How should pain be assessed in residents who cannot verbally express it?

• A. Rely on verbal complaints only.
• B. Observe nonverbal cues and use a nonverbal pain scale.
• C. Measure blood pressure as the sole indicator.
• D. Do not assess pain unless the resident asks.

Answer: (B)

When residents can’t verbalize pain, you assess it by watching for nonverbal cues and using a structured nonverbal pain scale. Look for facial expressions (grimacing, frowning), body language (restlessness, guarding, changes in posture or activity), vocalizations (moaning, sighing), and any changes from their usual behavior or mood. A validated tool like the FLACC scale or PAINAD helps translate what you observe into a pain score, guiding when to start or adjust pain management. Regular, proactive assessment is essential, and information from family about the resident’s typical pain indicators can be very helpful. Blood pressure or other vital signs alone aren’t reliable indicators of pain, and the resident should not wait to voice pain or ask about it—the assessment should happen consistently and after interventions to determine effectiveness.