Pain Management

4. Abnormal findings — the necessity chain

Finding → severity → comparison → risk → intervention → notification (provider + representative) → orders → response → reassessment.

*Model abnormal 1*
New pain 8/10 with guarding, up from a controlled baseline, limiting therapy participation — assessed (PQRST: new right-hip pain with movement), PRN analgesic given per order, provider notified, cause worked up, reassessed at 30 minutes (8/10 → 3/10), the effect and timing documented, and Section J and the care plan updated. RN judgment required to evaluate the new/uncontrolled pain.

*Model abnormal 2*
Suspected pain in a nonverbal resident: new grimacing, guarding, restlessness, and moaning with care (PAINAD 7, up from 1) — assessed for a source, PRN analgesic given per order, non-pharm measures added (repositioning, quiet), reassessed at 45 minutes (PAINAD 7 → 2), provider notified of the change and a scheduled analgesic requested; Section J updated. Skilled recognition required, as the resident cannot self-report.

Model abnormal 2

Suspected pain in a nonverbal resident: new grimacing, guarding, restlessness, and moaning with care (PAINAD 7, up from 1) — assessed for a source, PRN analgesic given per order, non-pharm measures added (repositioning, quiet), reassessed at 45 minutes (PAINAD 7 → 2), provider notified of the change and a scheduled analgesic requested; Section J updated. Skilled recognition required, as the resident cannot self-report.

1. Purpose and clinical relevance

4. Abnormal findings — the necessity chain