TEKNIK

ASSESMENT
NYERI
H.
Asriadi.,S.Kep.,Ns.,M.Kep

Untuk membedakan antara nyeri nosiseptif

dan nyeri neuropatik dapat digunakan

ID Pain
LANNS (The Leeds Assessment ofNeuropathic Symptoms and
Signs Pain Scale)

Pain Assessment Scales

Uni-Dimensional Scale
Only measures pain intensity
Appropriate for acute pain
The most common scale used in
outcome assessment (Analgesic
efficacy)

Verbal Rating Scale (VRS)

Numeric Rating Scale (NRS)
Visual Analog Scale (VAS)
Wong Baker Pain Rating Scale

Multi-Dimensional Scale
Both intensity (severity)
and unpleasantness
(affective)
Appropriate for chronic pain
Research /pathophysiology
Should be used in clinical
outcome assessment

McGill Pain Questionnaire (MPQ)

The Brief Pain Inventory (BPI)
The Memorial Pain Assessment Card
Catatan harian nyeri (Pain diary)

TOOL LAIN DALAM ASSESSMENT NYERI

Neonatal Infant Pain Scale

Nonverbal Pain Indicators (CNPI)
Pain Assessment in Advanced Dementia
Scale (PAINAD)
FLACC singkatan dari Face, Legs, Activity, Cry, and
Consolability
Comfort Scale
Opoid risk tool
Behaviour Checklist Addiction
Addiction Behaviors Checklist (ABC)

Photographic/Numeric Pain Scale

Modified
McGill Pain
Questionnaire
15 Minutes

Sensorik
Afektif
Evaluatif
Macam2
IRN
INS
71,4% Baik
28,6% Lumayan
dan sedang

Treatment

Relief

General Activity
Mood
Walking ability

Worst
Least

Normal work
Relation with other people
Sleep

Average
Enjoyment of life
Right Now

Quicker and easier

Well established reliability
in cancer, arthritis, and
AIDs.
Sensory, affective and
functional status
Useful for treatment
response
Takes up to 15 min
Good choice for patients
with progressive disease

Patient Pain Diary

Pain Scale

10

Dose
Morning

Dose
Afternoon

Evening

Bedtime

Location: Patient or nurse marks drawing

Intensity: Patient rates the pain. Scale Used:

Quality: Use patints words, e.g. prick, ache, burn, sharp, hot etc.
Onset, duration, variations, rhythms (spontaneus or evoked):
Manner of expressing pain: (Pain Behaviour)
What relieves the pain?

ultimodal Pain Management

Coordinated use of medication & non medication
to control the pain
Consider the psycho-socio-cultural-spiritual aspects
Acute pain interventions
Treatment
Methods

Remove the
cause
of pain

Surgery
Splinting

Drug therapy

Non-opioid
Aspirin & other

NSAIDs
Paracetamol
Combinations

Opioid

Physical
methods

Regional
analgesia

High-tech

Morphine Epidural infusion

Local anaesthetic
Others
+ opioid

Low-tech
Nerve bloks
Local
anesthetic
+ opioid

Psychological
approaches

Physiotherapy Psychoprophylaxis
Manipulation
TENS
Acupunture
Ice

Relaxation
Hypnosis

WHO Pain Ladder

AKIBAT KELOLA NYERI YANG TIDAK

ADEKUAT
1.Kardivaskuler
2.Paru

3.Gastrointestinal
4.Ginjal
5.Koagulasi
6.Imunologi
7.Otot

8.Psikis

1.Takikardi, Hipertensi,
Naiknya kerja jantung
2.Spasme otot nafas,
penurunan VC, atelektasis,
arterial hypoxemia,
naiknya risiko infeksi paru.
3.Ileus pascaoperasi.
4.Retensi urin, risiko oliguri.
5.Risiko tromboemboli.
6.Gangguan fungsi imunitas.
7.Kelemahan otot, kelelahan,
mobilitas terbatas, risiko
tromboemboli.
8.Ansietas, ketakutan,
frustasi, rasa tidak
nyaman.

Adult dosing guidelines for non-opioid

analgesics
Drug
Paraaminophenols
Salicylates

ROUTE
Oral
Oral

Ibuprofen
Ketoprofen
Indomethacin
Ketorolac

Oral
Oral
Oral
IV

Diclofenac Potassium
Meloxicam
Piroxicam
Elexoxib

Oral
Oral
Oral
Oral

Dose

500-1000 mg/4-6hr
max dose adults
4000 mg.
500-1000 mg/4-6hr
max dose adults
4000 mg.
400 mg/4-6hr.
25-50 mg/6-8hr.
25mg/8-12hr.
30mg initial.1530mg/
6-8hr not >5 days.
50 mg/8hr.
7.5-15 mg/24hr.
20-40 mg/24hr.
100-200 mg/12hr

Opioids
Analgesic
1.Morphine iv dose 0.1 mg/kg with additional
doses of 0.05 mg/kg.
2.Meperidine iv dose 1 mg/kg with additional doses
0.5 mg/kg.
3.Fentanyl iv dose 2 3 mcg/kg with additional
doses titrated by 0.5 mcg/kg until desired level of
analgesia is reached.

Paediatrics
Morphine (i.d. 0.05 0.1 mg/kg iv, then
titrate, maximum 10 mg/dose.
or
Fentanyl (i.d 1-2 g/kg, then titrate,
maximum 100 g/dose)