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ASSESSMENT ONE: Health Assessment
Health Assessment, GRU CONAT 09/14/2015
Terms in this set (198)
solely a color change, flat, and circumscribed
Something you can feel casued by superfical thickening in the epidermis; elevated lesion of differing color
examples: elevated nevus (mole)
Papules coalesce to form surface elevation wider than 1 cm
examples: psoriasis (scaly rash)
filled with serous fluid
superficial < 1 cm
examples: herpes, chicken pox, shingles
purulent fluid-filled lesion
-deeper than vesicle
superficial, raised, transient, and erythematous; slightly irregular shape from edema
example: mosquito bite
Elevated, solid lesion
Deep in dermis
example: lipoma, hemangioma
Raised, firm lesion
Deeper than papule (in dermis)
example: xanthoma (yellow", is a deposition of yellowish cholesterol-rich material that can appear anywhere in the body in various disease states)
encapsulated fluid-filled cavity in dermis or sub Q
compact, desiccated flakes of skin, dry or greasy, silvery or white, from shredding of dead excess keratin cells
examples: after scarlet fever or allergic reaction, dry skin
After a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen); permanent fibrotic change
example: healed area of surgery or injury
A benign excess of scar tissue beyond site of original injury, surgery, acne, ear piercing, tattoos, infections, burns.
Looks smooth, rubbery, shiny, and "clawlike"
Higher incidence in Black, Hispanics, and Asians
Scooped out but shallow depression;
Superficial; epidermis lost; moist but no bleeding; heals without scar because does not extend into dermis
Self-inflicted abrasion; superficial; sometimes crusted; scratches fro intense iching
Linear crack with abrupt edges; extends into dermis; dry or moist
example: cheilosis--at corners of mouth cause by excess moisture
Deeper depression extending into dermis, irregular shape; may bled, leaves scar when heals
is a profession that uses specialized knowledge and skills to promote wellness and to provide care to people in both health and illness in a variety of settings
a systematic problem solving approach intended to provide individualized nursing care
Evidence Based Assessment
the essential element of the first phase of the nursing process, and involves the collection of data for nursing purposes. Information is collected using the skills of observation, interviewing, physical examination, and intuition and from many sources, including clients, their family members or significant others, health records, other health team members.
is the collection of subjective and objective data about a patient's health
consist of information provided by the affected individual
include information obtained by the health care provider through observation and inspecting,percussing, palpating, and auscultating during thephysical examination
the totality of information available about the patient, including subjective data, objective data,and the patient's medical record and laboratory studies
What is the purpose of assessment?
the process of analyzing health data and drawing conclusions to identify diagnoses
1. Attending to initially available cues, which are pieces
of information, signs, symptoms, or laboratory data;
2. Formulating diagnostic hypotheses, which are tentative explanations for a cue or a set of cues and can serve as a basis for further investigation;
•3. Gathering data relative to the tentative hypotheses;
•4.Evaluating each hypothesis with the new data collected, which leads to a final diagnosis
which are pieces of information, signs, symptoms, or laboratory data
which are tentative explanations for a cue or a set of cues and can serve as a basis for further investigation
has no experience with specific patient populations and uses rules to guide performance.
understands a patient situation as a whole rather than as a list of tasks, attends to an assessment data pattern, and acts without consciously labeling it
has an intuitive grasp of a clinical situation and zeroes in on the accurate solution
the multidimensional thinking process needed for sound diagnostic reasoning and clinical judgment.
The process includes:
Identifying relevant information,
Gathering clinical cues,
Completing an assessment,
First-level priority problems
are emergent, life-threatening, and immediate, such as establishing an airway or supporting breathing
Second-level priority problems
Are next in urgency:
They require prompt intervention to prevent further
deterioration and may include a mental status change, acute pain, or abnormal laboratory values
Third-level priority problems
are important to the patient's health but can be addressed after more urgent problems. Examples include lack of knowledge or family coping
are certain physiologic conditions in which the approach to treatment involves multiple disciplines
systematic approach to practice that uses the best evidence, the clinician's experience, and the patient's preferences and values to make decisions about care and treatment
includes a complete health history and a full physical examination, yielding the first diagnoses
database is used for a limited or short-term problem. It is smaller in scope and more targeted than the complete database
evaluates the status of any identified problem at regular intervals to follow up on short term or chronic health problems
calls for rapid collection of crucial data, which often occurs while performing lifesaving measures
holistic health model
Assesses the whole person because it views the mind, body, and spirit as interdependent and functioning as a whole within the environment. Health depends on all these factors working together!
