Patients who suffer from aphasia or another disorder, which limits speech and comprehension, are often referred to as “non-communicative.” Caring for non-communicative patients is a special challenge, because you have to be able to pick up on nonverbal clues that the patient needs something.
This is especially important when it comes to pain management. The signs that a patient is in pain can be subtle and are often misinterpreted. Reading them correctly can make a tremendous difference in the comfort level of your charge.
Changes in Expression
The most obvious cue you’re likely to see when a patient is hurting is a sort of grimacing facial expression. The patient may clinch her eyes closed, frown and tense up the muscles in her face and neck.
Patients often make similar expressions to show their annoyance at things they don’t like, such as: moving them when they are asleep (sometimes necessary to prevent pressure sores), turning on bright lights or brushing their teeth.
Pay attention to what’s going on when the patient starts grimacing. If you take away the potential source of frustration (i.e. turn off the light or stop brushing the teeth), does it stop? If not, the patient is probably experiencing pain.
Rhythmic Physical Contractions
This is something you may run across in patients with neurological disorders, such as Alzheimer’s. The body will tense up – almost like a woman in labor having a contraction. Then it will relax. After a few minutes it will tense up again.
Like labor pains, these contractions may intensify over time. It’ll be difficult for patients to get comfortable or sleep during these episodes, though the patient may not make a pained expression. Instead you may observe a confused or glassy eyed look.
A lot of patients struggling with end of life illnesses have tremors. But if you really pay attention, you’ll begin to notice that the tremors tend to intensify when the patient’s in pain.
If your patient’s tremors are suddenly much stronger than normal, additional medication is probably in order.
Even patients who can barely move will often reach out to their caregivers, both literally and figuratively. Patients love for you to hold their hands, and will grab your hand if you are close enough. I had one who used to put her feet on top of mine when we were sitting nearby. Even something a simple as making eye contact means she is trying to communicate with you.
Most of the time these interactions are merely an opportunity to engage in one of the few pleasures physically limited patients can still enjoy – simple human contact.
However if you detect a sense of urgency in the patient’s body language as she attempts to communicate with you, you must consider the possibility that she’s trying to tell you she hurts.
Does her face seem tense? Sometimes instead of the more obvious grimace, patients have a shocked expression when they’re hurting. Is her skin paler than normal? Are her eyes wide, or is she moving her mouth like she wants to tell you something?
A lot of people don’t realize that there are different kinds of medication for different kinds of pain. This is why many terminally ill elderly patients have prescriptions for several different pain killers.
Talk to a medical professional – a doctor or hospice nurse – about the kinds of pain related episodes you’ve observed. They can give you specific instructions on which medication and is appropriate and how much to give.
The most important thing, though, is that the patient’s pain be addressed as quickly as possible. Most patients have a “go to” general pain medicine that can be given in the event of an emergency. Any time you undertake the care of a new patient, make sure you know what that medicine is and where it’s located.
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