All right you guys welcome back to another video lesson from ICU Advantage. All right so in this lesson we're gonna continue our discussion that we've had here talking about analgesics within our series here covering ICU drips. And specifically for this lesson, we're going to talk about the different assessment and monitoring that we do for our patients who are on these medications. You're certainly going to be finding yourself taking care of these patients constantly, so it's going to be really important that you guys are able to accurately assess your patient's pain, because sometimes in the critical care environment, they're just not going to be able to tell you what their pain scale is.
But before we begin here, if this is your first time here to our channel and watching one of our videos, and you'd really be interested in more of this critical care educational content such as this video here then i really invite you guys to subscribe to our channel down below make sure you hit that bell icon though and select all notifications that way you'll get the notification as soon as the lesson becomes available and you won't miss out on one and a special shout out to all our awesome subscribers out there the ones who keep coming back watching our videos supporting our videos with your likes and your comments That stuff really goes a long way to help support the channel, and I just want to say that I appreciate you guys. All right, and so for those of you who don't know me, my name is Eddie Watson, and this is ICU Advantage. All right, so let's go ahead and get on in and begin to talk about our assessment and monitoring of our patients on analgesics.
And so here, really our goal is we want to decrease our patient's pain level with the least amount of medication possible. And so... really in order to be able to do that, we have to find a way to rate our patient's pain, provide them the medication that they need, and then follow up and see what their response is to that medication.
And so in order to be able to rate our patient's pain, there's two different primary ways in which we can get this. The patients can either self-report their pain, or we can use some sort of behavioral score. So as a general rule of thumb, whenever your patient is able to self-report, That's what you want to be using.
But as you may very well know, within the ICU and when our patients are in critical condition, a lot of times they're not going to be able to self-report pain to us. And so in a lot of cases, we're going to have to use one of these behavioral scores in order to be able to appropriately assess the level of pain that our patient has. Now there definitely are many different ways in which you can do this.
But probably the most common one that we usually will see is a scoring system called the Critical Care Pain Observation Tool, or what we so lovingly call our CPOT. And so with our score for our CPOT, we're going to have a max score of eight points. Now, I really wish they would have made this a 10 point scale, because that really just lines up with the scoring and the scaling that we're used to. But once you do this enough, you definitely will get an idea of where your patients are falling on. on this scale and use that to determine how much medication we need to be giving them.
Now in order to get this score, we're going to look at four different indicators and score each one of those either a 0, a 1, or a 2. These four indicators are going to be our patient's facial expression, their body movement, muscle tension, and then either vent compliance or vocalization. So let's go ahead and start off and talk about the facial expression here. And the facial expression is probably one of the best indicators we have to try and determine if our patients are having pain.
Like I said, they can either score a 0, a 1, or a 2. And a 0 would be when they're just relaxed and neutral. So we're not going to observe any muscle tension. Now a score of 1 is going to be what we call tense.
And so this is where we're going to see things like frowning, lowering of their brows, tightening of their eyes. These are going to be signs of what we call tense. And so finally a score of 2, this is going to be for our patients who are grimacing.
And this is where we're going to see everything within that tense category, but they're also going to have their eyelids tightly closed. And you may also see their mouth opening and biting down on our ET tube. So now for our body movement, again we're going to score 0, 1, or 2. And so for a score zero, this is where they're going to be absent of movements or really having a normal position.
Now a score one is going to be what we call protection. And this is essentially where they've got slow, cautious movements, where they're touching or rubbing a pain site, where they're really seeking attention through their movement. And then finally... Score a two is going to be restlessness and agitation.
And this one's pretty self-explanatory, but this is where you're going to see them pulling at tubes, attempting to sit up, moving their limbs and thrashing around. They're not following commands at this point, trying to get out of bed, striking staff, really getting combative. So moving on to our muscle tension, again, we're going to score the zero, one, or two.
And zero, once again, is going to be relaxed. And with these patients, you're going to have no resistance to any kind of passive movements. A score of 1, once again, is either tense or rigid.
And this is where you're going to feel that resistance when you're trying to do passive movements with them. And so finally for a score of 2, this is where we're going to see very tense or rigid. And so this is where those patients are going to have that strong resistance to the different passive movements or really an inability to even complete them.
All right, so for our last indicator, we have to divide this one up into two groups, either our intubated patients or our extubated patients. Once again, for both of these, we're still going to have a score of 0, 1, or 2. And so let's start off and talk about our intubated patients. And here we're going to see them tolerating the vent or really any movement that we do.
So we're not going to have any alarms being activated, and they're going to be easy to ventilate. Now a score of one is going to be what we call coughing but tolerating. And so here you're going to see your patients coughing. The alarms might be activated, but they do stop spontaneously.
And now a score of two, this is going to be where we have patients who are fighting the ventilator. So they're going to be asynchronous with the vent. They're going to be blocking those ventilations.
The alarms are going to be constantly going off. Trust me, you will know these patients when you see them. That vent will not shut up.
So now moving over and talking about patients who are extubated, now we're going to be looking at their vocalization. So for them, a score of zero is going to be that they're talking in a normal tone or that they're not making any sound. A score of one is going to be either sighing or moaning.
Again, pretty self-explanatory. And then finally, a score of two is going to be when your patients are crying out and sobbing. So that's how we assess each of these indicators. And so what you're going to do then for your patient is you're just going to go through each one of these indicators, figure out what their score is, add all those scores together, and then determine what their total CPOT score is.
Obviously, a patient who appears to have no pain is probably going to score either zero or pretty low on the scale. And a patient who is just writhing in pain, that they're going to have a very high score upwards of eight. And then based on this score, We're either going to provide bolus medication or increase or decrease the rate of our continuous infusion, ensuring that we're providing appropriate pain coverage for our patients.
And so with these behavioral scores, I did want to mention two last things. The first with this score is that it may be less sensitive in our brain-injured patients. So keep that in mind. As well as we often hear people talk about looking at their vital signs and being able to tell that they're in pain.
And it really is important to know that there isn't any solid evidence to really suggest that we can use vital signs as a true indication of pain. The best way that we can really look at that is if we do see these indications of what we think might be pain in our patient's vital signs, then we should be using that as a cue to really go in there and provide further assessment using the CPOT. in order to truly be able to tell if our patients are in pain or not. Like I said, though, ultimately, if the patient is able to self-report, that's the score that we want to be using. And so with that said, that's going to conclude this lesson here, talking about the analgesics and really specifically how we assess and monitor our patient on these drugs.
I really hope that after this lesson that you guys have a much better understanding of how we're assessing our patients that are on these medications, because it's really going to be important to... especially in the cases where those patients can't communicate with us well, that we have to have a way to be able to monitor them and assess and determine, do we need to be giving them more pain medication or are we giving them enough or perhaps even too much? All right, and so with that said, I want to thank you so much for watching. If you found this lesson useful, go down below, leave us a like or a comment, let us know what you thought. And if you haven't already, subscribe to our channel here on YouTube, as well as look us up on Facebook, Instagram, and Twitter, and make sure and follow us over there.
As well as while you're waiting for our next lesson to become available, head on over and check out another one of our awesome videos here. As always, thank you guys so much for watching, and you guys have a great day.