Health promotion and disease prevention
Involve changing people's unhealthy behaviors through a set of positive acts. The focus is on teaching and helping the consumer choose a healthier lifestyle
A medical diagnosis is used to evaluate:
A a person's state of health.
B the response of the whole person to actual or potential health problems.
C a person's culture.
D the cause of disease.
A structured interaction between you and the patient. The terms governing this interaction should be stated clearly at the start of the interview so that openness and trust is facilitated.
Your mutual goal is the patient's optimal health!
The exchange of information so that each person clearly understands the other; based on behavior, conscious and unconscious, remembering that all behavior has meaning
Are specific to the examiner;
3.the ability to listen
Relate mainly to the physical setting.
ensuring privacy, preventing interruptions, creating a conducive environment, arranging equal status seating, wearing appropriate attire, and documenting responses via note-taking or an electronic health record without interfering with the conversation
During the first phase, begin the interview by introducing
yourself and your role
Start with open-ended questions, which ask for narrative information. Then use closed or direct questions, which ask for specific information in short, one- or two-word
Signal that the interview is ending, which gives the patient one last chance to share concerns or express himself or herself. Also, briefly summarize what you learned during the interview
10 traps of interviewing
• Providing false assurance or reassurance,
• Giving unwanted advice,
• Using authority,
• Using avoidance language,
• Engaging in distancing,
• Using professional jargon,
• Using leading or biased questions,
• Talking too much,
• Interrupting, and
• Using "why" questions.
Important in establishing rapport and conveying information while providing clues to understanding feelings
• Physical appearance,
• Facial expression,
• Eye contact,
• Voice, and
When preparing the physical setting for an interview, the interviewer should:
A. set the room temperature between 64° F and 66° F.
B. reduce noise by turning the volume on the television or radio down.
C. conduct the interview at eye level and at a distance of 4 to 5 feet.
D. stand next to the patient to convey a professional demeanor.
Parents or caretakers accompany children to the health care setting. Starting at ___ years of age, the interviewer asks the child directly about his or her presenting symptoms.
When addressing a toddler during the interview, the health care provider should:
A. ask the child, before the caretaker, about symptoms.
B. use nonverbal communication.
C. use short, simple, concrete sentences.
D. use detailed explanations.
Nonverbal communication is the primary form of
communication for which group of individuals?
D. Older adults
Complete health history
Purpose is to collect subjective data.
By combining subjective data with objective data from the physical examination and laboratory studies, you create a database to make a judgment or diagnosis about the individual's health status
The health history includes a detailed, chronological record of the health problem
The health history is a screening tool for abnormal symptoms, health problems, and concerns. It also records health promotion behaviors and coping skills
First category collected in a complete health history;
Such as the patient's name, date of birth, occupation, primary language, andcommunication needs
Source of History
Second category collected in a complete health history;
Which is usually the patient but may be someone else, such as a relative or interpreter
Reason for Seeking Care
Third category collected in a complete health history;
(Formerly known as the chief complaint.)
In the patient's own words, briefly describe the reason for the visit stating one or two symptoms or signs and their duration
Present Health or History of Present Illness
Fourth category collected in a complete health history;
For a well person, briefly note the general state of health. For a sick person, chronologically record the reason for seeking care.
Provocative or Palliative (what makes it worse/better)
Quality or Quantity (For example, is the pain sharp or dull, throbbing?)
Regian or Radiation(Location)
Severity Scale (Numeric pain intensity scale)
Understand Patient's Perception (Activities of Daily Living assessment)
Past Health Events
Fifth category collected in a complete health history;
Investigate their past, such as illnesses, injuries, hospitalizations, surgeries, and allergies, and current prescribed and herbal medications.
Sixth category collected in a complete health history;
Gather family information to help detect health risks for the patient, and assist with early screening and periodic surveillance.
Several questions should be added to assess spiritual resources or religion, nutritional status, and immigration status as applicable.
