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    Johnson R Gill
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    This document is a pain assessment form used in an ICU. It asks patients to rate their pain level on a scale, describe the character, location, and any radiation of their pain. It also notes the pain management plan and includes spaces for reassessment of the patient's pain.

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    This document is a pain assessment form used in an ICU. It asks patients to rate their pain level on a scale, describe the character, location, and any radiation of their pain. It also notes the pain management plan and includes spaces for reassessment of the patient's pain.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    8 views1 page

    Pain

    Uploaded by

    Johnson R Gill
    This document is a pain assessment form used in an ICU. It asks patients to rate their pain level on a scale, describe the character, location, and any radiation of their pain. It also notes the pain management plan and includes spaces for reassessment of the patient's pain.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    PAIN ASSESSMENT IN ICU

    Are you feeling pain? Yes  No 


    If yes,
    PATIENT’S LABEL
    a. How severe is your pain (grade on a VAS Scale)

    b. What is the character of your pain?


    Aching  Burning  Crushing  Dull  Sharp 
    Shooting  Tingling  Throbbing  Radiating 
    c. Is it continuous of intermittent?
    Continuous  Intermittent 
    d. What is the location of your pain?
    Face  Head  Neck  Chest  Upper Abdomen 
    Lower Abdomen  Extremities: Upper  Lower  Any other 
    e. Does your pain radiate to any other site? Yes  No 
    If yes, specify the site ____________________________________________________________

    PAIN MANAGEMENT PLAN

    _____________________________________________________________________________________
    _____________________________________________________________________________________

    Name: _________________________ BLK ID _______ Date ________ Time ________ Sign __________

    Pain Reassessment:
    Date/ Time Remarks Signature/ BLK ID

    Dr. B. L. Kapur Memorial Hospital, Pusa Road, New Delhi -110005


    Tel: +91 11 3040 3040, Ambulance Helpline: +91 11 3065 3030
    BLK/CC&RM/15/00/2013

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