earlier and better warning. It is also the observation most often omitted in favour of recording a respiratory rate.
Pain that was settling and worsens, or changes in nature, may indicate a complication rather than inadequate analgesia. Increasing the dose without assessing the change is how a leak or a compartment problem is missed.
Pain persisting beyond healing involves changes in the nervous system itself, and is influenced by sleep, mood, activity, fear and circumstance. Treating it as an ongoing injury leads to endless investigation and no improvement.
Repeated scans in chronic pain frequently find incidental changes that are then blamed, reinforcing the belief that the body is damaged and increasing disability. More imaging is rarely the answer.
People with chronic pain are routinely told nothing is wrong, implied to be exaggerating, or labelled as difficult. That experience is described by patients as damaging as the pain, and it changes how they engage with care.
Strong analgesia for long-term non-cancer pain generally provides little lasting benefit and carries substantial harm. Saying that honestly, while not abandoning the person, is the difficult and necessary position.
The realistic aim is usually reduced interference with life rather than abolition of pain, and stating that plainly is kinder than implying a cure is coming. People can build a life around managed pain and cannot around waiting.
Paced increases in activity improve function and pain over time, while rest and avoidance worsen both. The initial increase hurts, which is why it must be explained and supported rather than simply recommended.
Learning how persistent pain works, and that hurt does not always mean harm, measurably reduces pain and disability. Teaching this is one of the most effective available interventions and it costs a conversation.
Depression, anxiety and poor sleep amplify pain and are treatable, and treating them improves the pain more than most analgesia does. Not asking is the commonest omission.
Loss of work, income and role drives much of the suffering, and practical help with those changes more than a prescription. It is rarely regarded as clinical work and it should be.
People whose whole life is organised around the next appointment and the next test do worse. Building a life alongside the pain is the outcome, and helping somebody towards it is the job.
Children's pain has been systematically underestimated, including in newborns who were once operated on with minimal analgesia. Residual under-treatment persists and is based on assumptions rather than evidence.
Premature and newborn infants feel pain, show it through facial expression, cry, movement and physiological change, and repeated untreated pain affects their later development. Heel pricks and cannulation are not trivial.
From a young age children can indicate pain using faces, scales or their own words, and they are more accurate than adults assume. Asking the child, not only the parent, is the standard.
Much of a child's distress is fear of the procedure rather than the pain itself, so preparation, honesty, a parent present, distraction and not lying about whether it will hurt are the effective interventions.
A child told something will not hurt and then hurt does not trust the next encounter, or the one after, for years. Honesty about pain is a long-term investment in that child's healthcare.
Persistent pain in older people is frequently accepted as inevitable by patients and clinicians, and therefore never treated. It is usually caused by treatable conditions.
Older people under-report pain out of stoicism, fear of investigation, not wanting to trouble anybody, or belief it is expected. Asking specifically, and asking about function, finds what a general enquiry misses.
Pain contributes directly to confusion, immobility, poor appetite, falls and loss of independence. Treating it prevents the geriatric syndromes that get attributed to age.
Reduced kidney and liver function, more medicines, and greater sensitivity to sedation mean smaller doses and careful review. That is a reason for care in prescribing, not a reason to withhold relief.
Whether they can dress, walk to the toilet, sleep or leave the house tells you more than a score, and it is what they actually care about. It also makes improvement visible.
People with dementia receive substantially less analgesia than people with the same conditions and intact cognition. They feel pain identically; they simply cannot report it in the expected way.
New agitation, aggression, calling out, resisting care, refusing food, withdrawal, pacing or disturbed sleep in somebody with dementia is frequently pain. Interpreting it as the dementia progressing is the standard error.
Behaviour caused by pain is regularly treated with sedatives or antipsychotics, which subdues the person without addressing the cause and carries serious harm. This is a common and consequential mistake.
Constipation, urinary retention, a pressure sore, a sore mouth, an infection, a fracture from an unwitnessed fall, or arthritis in somebody being moved. A physical examination finds most of it.
Where pain is plausible, a trial of regular simple analgesia with observation of behaviour is both treatment and diagnosis. Behaviour improving is the answer.