Review of Systems
Seventh category collected in a complete health history;
Evaluate the past and present health of each body system, double check for significant data that may have been omitted, and assess health promotion practices
Eighth category collected in a complete health history;
Finding out about ADLs and IADLs, measuring a person's self-care ability
Activities of Daily Living
bathing, dressing, toileting, eating, walking
Instrumental Activities of Daily Living
housekeeping, shopping, cooking, doing laundry, using the telephone, managing finances, nutrition, social relationships and resources; self-concept and coping; and home environment
Which of the following is included in documenting a history source?
A. Appearance, dress, and hygiene
B. Cognition and literacy level
C. Documented relationship of support systems
D. Reliability of informant
The CAGE test is a screening questionnaire that helps to identify:
A. unhealthy lifestyle behaviors.
B. personal response to stress.
C. excessive or uncontrollable drinking.
When recording information for the review of systems, the interviewer must document:
A. physical findings, such as skin appearance, to support historic data.
B. "negative" under the system heading.
C. the presence or absence of all symptoms under the system heading.
D. objective data that support the history of present illness
Assessment of self-esteem and self-concept is part of the functional assessment. Areas covered under self-esteem and self-concept include:
A. education, financial status, and value-belief system.
B. exercise and activity, leisure activities, and level of independence.
C. family role, interpersonal relations, social support, and time spent alone.
D. stressors, coping mechanisms, and change in past year.
The nurse questions the reliability of the history provided by the patient. One method to verify information within the context of the interview is to:
A. review previous medical records.
B. rephrase the same questions later in the interview.
C. ask the patient if there is someone who could verify information.
D. call a family member to confirm information.
A study of the whole person, covering the general health state and any obvious physical characteristics; Start INSPECTION at moment you first encounter person
It covers four areas: physical appearance, body structure, mobility, and behavior. Changes in any area may indicate illness.
General Survey; includes an assessment of the person's age, sex, level of consciousness, skin color, facial features, and overall appearance
General Survey; addresses stature, nutrition, symmetry, posture, position, body build or contour, and any obvious deformities
General Survey; concerned with gait, range of motion, and the presence of involuntary movement
General Survey; considers facial expression, mood and affect, speech, dress, and personal hygiene
You may use a standardized balance or electronic standing scale. Instruct the person to remove heavy outer clothing and shoes before standing on the scale
Use a wall-mounted device or the measuring pole on the balance scale; have the shoeless person stand straight and look straight ahead
Body Mass Index
Practical marker of optimal healthy weight for height and an indicator of obesity or malnutrition
accurate and the most convenient way to take temperature
If just taken hot or cold liquids-
◦ WAIT 15 minutes
If just smoked,
◦ Wait 2 minutes
The most accurate route to take temperature, and the result is as close to core temperature as possible without using more invasive measures
senses infrared emissions of the eardrum, so it is an accurate measurement of core temperature
temporal artery thermometer
uses infrared emissions from the temporal artery and provides an average of multiple readings of temperature.; There are conflicting reports regarding its accuracy
1 of 3 qualities when palpating for pulse; Normally ranges from 50 to 95 beats per minute but varies with age and gender
Normal Adult: 60-100
Normal Child: 80-110
Normal Infant: 60-160
1 of 3 qualities when palpating for pulse; normally has an even, regular tempo
1 of 3 qualities when palpating for pulse; shows the strength of the heart's stroke volume
1+ Weak, Thready
3+ Full, Bounding (increased stroke volume)
Relaxed, regular, automatic, and silent. The normal rate varies with the patient's age, and the ratio of the pulse rate to respiratory rate commonly is 4:1.
The force of the blood pushing against the blood vessel walls
determined by five factors:
1. cardiac output
2. peripheral vascular resistance
3. volume of circulating blood
5. vessel wall elasticity
The maximum pressure felt on the artery during left ventricular contraction (or systole)
The elastic recoil (or resting) pressure the blood exerts constantly between contractions.
The difference between the systolic and diastolic pressures and reflects the stroke volume.
Mean Arterial Pressure
The pressure forcing blood into the tissues, averaged over the cardiac cycle.
The sounds a medical personnel listen for when they are taking blood presuure
A sensor attached to the individual's finger or earlobe has a diode that emits light and measures light absorption of pulsatile flow.
