Wilderness Emergency Medical Services Institute


Obtaining a History of Present Illness or Pain

by

Bernie Roche, RN, BScN, W-EMT, OSJ




ASSESSMENT BY PQRST CHECKLIST

This assessment checklist system may be used
for general assessments, or specifically for pain.

Quick Synposis


    P = Provocation and Palliation

        What causes it?
        What makes it better?
        What makes it worse?


    Q = Quality and Quantity

        How does it feel, look or sound?
        How much of it is there?


    R = Region and Radiation

        Where is it?
        Does it spread?


    S = Severity and Scale

        Does it interfere with activities?
        How does it rate on a severity scale of 1 to 10?


    T = Timing and Type of Onset

        When did it begin?
        How often does it occur?
        Is it sudden or gradual?




Obtaining a History of Present Illness or Pain

A More detailed Look at Questioning



    Provocation and Palliation

    • What causes it?
    • What makes it better?
    • What makes it worse?

      • What seems to trigger it? Stress? Position? Certain activities? Arguments?
      • Does it seem to be getting better, or getting worse, or does it remain the same?
      • What relieves it: changing diet? changing position? taking medications? being active? resting?
      • What makes (the problem) worse?


    Quality and Quantity

    • How does it feel, look or sound?
    • How much of it is there?
    • (This is a difficult one as the rating will differ from patient to patient.)

      • Is it sharp? Dull? Stabbing? Burning? Crushing?
      • Try to let patient describe the pain, sometimes they say what they think you would like to hear.

      • If describing a discharge: Thick? Runny? Clear? Colored?
      • If describing a psychological problem: Do the voices drown out other sounds?
      • Whose voice does it sound like?


    Region and Radiation

    • Where is it?
    • Does it spread?

      • Where does the pain radiate?
      • Is it in one place?
      • Does it go anywhere else?
      • Did it start elsewhere and is now localized to one spot?

      • In the case of pain, does it travel:
      • Down your back?
      • Down your arms?
      • Up your neck?
      • Down your legs?


    Severity and Scale

    • Does it interfere with activities?
    • How does it rate on a severity scale of 1 to 10?

      • How bad is it when it's at its worst?
      • Does it force you to sit down, lie down, slow down?
      • How long does an episode last?


    Timing and Type of Onset

    • When did it begin?
    • How often does it occur?
    • Is it sudden or gradual?

      • How long does it last?
      • What time did it begin?
      • When was the first date it happened?
      • What were you doing when you first experienced or noticed it?

      • How often do you experience it: hourly? daily? weekly? monthly?
      • When do you usually experience it: daytime? night? in the early morning?
      • Are you ever awakened by it?
      • Does it lead to anything else?
      • Is it accompanied by other signs and symptoms?
      • Does it ever occur before, during or after meals?
      • Does it occur seasonally?


    Other questions to ask:

    • Any medication or allergies?
    • Does it hurt on deep inspiration?
    • Activity at onset?
    • Any history of pain?
    • Is it the same?
    • Different?
    • Any family history of heart disease, lung problems, diabetes, stroke, hypertension?
    • Check LOC.
    • Pupils?
    • JVD?
    • Midline trachea?
    • Any recent trauma?





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 Medical Services Institute

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