Palliative care is the active treatment of symptoms and suffering in serious illness, alongside treatment aimed at the disease. It is not a synonym for giving up, and that misunderstanding delays it by months.
Heart failure, lung disease, kidney failure, dementia, neurological disease and frailty all cause severe symptoms and predictable decline, and people with them receive far less palliative care than cancer patients. That gap is large.
Early palliative care alongside disease treatment improves symptoms, mood and quality of life, and in some studies people live longer. That fact is the strongest argument against treating it as a last resort.
It attends to physical symptoms, psychological distress, social and financial consequences, and spiritual concerns, and it treats the family as within its scope. That breadth is what distinguishes it.
Basic symptom control, honest conversation, planning ahead and good nursing care can be delivered by any competent generalist. Waiting for a specialist team that may not exist is not a plan.
Introducing symptom-focused care early, alongside active treatment, is what allows planning, prevents crises and builds a relationship before things become urgent. Late referral is the commonest failure in this subject.
Would you be surprised if this person died within the next year. If the answer is no, then conversations about what matters to them, and about what should happen in a crisis, should already be happening.
A person whose deterioration was foreseeable and unplanned ends up in an emergency department at three in the morning receiving treatment nobody wanted. Anticipatory planning is what prevents that specific, common event.
A conversation that is not documented, or is documented where the out-of-hours service cannot see it, has not happened as far as the crisis is concerned. Making it findable is part of making the plan.
People change their minds as circumstances change, and a plan made six months ago is revisited rather than enforced. Saying that it can be changed is what makes people willing to make one.
Breathlessness is terrifying, and fear worsens it, producing a cycle. Patients and families rank it among the most distressing symptoms, and it is less well treated than pain.
Fluid, infection, anaemia, a collapsed lung, a clot, or fluid around the lung may all be treatable, and treating the cause relieves the symptom best. Assuming it is untreatable because the illness is advanced is an error.
Sitting upright, a fan or moving air on the face, an open window, breathing techniques, calm presence, reducing exertion, and specific medicines. Moving air on the face is remarkably effective and almost free.
Oxygen helps when the blood oxygen is low and frequently does not help breathlessness with normal levels, while a mask isolates and frightens. A fan sometimes helps more than oxygen, which surprises people.
Panic escalates breathlessness and a calm person who stays interrupts that. Leaving a breathless frightened patient alone to fetch something is the moment it becomes a crisis.
Constipation, medicines, raised calcium, obstruction, a full stomach, anxiety, pain and raised pressure in the skull all cause nausea, and each responds to different treatment. Choosing an anti-sickness agent blindly is why the first one often fails.
Strong analgesia, immobility, reduced intake and illness together make constipation almost certain, and it causes pain, vomiting, confusion and distress. It is prevented alongside the analgesia rather than treated afterwards.
Dry mouth, thrush, ulcers and thick secretions make eating, drinking, talking and being kissed painful. Regular mouth care is among the highest-value comfort measures available and it is frequently the first thing dropped.
A dry mouth is relieved by mouth care, sips and ice rather than by a drip, and patients with dry mouths given fluids intravenously remain uncomfortable. Treating the mouth treats the symptom.
Itch, hiccups, a sore heel, a full bladder, a crumpled sheet. At the end of life these are not minor, and attending to them is the substance of the care rather than its periphery.
Pain, a full bladder, constipation, infection, low oxygen, medicines, withdrawal, raised calcium and fear all cause agitation at the end of life. Most are treatable and the first three account for a great deal.
Sedating an agitated dying person without looking for a cause leaves them subdued and still suffering. It is sometimes necessary and it is not the opening move.
Agitation in the last days is frequently more distressing for the family than for the patient, and explaining what is happening reduces their suffering considerably. They need to be told it is not pain if it is not.
Reduced noise, soft light, familiar people, a calm voice and not correcting confused statements all help. Restraint and argument reliably make it worse.
Agitation is sometimes distress about something unresolved — a person not seen, something unsaid, a fear about faith or family. Asking, gently, occasionally resolves what no medicine touches.
Secretions pooling in the throat produce a rattling sound that distresses families intensely and generally does not distress the unconscious patient. Explaining that, and repositioning, helps more than suction.
