🩺 基础护理，快速掌握 · 第2课，共5课 · 5 min
疼痛就是患者所说的那样
Pain Is What the Client Says It Is
😐 一位患者正和访客说笑，却给疼痛打了8/10分。一名护生记录道“看起来很舒适，不太可能有疼痛”。那条记录是错误的，考试一定会让你明白为什么。
😐 A client is laughing with visitors and rates pain 8/10. A nursing student charts 'appears comfortable, pain unlikely.' That chart note is wrong, and the exam will make sure you know why.
💡 核心要点
患者的自我报告比你的观察更重要。要选择与患者年龄和能力相匹配的量表，治疗后始终要重新评估。
The client's self-report wins over your observation. Pick the scale that matches the client's age and ability, and always reassess after treating.
🧠 为什么重要
疼痛是SUBJECTIVE的：患者的主诉是最可靠的指标，即使真的有疼痛，行为或生命体征也可能正常，慢性疼痛尤其如此。使用结构化方法进行评估，例如PQRST（诱发因素、性质、部位和放射、严重程度、时间）或OLDCARTS。要根据患者情况选择量表：能自我报告的成人使用0到10的NUMERIC量表，约3岁起使用WONG-BAKER FACES量表，不能自我报告的婴幼儿使用FLACC量表（面部、腿部、活动、哭闹、安慰性），不能自我报告的危重成人（例如插管患者）使用CPOT或BPS，晚期痴呆患者使用PAINAD。每次干预后都要重新评估，口服药物后约30到60分钟，IV给药后约15到30分钟。要将重新调整体位、冰敷或热敷、分散注意力和放松等非药物措施与药物结合使用，而不是用它们代替药物。
Pain is SUBJECTIVE: the client's report is the most reliable indicator, and behavior or vital signs can be normal in real pain, especially chronic pain. Assess with a structured approach such as PQRST (provoking factors, quality, region and radiation, severity, timing) or OLDCARTS. Choose the scale for the client: the 0 to 10 NUMERIC scale for adults who can self-report, the WONG-BAKER FACES scale from about age 3, the FLACC scale (face, legs, activity, cry, consolability) for infants and young children who cannot self-report, the CPOT or BPS for critically ill adults who cannot self-report, such as intubated clients,, and PAINAD for advanced dementia. Reassess after every intervention, roughly 30 to 60 minutes after an oral medication and 15 to 30 minutes after an IV dose. Combine non-pharmacological measures such as repositioning, ice or heat, distraction and relaxation with medication rather than instead of it.
🏥 真实场景
👶 一名六个月大的婴儿在麻醉后监护室里什么也说不出来。护士进行FLACC评分：面部做鬼脸，腿部蜷起，哭闹无法安慰。评分为8。这个数字为使用镇痛药提供了依据，记录了反应，并让下一位护士能够进行比较。没有这个工具，“烦躁的婴儿”就会变成争论，而不是评估。
👶 A six-month-old in the post-anesthesia unit cannot say anything. The nurse scores FLACC: face grimacing, legs drawn up, inconsolable crying. Score 8. That number justifies the analgesic, documents the response, and lets the next nurse compare. Without the tool, 'fussy baby' becomes an argument instead of an assessment.
📌 要点总结
- 自我报告是金标准；生命体征正常不能排除疼痛Self-report is the gold standard; normal vital signs do not rule out pain
- 成人使用Numeric，3岁起使用FACES，不能自我报告的婴幼儿使用FLACC，插管成人使用CPOT或BPS，痴呆患者使用PAINADNumeric for adults, FACES from age 3, FLACC for infants and young children who cannot self-report, CPOT or BPS for intubated adults, PAINAD for dementia
- 每次干预后重新评估，并记录反应Reassess after every intervention and chart the response
📖 本课术语
阿片类药物（morphine、hydromorphone、fentanyl、oxycodone） (Opioids (morphine, hydromorphone, fentanyl, oxycodone)): 缓解严重疼痛但抑制呼吸和意识；每剂前评估镇静程度和呼吸频率，频率低于12或患者难以唤醒时暂缓使用，治疗永不消失的便秘，并备好naloxone。
NSAIDs（ibuprofen、naproxen、ketorolac） (NSAIDs (ibuprofen, naproxen, ketorolac)): 缓解疼痛和炎症，代价是胃出血、肾损伤和心脏病发作或卒中风险；随食物服用，与抗凝药合用时避免使用，肾脏疾病时避免使用，妊娠20周起避免使用，ketorolac通过任何途径总共限用5天。
✅ 自我测试
一位慢性背痛患者平静地看着电视，却给疼痛打了7/10分。护士应该怎么做？A client with chronic back pain rates it 7/10 while calmly watching television. What should the nurse do?
- 记录患者没有疼痛，因为其行为不相符Document that the client is not in pain because behavior does not match
- 等到患者出现痛苦表情再处理Wait until the client shows grimacing
- 接受患者的主诉并治疗疼痛Accept the report and treat the pain
- 因为患者看起来很舒适而减少剂量Reduce the dose because the client looks comfortable
答案: C · 接受患者的主诉并治疗疼痛
疼痛就是患者所说的那样。慢性疼痛往往不会引起明显的行为或生命体征变化。
Pain is what the client says it is. Chronic pain often produces no visible behavioral or vital sign changes.
哪种疼痛量表最适合4岁的儿童？Which pain scale is most appropriate for a 4-year-old?
- 0–10数字评分量表0–10 numeric rating scale
- Wong-Baker FACES量表Wong-Baker FACES scale
- PAINAD
- 视觉模拟量表（VAS）Visual analog scale (VAS)
答案: B · Wong-Baker FACES量表
FACES量表适用于约3岁起的儿童。数字量表需要抽象理解能力，而大多数幼儿还不具备。
The FACES scale works for children from about age 3. Numeric scales require abstract understanding most preschoolers lack.
给予IV阿片类药物后，护士应该何时重新评估疼痛？When should the nurse reassess pain after giving an IV opioid?
- 下一次按计划测量生命体征时At the next scheduled vital signs
- 只有在患者呼叫时Only if the client calls
- 约15到30分钟内Within about 15 to 30 minutes
- 2小时后After 2 hours
答案: C · 约15到30分钟内
IV阿片类药物起效快；应在约15到30分钟时重新评估效果，以及是否出现镇静或呼吸抑制。下一次按计划测量生命体征可能在数小时后，远晚于药效高峰和呼吸抑制最可能发生的时间窗。
IV opioids act fast; reassess at roughly 15 to 30 minutes for effect and for sedation or respiratory depression. The next scheduled vital signs may be hours away, long after the peak effect and the window when respiratory depression is most likely.
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