Term referring to the concentration of oxygen in the blood. It measures the percentage of hemoglobin binding sites in the bloodstream occupied by oxygen.
Normal levels are considered 95-100%
The Doppler technique:
A. is used to assess the apical pulse.
B. augments Korotkoff sounds during blood pressure measurement.
C. provides an easy and accurate measurement of the diastolic pressure.
D. measures arterial oxygenation saturation.
The tympanic membrane thermometer (TMT):
A. provides an accurate measurement of core body temperature.
B. senses the infrared emissions of the cerebral cortex.
C. is not used in unconscious patients.
D. accurately measures temperature in 20 to 30 seconds.
Endogenous obesity is:
A due to inadequate secretion of cortisol by the adrenal glands.
B caused by excess adrenocorticotropin production by the pituitary gland.
C characterized by evenly distributed excess body fat.
D a result of excessive secretion of growth hormone in adulthood.
The nurse records that the patient's pulse is 3+ or full and bounding. Which of the following could be the cause?
Accurate Blood Pressure
The width of the cuff 's rubber bladder should equal 40% of the circumference of the person's arm.
The length of the bladder should equal 80% of this circumference.
A highly complex and subjective experience that originates from the central nervous system or peripheral nervous system or both.
Develops when functioning and intact nerve fibers in the peripheral and central nervous systems are stimulated.
It starts outside the nervous system from actual or potential tissue damage.
Four phases: transduction, transmission,
perception, and modulation.
This pain typically is predictable and time limited based on the extent of the injury
Does not adhere to typical and predictable phases.
It implies an abnormal processing of the pain message as a result of an injury of the nerve fibers.
It is sustained on a neurochemical level.
Pain that originates from larger internal organs, such as the stomach, intestines, gallbladder, and pancreas
Pain that originates from musculoskeletal tissues or the body surface
Deep Somatic Pain
Pain that comes from sources such as blood vessels, joints, tendons, muscles, and bone
Pain that is derived from the skin and subcutaneous tissues
Pain that is felt at a particular site but originates
from another location.
Pain that short-term and self-limiting, often follows a predictable track, and dissipates after the injury heals.
A self-protective purpose; it warns of actual or threatened tissue damage
Pain that continues for 6 months or longer. It results from abnormal processing by pain fibers from peripheral or central sites and does not stop when the injury heals.
The level of pain intensity does not reflect the physical findings
A transient spike in pain level in an otherwise controlled pain syndrome or the result of incident or episodic pain
Which of the following statements regarding cultural/racial differences in the treatment of pain is true?
A. White individuals receive more analgesic therapy than black or Hispanic individuals with similar symptoms.
B. Black and Hispanic individuals have been found to have a higher pain tolerance than white individuals.
C. Pain modulation is more highly developed in black and Hispanic individuals.
D. Neurotransmitters are more concentrated in white individuals than in black and Hispanic individuals.
Specialized nerve endings that are designed to detect painful sensations are:
B. dorsal horns.
D. C fibers.
An older adult patient with dementia has a pain rating of 5 on the Pain Assessment in Advanced Dementia (PAINAD) scale. The nurse should:
A. reassess the pain level in 3 to 4 hours.
B. administer prescribed pain medication.
C. ask the patient to verify the pain rating.
D. use only nonpharmacologic pain relief interventions.
Refers to the degree of balance between nutrient intake and nutrient requirements
Affected by many factors, including physiologic, psychosocial, developmental, cultural, and economic factors.
• Nurse's goal is to determine whether the patient has
optimal nutrition, undernutrition, or overnutrition
Recommended for full-term infants for the first year of life because it is ideally formulated to promote normal infant growth and development and natural immunity
Required for proper growth and central nervous system development; infants and children younger than two need this
Involves rapid physical growth and endocrine and hormonal changes and requires an increase in calories, protein, calcium, and iron.
-First, it identifies people who are malnourished or are at risk for malnutrition.
-Second, it provides data for designing a nutrition plan to prevent malnutrition.
-Third, it establishes baseline data for evaluating nutritional care.