Deep suction in a dying patient is uncomfortable, stimulates more secretions and is usually done to relieve the observers. Position, reduced fluids and explanation are the better response.
Long pauses, irregular patterns, deep sighing breaths and periods that look like the last one. Families watching this need to know it is expected, or they experience each pause as a crisis.
Cool mottled hands and feet, reduced urine, no interest in food or fluid, sleeping almost all the time, and reduced responsiveness. These are signs of dying rather than of something needing correction.
Hearing is thought to persist, and families should be encouraged to speak, hold hands and say what they need to. So should staff, who should not discuss the patient over them.
Reduced interest in food and drink is expected in the last weeks and days, and it is not the cause of the decline. Understanding the direction of that relationship changes everything for a family.
Artificial feeding and fluids in the last days generally do not extend life or improve comfort, and can cause fluid overload, secretions and breathlessness. That is counterintuitive and needs explaining gently.
Refusal of food is experienced as refusal of care, and in many cultures not feeding a dying relative is unthinkable. Naming that openly, and offering other ways to care, relieves more than any explanation of physiology.
Small tastes of anything wanted, for pleasure rather than nutrition, and thorough mouth care. That is the intervention, and it gives the family something to do.
Whether to give fluids is discussed as a shared decision with the family, revisited as things change, and never presented as a rule. A decision imposed is remembered as an abandonment.
Failure to recognise dying leads to burdensome investigations, transfers, resuscitation attempts and a death nobody prepared for. Recognising it is a clinical skill and it is the gateway to everything in this manual.
Progressive weakness, spending nearly all the time in bed, no interest in food or drink, difficulty swallowing medicines, reduced consciousness, and deterioration day by day rather than week by week.
Predicting timing is unreliable, and people occasionally improve. Saying that honestly — that this looks like dying and could be days, and that you will keep reviewing — is more useful than false precision.
Observations, blood tests, medicines with no immediate purpose, and fluid charts can be stopped, while comfort medicines are continued and made available. Continuing them is an active decision, not a default.
Families frequently say afterwards that nobody told them the person was dying. Saying it plainly, using the word, is the single most consequential communication in this subject.
Beginning with what the person already knows and what they want to know avoids both delivering news they already have and forcing information they do not want. Asking is the whole technique.
Euphemisms leave people uncertain what has been said. Dying, and died, are the words that communicate, and avoiding them protects the speaker rather than the listener.
After difficult information, the impulse is to fill silence with facts or reassurance. Sitting quietly and not leaving is a skilled response, and people remember who stayed.
Hope for cure becomes hope for time, for comfort, for being at home, for seeing somebody. Telling a person there is no hope is both untrue and cruel; helping them find what to hope for is the work.
Being at home, avoiding hospital, being able to think clearly, a particular event, not being a burden. Without asking, the plan is built around clinical goals rather than around the remaining life.
Most care of dying people is given by family members, unpaid, exhausted, frightened and untrained. Teaching them practically — how to turn, how to give medicine, what to expect — is a direct clinical intervention.
Families cope far better with breathing changes, secretions, agitation and reduced consciousness when warned in advance. Unwarned, each of those becomes an emergency call and a frightening memory.
A number that is answered, and clear guidance on what warrants calling, prevents ambulance calls and hospital admissions nobody wanted. The absence of that number explains a great many deaths in the wrong place.
Carers develop depression, exhaustion, physical injury and financial hardship, and they consistently neglect their own health. Asking about them directly is legitimate and is almost never done.
Carers frequently cannot leave the bedside for fear the person will die alone, and many deaths occur in the moments they step away. Preparing them for that possibility beforehand prevents lasting guilt.
How the death is confirmed and communicated, whether the family were rushed, whether they were allowed to stay, and whether anybody was kind is recalled in detail for decades. It costs time and almost nothing else.
Care of the body according to the family's faith and wishes, asking rather than assuming what is required, time without being hurried, and clear information about what happens next and what they must do.
Grief is individual, unpredictable, physical as well as emotional, and does not proceed through neat phases. Telling somebody which stage they are in is unhelpful and inaccurate.
