A client's family asks if their loved one who is actively dying appears to be in pain. The client is unresponsive. What pain assessment approach should the nurse use?

PAIN ASSESSMENT IN UNRESPONSIVE OR NON-VERBAL PATIENTS requires observational behavioral tools. The inability to self-report pain does NOT mean pain is absent — it means the nurse must observe for behavioral indicators. BEHAVIORAL PAIN SCALES FOR NON-VERBAL PATIENTS: CPOT (Critical-Pain Observation Tool) — developed for ICU/critical care non-verbal patients; assesses: facial expression (relaxed vs. tense vs. grimacing), body movements (absence of movements vs. protection vs. restlessness), muscle tension (relaxed vs. tense vs. very tense), compliance with ventilator/vocalization; score 0-8; PAINAD (Pain Assessment in Advanced Dementia) — developed for dementia patients; assesses: breathing, negative vocalization, facial expression, body language, consolability; score 0-10; FLACC (Faces, Legs, Activity, Cry, Consolability) — used for children and non-verbal adults; AT END OF LIFE: The goal of pain management is comfort; many patients receive scheduled opioids regardless of responsiveness; titrate to behavioral indicators of comfort; involve the palliative care team; speak to the family about what they observe; CULTURAL CONSIDERATION: Some families interpret treatment of terminal pain as hastening death; provide clear education that adequate pain management is humane and does not hasten death (the principle of double effect is not actually an issue with appropriate dosing).