The first step in nutritional assessment
comprehensive nutritional assessment
If screening identifies nutritional risks, the patient
should undergo this: dietary history and clinical information, physical examination, anthropometric measures, and routine laboratory data
24-hour diet recall
The easiest and most popular method for assessing dietary intake
To evaluate growth, development, and body composition;
Include height,weight, triceps skin-fold thickness, elbow breadth,arm span, and frame size
Obesity Class 1
Obesity Class 2
Extreme Obesity Class
vitamin C deficiency
may have the following clinical manifestations petechiae or ecchymoses, bleeding gums, joint pain, and splinter hemorrhages of the nails.
may have the following clinical manifestations: nasolabial seborrhea, red conjunctivae, cheilosis, angular stomatitis, and purplish-colored tongue
vitamin B12 deficiency
may have the following clinical manifestations: pale conjunctivae, disorientation, or irritability.
may have the following clinical manifestations: pale conjunctivae, angular stomatitis; pale tongue; and brittle, ridged, or spoon shaped nails.
Nutritional status is best determined by:
A. serum albumin.
B. clinical manifestations.
D. 24-hour diet recall.
Dietary guidelines suggest that overall fat consumption should be:
A. less than 300 mg per day.
B. between 10% and 20% of the total calorie intake.
C. between 20% and 35% of the total calorie intake.
D. mostly trans-fatty acid or saturated fat.
A comprehensive nutritional assessment always includes:
A. anthropometric measures.
B. a direct observation of feeding and eating processes.
C. a work history.
D. a comprehensive metabolic panel.
Obese persons with more fat in the upper body, especially the abdomen, have:
A. gastronomic obesity.
B. gynoid obesity.
C. anthropometric obesity.
D. android obesity.
The body's largest organ system. It acts as the sentry that guards the body from environmental stress and adapts to other environmental influences
skin's thin, tough outer layer
inner supportive layer of skin
the adipose tissue below the dermis
hair, sebaceous and sweat glands, and nails
It offers protection, prevents penetration, allows perception, regulates temperature, allows identification, allows communication of emotions, repairs wounds, absorbs and excretes some metabolic wastes, and produces vitamin D
immature skin of infants
skin that cannot effectively prevent fluid loss or regulate temperature
causes changes in the stratum corneum that give chemicals easier access to the body, change hair distribution, and cause other changes that lead to
A student nurse has been assigned to teach fourth graders about hygiene. While preparing, the student nurse adds information about the sweat glands. Which of the following should be included while discussing this topic?
A. There are two types of sweat glands: eccrine glands and sebaceous glands.
B. The evaporation of sweat, a dilute saline solution, increases body temperature.
C. Eccrine glands produce sweat and are mainly located in the axillae, anogenital area, and navel.
D. Newborn infants do not sweat and use compensatory mechanisms to control body temperature.
Risk factors that may lead to skin disease and breakdown include:
A. loss of protective cushioning of the dermal skin layer.
B. decreased vascular fragility.
C. a lifetime of environmental trauma.
D. increased thickness of the skin.
What term refers to a linear skin lesion that runs along a nerve route?
The components of a nail examination include:
A. contour, consistency, and color.
B. shape, surface, and circulation.
C. clubbing, pitting, and grooving.
D. texture, toughness, and translucency.
To determine if a dark-skinned patient is pale, the nurse should assess the color of the:
C. palms of the hands.
D. skin in the antecubital space.
An example of a primary lesion is a(n):