Grief that is prolonged, disabling, or accompanied by inability to function or thoughts of self-harm needs support beyond time. Distinguishing that from ordinary grief matters and it requires somebody to ask.
Children who are told honestly, allowed to see the person and included in rituals generally cope better than those protected from it. Exclusion is usually for the adults' benefit.
Rituals about who may touch the body, the direction it faces, washing, timing of burial or cremation, and who must be present carry enormous weight. Getting them wrong causes lasting distress that cannot be repaired.
Assumptions based on somebody's apparent religion or ethnicity are frequently wrong, and practice varies within every tradition and every family. A single respectful question resolves it.
In many families decisions are made collectively, and in some the patient is expected not to be told directly. Honouring that while preserving the patient's own right to know what they wish to is delicate and necessary work.
Some patients decline sedation or analgesia for religious or personal reasons, and that choice is respected once it is genuinely informed. It is not a failure of your explanation.
Fear of judgement, unresolved guilt, the question of whether a life meant anything. These cause real suffering, they respond to being heard, and identifying when somebody should be offered a chaplain or an elder is part of the work.
Nurses who care for dying people accumulate losses without the rituals or acknowledgement a family receives. That accumulation causes real distress and it is rarely named or addressed.
Being required to continue treatment that prolongs dying, or to withhold comfort that is unavailable, causes lasting harm. It comes from knowing what right care is and being unable to give it.
A patient your own age, a child, somebody who reminded you of a relative, a death that went badly. That these persist is a sign of engagement rather than of inadequate professionalism.
Structured opportunities to discuss deaths, and informal support between colleagues, reduce lasting harm. Both need protecting rather than being fitted into gaps between tasks.
Done well, this is among the most valuable things a nurse can do, and families remember it for the rest of their lives. That is not consolation for the cost; it is a reason the cost is worth bearing.
Pain in childbirth is normal, purposeful and extremely severe, and a woman's choices about how to manage it — from breathing and water and movement to regional anaesthesia — are hers to make and to change during labour. Being talked out of an epidural, or pressured into one, are both failures of the same kind.
Pain felt in an amputated limb is real, common, neurological and not psychological. Dismissing it damages trust and leaves treatable pain untreated, and it responds to nerve pain approaches rather than to escalating ordinary analgesia.
Pain in a sickle episode is frequently as severe as any in medicine and is consistently under-treated because staff doubt the reported severity in a patient who looks well. Warmth, hydration and prompt adequate analgesia are the treatment, and delay prolongs the episode.
Dressing changes, particularly of burns and chronic wounds, are among the most painful things routinely done to patients. Analgesia timed to be working beforehand, soaking adherent dressings, letting the patient call a pause, and not rushing are what make them bearable.
Wisdom teeth, period pain, pain during intercourse, pain from a badly fitting prosthesis or a pressure sore nobody has looked at. A great deal of severe pain persists for years simply because no one ever asked a direct question about it.
Pain is what the patient says it is; reassessment after treatment; behavioural assessment in those who cannot report; recognising dying; breathlessness management; and that palliative care is not confined to the last days or to cancer.
Recording a pain score and never reassessing; withholding analgesia from somebody who cannot confirm the pain; interpreting agitation in dementia as progression rather than pain; assuming oxygen is the answer to breathlessness; suctioning a dying patient for the family's benefit; failing to tell a family the person is dying.
Ask, believe, treat, reassess. Give regularly with extra available. Match the agent to the type of pain. Look for a cause of agitation before sedating. Say the word dying. Ask what matters to them.
Ask what the pain stops them doing. Time the analgesia before the turn. Ask when in the dose cycle the pain returns. Try a fan before oxygen. Offer mouth care hourly. Tell the family what they will see.
Both halves of this subject rest on the same act: asking somebody what they are experiencing, believing the answer, and doing something about it today rather than at the next review.
Written in plain sentences on purpose. Nursing is studied in a second language by a large share of the students who will read this, and a sentence that has to be decoded twice is a sentence that teaches less.
These are the twelve questions written with this SUNYRA nursing manual, to check what it teaches. They are not past papers and were not written to any one examination's pattern; an examination tag means only that the examination's published blueprint covers this subject. Difficulty was not graded in the source, so every question is marked medium.
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