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Which pain assessment tool would the nurse utilize for a patient who has cognitive impairment and pain related to an ankle fracture?

According to the American Geriatrics Society, pain is highly prevalent in persons with dementia, yet it is often underdiagnosed and undertreated. For a patient with cognitive impairment experiencing pain from an ankle fracture, a nurse would utilize an observational pain assessment tool, such as the Pain Assessment in Advanced Dementia (PAINAD) scale. This scale is designed to evaluate pain through observable behaviors rather than relying on self-report, which is not possible for those with limited communication abilities.