D. port-wine stain.
A scooped-out, shallow depression in the skin is called a(n):
Cause‐ peripheral vascular vasoconstriction - Anemia‐ Shock ‐ Arterial insufficiency - Exposure to cold, smoking, stress/fear
Inspect - Generalized pallor‐pale or
dull (feels cool to touch) - Check mucous membranes, lips, nail beds - Dark skin‐ appears ashen gray
Causes: MANY (heart, lungs, shock) Look for other clinical signs (LOC,RR) - Central • Oxygen/hemoglobin deficit - Peripheral • Decreased circulation
INSPECT: light skin‐ dusky blue (lips, nail beds) • Dark Skin‐ difficult, dull (conjunctiva, oral mucosa, nail beds) • O2 Sats Objective data to support
Cause - rising bilirubin in blood • Liver dysfunction • Newborn (OK finding @ 3‐4 day life)
Inspect: Hard & soft palate (first) • Sclera • Mucous membranes • Skin‐ late
Causes: Many possible etiologies • Excess blood in the dilated capillaries • Fever, local inflammation, emotional reaction
Inspect & Palpate: Temperature of skin (palpate) warmth, tightness or hardening tissue. Dark Skin‐ palpate for signs of infection
Exudate; thin watery, fairly clear drainage--serum
Exudate; contains both serous and red blood cells
Exudate; mostly RBC; looks like blood
Exudate; made of white blood cells; pus, color may vary, may have odor
Condition in which interstitial spaces contain such excessive amounts of fluid that the skin remains depressed after palpation
♣ 1+ Mild Pitting; slight indentation;
♣ 2+ Moderate pitting; indentation subsides rapidly
♣ 3+ Deep pitting; indentation remains for a short time
♣ 4+ Very deep pitting; indentation lasts a long time
(German Measles): Pink, popular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots
Small, tight vesicles first appear on trunk and spread to face, arms, and legs (not palms or soles). Vesicles erupt in succeeding crops over several days; they become pustules and then crusts. Intensely pruritic (itchy)
Moist, thin-roofed vesicles with thin, erythematous base. Rupture to form thick, honey-colored crusts. Highly contagious bacterial infection of skin; most common in infants and children. Infection can spread to other body areas and other children and adults by direct contact
circular lesion, begins in the center and spreads to periphery
lesions run together
distinct lesions, individual lesions that remain separate
twisted, coiled, snakelike lesions
clusters of lesions
a scratch, streak, line or striped lesion
or iris lesion, resembles iris of the eye, concentric rings color in lesions
linear arrangement along a unilateral nerve route
annular lesions grow together
prolonged, intense scratching eventually thickens skin and produces tightly packed sets of papules, looks like surface of moss
bruise or wound whose shape suggests that an instrument or weapon caused it
bruise you can feel
Basal cell carcinoma
The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias (broken blood vesssel).
what part of the stethoscope is for high pitched sounds
-breath, bowel, and normal heart sounds
what part of the stethoscope is for soft, low-pitched sounds
-extra heart sounds or murmurs
Staging of bruises:
- immediate‐24 hrs: red, blue or purple
- 1‐5 days: blue to purple
- 5‐7 days: green
- 7‐10 days: yellow
- 10‐14 days: brown to disappear
Occur anywhere on body
Flat, raised, smooth, rough, hairy
Evaluation of moles
▪ Border irregular
▪ Color variation
▪ Diameter > 6mm
▪ Evolving, elevation, enlargement
BIOPSY‐ only way to be sure!
Squamous cell carcinoma
common form of skin cancer that develops in the thin, flat squamous cells that make up the outer layer of the skin
A firm, red nodule
A flat sore with a scaly crust
A new sore or raised area on an old scar or ulcer
A rough, scaly patch on your lip that may evolve to an open sore
A red sore or rough patch inside your mouth
A red, raised patch or wart-like sore on or in the anus or on your genitals
Most serious type of skin cancer, develops in the cells (melanocytes) that produce melanin — the pigment that gives your skin its color
A change in an existing mole; The development of a new pigmented or unusual-looking growth on your skin
A cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat or in other organs.
The patches are usually red or purple and are made of cancer cells and blood cells. The red and purple patches often cause no symptoms, though they may be painful.
If the cancer spreads to the digestive tract or lungs, bleeding can result. Lung tumors can make breathing hard
Screening; (discover the problem early before it worsens),
example: self skin self-care exams:
‐Why self‐assessment is important???
‐To use mirrors!
‐To look at all areas, both sun‐exposed & not!
ringworm; circular, clear centers, pustules, scales (fungal)
absence of melanin pigment in patchy areas
Any condition that slows or stops the flow of blood through your arteries. Arteries are blood vessels that carry blood from the heart to other places in your body.
Vein walls are weakened and valves are damaged. This causes the veins to stay filled with blood, especially when you are standing.
Common, potentially serious bacterial skin infection.
Appears as a swollen, red area of skin that feels hot and tender.
deformity of the fingers and fingernails associated with a number of diseases, mostly of the heart and lungs
The Brief Pain Inventory
rate pain within the past 24 hours (0-10)
The Short-Form McGill Pain Questionnaire
Rank a list of descriptors in terms of their intensity and to give an overall intensity rating to his or her pain
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