Nursing Care Plan for Pain

Nursing Care Plans for Pain (Chronic/Acute)

Nursing Care Plans for pain can be used for patients having unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain).

Pain is a highly subjective state in which a variety of unpleasant sensations and a wide range of distressing factors may be experienced by the sufferer. Pain may be a symptom of injury or illness. Pain may also arise from emotional, psychological, cultural, or spiritual distress. Pain can be very difficult to explain, because it is unique to the individual; pain should be accepted as described by the sufferer. Pain assessment can be challenging, especially in elderly patients, where cognitive impairment and sensory-perceptual deficits are more common.

*Acute pain – duration of less than 6 months

*Chronic pain – duration of greater than 6 months

RELATED FACTORS:

Acute:

• Musculoskeletal disorder
• Trauma
• Pressure points
• Emotional, psychological, spiritual or cultural distress
• Cardiovascular pain
• Diagnostic test or medical treatments
• Pregnancy
• Postoperative pain
• Immobility/improper positioning
• Anxiety/stress

Chronic:

• Physical or psychological disability

AS EVIDENCED BY:

Acute:

• Patient reports or demonstrates discomfort. (Pain Score)
• Autonomic response to acute pain: (e.g., diaphoresis, change in BP, P, R, pupillary dilatation, pallor, nausea)
• Narrowed focus (e.g., altered time perception, withdrawal from social or physical contact)
• Facial mask of pain
• Guarding behavior, protecting body part
• Relief or distraction behavior (e.g., moaning, crying, pacing, restlessness, seeking out other people or activities)

Chronic:

• Weight changes
• Atrophy of involved muscle group
• Fear of re-injury
• Reduced interaction of people
• Altered ability to continue previous activities
• Sympathetic mediated responses (e.g., temp., cold, changes of body position, hypersensitivity)
• Verbal or observed evidence of protective behavior, guarding behavior, facial mask, irritability, self-focusing, restlessness, depression

PLAN AND OUTCOME

• Patient verbalizes adequate relief of pain or ability to cope with incompletely relieved pain.

NURSING INTERVENTIONS:

ON GOING ASSESSMENT

• Assess characteristics of pain: location, severity on a scale of 1 – 10, type, frequency, precipitating factors, and relief factors using the pain assessment form.
• Observe or monitor signs and symptoms associated with pain, such as BP, HR, temperature, color & moisture of skin, restlessness and ability to focus. Some people deny the experience of pain when it is present. Attention to associated signs may help the nurse in evaluating pain.
• Assess for probable cause of pain.
• Assess patient’s knowledge of or preference for the types of pain relief strategies available. Some patients may be unaware of the effectiveness of non-pharmacological methods and may be willing to try them. Often a combination (e.g., mild analgesics with distraction or heat) may be most effective.
• Evaluate the patient’s response to pain and medications or therapeutics aimed at abolishing or relieving pain. It is important to help the patients express as factually as possible the effect of pain relief measures.
• Assess to what degree cultural, environmental, interpersonal, & intrapsychic factors may contribute to pain or pain relief. Evaluate the unique response of each patient rather than stereotyping any patient response.
• If the patient is on PCA, assess the following: pain relief, patency of IV line, amount of pain medication the patient is requesting & possible PCA complications (excessive sedation, respiratory distress, urinary retention, nausea & vomiting, constipation, & IV site pain, redness or swelling.
• Anticipate need for pain relief. One can most effectively deal with pain by preventing it. Early intervention may decrease the total amount of analgesic required.
• Respond immediately to complaint of pain. In the midst of painful experiences, a patient’s perception of time may become distorted. Prompt responses to complaints may result in decreased anxiety in the patient. Teach patient to request analgesics before pain becomes severe.
• Eliminate additional stressors or sources of discomfort whenever possible.
• Provide rest periods to facilitate comfort, sleep, and relaxation. A quiet environment and a darkened room are measures that help facilitate rest.
• Offer analgesics every __ hours or prn (according to physician’s order). Evaluate effectiveness and observe for any signs and symptoms of untoward effects.
• Explore non-pharmacological methods for reducing pain/promoting comfort:

1. Back rubs
2. Slow rhythmic breathing
3. Repositioning
4. Diversional activities such as music, TV, etc.
5. Warm or cold compress

• Notify the physician if interventions are unsuccessful or if the current complaint is a significant change from the patient’s past experience of pain. Patients who request pain medications at more frequent intervals than prescribed may actually require higher doses or more potent analgesics.

Chronic Pain:

• Encourage the patient to keep a pain diary to help in identifying aggravating and relieving factors of chronic pain.
• Acknowledge and convey acceptance of the patient’s pain experience.
• Provide the patient/family with information about chronic pain.

EDUCATION / CONTINUITY OF CARE

• Provide anticipatory instruction on pain causes, appropriate prevention, and relief measures.
• Instruct the patient to report pain & to evaluate and report effectiveness of measures used.
• Teach patient effective timing of medication dose in relation to potentially uncomfortable activities and prevention of peak pain periods.
• Teach the patient about non pharmacologic pain management strategies – cold/warm applications, massage, progressive relaxation, music, imagery, diversional activities, etc.
• Teach the patient & family about the use of pharmacological interventions for pain management:

1. Nonopioids (paracetamol; NSAIDs; & selective NSAIDs (COX-2 inhibitors) – can be taken orally and not associated with dependency and addiction.
2. Opioid analgesics (narcotics) – watch for side effects such as nausea, vomiting, constipation, sedation, respiratory depression, tolerance and dependency.
3. Antidepressants – may be useful adjuncts in a total program of pain management, especially for those with chronic neuropathic pain. In addition to their effect on the patient’s mood, the antidepressants may have analgesic properties apart from their antidepressant actions.

• Refer the patient and family to community support groups and self-help groups for people coping with chronic pain.

More : Nursing Care Plan for Pain - Assessment, Diagnosis and Interventions

Source : http://nursinglibrary.info/nursing-care-plans/nursing-care-plans-for-pain-chronic-acute/