Preadministration Assessment

As part of the preadministration assessment, the nurse reviews the patient's health history, allergy history, and past and current drug therapies. This is especially important when a narcotic is given for the first time because data may be obtained during the initial history and physical assessment that require the nurse to contact the primary health care provider. For example, the patient may state that nausea and vomiting occurred when he or she was given a drug for pain several years ago. Further questioning of the patient is necessary because this information may influence the primary health care provider regarding administration of a specific narcotic drug. Guidelines for the initial pain assessment are listed in Display 19-2. Questions to include in the assessment of pain include the following:

• Does the pain keep you awake at night? Prevent you from falling asleep or staying asleep?

• What makes your pain worse?

• Does the pain affect your mood? Are you depressed? Irritable? Anxious?

• What over-the-counter or herbal remedies have you used for the pain?

• Does the pain affect your activity level? Are you able to walk? Perform self-care activities?

• Patient's subjective description of the pain (What does the pain feel like?)

• Intensity, severity, and duration

• Any factors that influence the pain

• Patterns of coping

• Effects of previous therapy (if applicable)

• Nurses' observations of patient's behavior

The nurse may request that the patient evaluate the pain using a standardized pain scale measurement tool. The pain is rated using a scale of 1 to 10, with 10 being the most severe pain and 1 being the least discomfort. Failure to adequately assess pain is a major factor in the undertreatment of pain.

It is especially important for the nurse to assess the type, location, and intensity of pain before administering the narcotic analgesic. Immediately before preparing a narcotic analgesic for administration, the nurse assesses the patient's blood pressure, pulse, and respiratory rate.

In addition, a thorough drug history, as well as physical assessment, may raise a question of drug dependency. The nurse must notify the primary health care provider of any suspicion of drug dependency.

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