acute pain care plan

Topics: Pain, Opioid, Suffering Pages: 4 (695 words) Published: May 27, 2014


References:

Doenges, M (1992). Nurse’s Pocket Guide: diagnoses, prioritized interventions, and rationales, (13th ed.). Philadelphia: P.A. Davis Company.

Pain. November 5, 2013. Elselvier. Retrieved from http://www.us.elselvierhealth.com.

Vallerand, A. (2013). Davis’s drug guide for nurses, (13th ed.) Philiadelphia:P.A. Davis Company.

Nursing Diagnosis

Acute pain related inflammation secondary to Diverticulitis m/b pt rating pain a “6” on a scale of 0-10, pt guarding abdomen with movements, and facial grimacing with position change.

Outcomes(s)
Pt will have decreased pain as evidence by pt rating pain a 3 or less on a scale of 0-10, pt able to change position and move without and guarding of the abdomen and facial grimacing by the end of the clinical day. Nursing Interventions

1. Obtain pts assessment of pain to include location, characteristics, onset, duration, frequency, quality, intensity. Assess pain on a 0-10 pain scale every hour with rounding. Assess pts description of pain. Acknowledge the pain experience and convey acceptance of pts response to pain.

2. Assess vital signs noting pulse and heart rate q4h. Monitor skin color and temperature, which are usually altered by acute pain.

3. Asses for referred pain, as appropriate.

4. Administer PRN pain medication as per MD order (Hydrocodone/Tylenol 7.5/325 mg PO 3x daily). Assess pain on a 0-10 pain scale, administer medication if pain is 6 or above.

5. Assess pts acceptable level of pain and pain control goals. Teach pt to report pain before it gets severe (8/9 on a scale of 0-10).

6. Provide comfort measures (ie. Touch, repositioning, use of hot or cold packs, nurse’s presence, quiet environment, and calm activities.

7. Evaluate and document pts response to analgesia and assist in transitioning or altering drug regimen, based on individual needs and protocols....

References: Doenges, M (1992). Nurse’s Pocket Guide: diagnoses, prioritized interventions, and rationales, (13th ed.). Philadelphia: P.A. Davis Company.
Pain. November 5, 2013. Elselvier. Retrieved from http://www.us.elselvierhealth.com.
Vallerand, A. (2013). Davis’s drug guide for nurses, (13th ed.) Philiadelphia:P.A. Davis Company.
Nursing Diagnosis
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