Although the best indicator of a patient’s pain is
self-report (Jacox, Carr, Payne, 1994, p. 3), because Kathy
was suffering from delirium, it was more difficult to
assess pain through her self-report. Vital signs are also
not good indicators of pain, because medications, fever,
dehydration, and other systemic issues can mask
physiologic responses to pain. We sought to find the
balance between keeping Kathy comfortable and not
overmedicating her to the point of obtundation and beyond.
Confused and nonverbal patients need to be assessed
using measures other than the verbal or
numeric scale. Several pain scales are available for clinical
use. One method of assessing pain in the confused
patient is the Faces Pain Scale–Revised. This pain scale
has been validated in mild to moderately cognitively impaired
adults (Ware, Epps, & Packard, 2006).