2.3: The PQRSTU Assessment

There are many tools to help you further explore a client’s symptoms or signs. A common one follows the mnemonic PQRSTU as illustrated in Figure 2.2, which offers a systematic approach to asking assessment questions without leaving out any details.

Figure 2.2: The PQRSTU assessment mnemonic

 

The mnemonic is often used to assess pain, but it can also be used to assess many signs and symptoms related to the client’s main health needs, and other signs and symptoms that are discussed during the complete subjective health assessment. Table 2.3 lists examples of prompting questions using this mnemonic.

 

Table 2.3: The PQRSTU assessment mnemonic

PQRSTU	Questions Related to Pain	Questions Related to Other Symptoms
Provocative	What makes your pain worse?	What makes your breathing worse?
Palliative	What makes your pain feel better?	What makes your nausea better?
Quality	What does the pain feel like? Note: If the client struggles to answer this question, you can provide suggestions such as “aching,” “stabbing,” “burning.”	What does the itching feel like?
Quantity	How bad is your pain?	How bad is the itching?
Region	Where do you feel the pain? Point to where you feel the pain.	Where exactly do you feel the nausea?
Radiation	Does the pain move around? Do you feel the pain elsewhere?	Do you feel the nausea elsewhere?
Severity (severity scale)	How would you rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you’ve ever experienced? Note: The severity scale is an important assessment of pain and when used can provide evaluation of a treatment’s effectiveness. After eliciting a baseline, you may provide some sort of pain control intervention and then reassess the pain to see if it was effective.	How would you rate your breathing issues on a scale of 0 to 10, with 0 being no problems and 10 being the worst breathing issues you’ve ever experienced?
Timing	When did the pain start? What were you doing when the pain started? Where were you when the pain started? Is the pain constant or does it come and go? If the pain is intermittent, when did it last occur? How long does the pain last?	When did your breathing issues begin? What were you doing when the itching first started? Where were you when the itching first started? Is the nausea constant or does it come and go? If the nausea is intermittent, when did it last occur? How long did the nausea last?
Treatment	Have you taken anything to help relieve the pain? Have you tried any treatments at home for the pain?	Have you taken anything to relieve the itching better? Have you tried any treatments at home for the itching?
Understanding	What do you think is causing the pain?	What do you think is causing the rash?

The order of questions you ask will often depend on the symptom or sign and the flow of the conversation with the client. You will also want to be aware of responses that don’t seem to align. For example, if a client responds to the question about quantity of pain by saying “the pain isn’t too bad,” but then rates the severity of their pain as being 8/10, you should probe further. It is okay to say to the client, “I noticed you rated your pain fairly high, at 8/10, but you said it isn’t too bad. Can you tell me more about that?”

Clinical Tip

When using the PQRSTU mnemonic for assessment, be sure to apply it comprehensively so that you elicit a full understanding of a particular sign or symptom. See Film Clip 2.2 for effective demonstration of using the PQRSTU mnemonic, and Film Clip 2.3 for ineffective demonstration of using the PQRSTU mnemonic.

Film Clip 2.2: Effective use of the PQRSTU mnemonic

Film Clip 2.3: Ineffective use of the PQRSTU mnemonic

Developmental and Cultural Considerations

Younger children or clients with developmental delays or disabilities, or cognitive impairments, may not be able to answer the types of questions shown in Table 2.3. The care partner might be able to help answer some of these questions, and in that case, you should explore “why” and “how” questions. For example, if the care partner indicates that the infant’s pain started two weeks ago, you should ask “Why or how do you know that it started then?” Or if you are working with a young child, you will need to modify your language to be more understandable (e.g., “Where does it hurt?” “Where is your owie?”).

You can also assess pain in young children using the Wong-Baker FACES Pain Rating Scale (see Figure 2.3). When using this scale, ask the client to choose the face that best depicts the pain they are experiencing. You may need to explain what the faces mean: Face 0 doesn’t hurt at all, Face 2 hurts just a little bit, Face 4 hurts a little bit more, Face 6 hurts even more, Face 8 hurts a whole lot, and Face 10 hurts as much as you can imagine.

Figure 2.3: Wong-Baker FACES® Pain Rating Scale Wong-Baker FACES Foundation (2019). Wong-Baker FACES® Pain Rating Scale. Retrieved May 29, 2019, with permission from http://www.WongBakerFACES.org (see their website for licensing)

 

Alternative scales exist to assess pain and other symptoms that are more relevant to certain cultures. See Figure 2.4 for an example of a Sun-Cloud-Pain Scale. On this sliding scale, 0 indicates that the client feels very well whereas 5 indicates that the client is feeling very unwell.

 

Figure 2.4: Sun-Cloud-Pain Scale. Graphic Created Using Icons by Linseed Studio from the Noun Project.

Test Yourself

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