Nursing Care Plan for Pain Management

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nursing care plan for pain

Pain is one of the most common reasons why patients see their doctors. Because of how common it is, nurses should have the skills not just in assessing the pain but managing it as well.

And to help you out, here’s a guide to drafting the best nursing care plan for pain management.

What is Pain?

Pain is highly subjective. What your patient says about the pain he is experiencing is the best indicator of that pain. We can’t prove or disprove what the patient is feeling. We also can’t assume.

Pain can be classified into two types. You can distinguish one from the other according to the cause, onset, and duration.

Acute pain

Acute pain can have a sudden or slow onset with an intensity ranging from mild to severe. It can happen after a medical procedure, surgery, trauma or acute illness. It has a duration of less than 6 months.

Chronic pain

For pain to be classified as chronic, the patient needs to be experiencing it for more than 6 months. Its intensity can range from mild to extremely incapacitating. In some cases, chronic pain can restrict a patient’s ability to perform his Activities of Daily Living and this usually ends up with feelings of despair.

Chronic pain has two subcategories: malignant and non-malignant.

Malignant refers to pain associated with cancer and other progressive diseases. Non-malignant chronic pain, on the other hand, refers to pain that persists beyond the expected time of healing.

The Nursing Care Plans

If you are caring for a patient who is in pain, it’s important that you know the skills to assess and manage his discomfort properly. As a guide, here are some nursing care plans for pain management you can use.

Acute Pain

acute pain management

May be related to
-Injuring agents (biological, chemical, physical, psychological)

Possibly evidenced by
-Patient’s report of pain
-Guarded and protective behavior
-Loss of appetite
-Inability to perform Activities of Daily Living
-Narrowed focus
-Autonomic responses
-Changes in muscle tone
-Expressive behavior (restlessness, crying, moaning)
-Facial mask of pain
-Sleep disturbance

Desired outcome
-Verbalizes pain relief methods
-Demonstrates use of appropriate diversional activities and relaxation skills
-Reports pain management methods relieve pain to a satisfactory level
-Reports ability to get enough sleep and rest
-Displays improved vital signs and muscle tone

Nursing Interventions Rationale
Perform a comprehensive assessment. Assess location, characteristics, onset, duration, frequency, quality and severity of pain. Assessment is the first step in managing pain. It helps ensure that the patient receives effective pain relief.
Observe for nonverbal indicators of pain: moaning, guarding, crying, facial grimace. Some patients may deny the existence of pain. These behaviors can help with proper evaluation of pain.
Accept patient’s description of pain. Pain is highly subjective.
Obtain vital signs. Vital signs are usually affected when pain is present.
Assess the client’s current use of medications. Aids in planning and in obtaining medication history.
 Anticipate the need for pain management. Early and timely intervention is key to effective pain management. It can even reduce the total amount of analgesia required.
 Provide a quiet environment. Additional stressors can intensify patient’s perception and tolerance of pain.
 Use nonpharmacological pain relief methods (relaxation exercises, breathing exercises, music therapy). Works by increasing the release of endorphins, boosting the therapeutic effects of pain relief medications.
Provide optimal pain relief by administering prescribed pain relief medication. Various types of pain requires different analgesic approaches. Some responds well to non-opioid pain relievers while others demand a combination of non-opioid and low dose opioid.
Review patient’s medication records and flow sheet. It helps determine the effectiveness of the pain control measures. If the patient demands pain medications more frequently, a higher dose may be needed.
Document patient’s response to pain management. It helps the entire healthcare team evaluate their pain management strategy.

Chronic pain

chronic pain

May be related to
-Chronic physical and psychological disability
-Injuring agents (biological, chemical, physical, psychological)

Possibly evidenced by
-Patient’s report of pain
-Changes in sleep pattern
-Changes in appetite
-Irritability, restlessness, depression
-Weight changes
-Atrophy of involved muscles
-Less interaction with people
-Sympathetic mediated responses
-Facial mask
-Guarding behavior

Desired outcome
-Verbalizes or demonstrates relief or control of pain
-Demonstrates use of both nonpharmacological and pharmacological pain relief strategies
-Shows ability to engage in activities
-Shows use of appropriate therapeutic interventions

Nursing Interventions Rationale
Perform a comprehensive assessment. Assess location, characteristics, onset, duration, frequency, quality and severity of pain. Assessment is the first step in managing pain. It helps ensure that the patient receives effective pain relief.
Check current and past analgesic/narcotic drug use. It helps obtain a medication history.
Review the patient’s expectation of pain relief. It’s possible that pain may not be completely resolved but it can be lessened significantly.
Encourage patient to use breathing techniques and positive affirmations. This helps the patient achieve generalized relaxation which aids in reduced perception of pain.
Explore the patient’s need for medications from the three classes of analgesics: NSAIDS, opioids and nonopioids. Combinations of analgesics may enhance pain relief.
As much as possible, use tranquilizers, narcotics, and analgesics sparingly. These medications promote addiction and can cause sleep disturbance.
Encourage use of nonpharmacological interventions (massage, guided imagergy, breathing techniques). They help reinforce pharmacological interventions.
Determine the patient’s appetite, bowel elimination, and ability to rest and sleep. Side effects should be monitored and managed accordingly.
Evaluate effectiveness of pain medications and ask to decrease or increase dose and frequency as necessary. Medications should be adjusted to achieve optimum pain relief without causing severe adverse effects.

 

Resources:

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.

See Also: Nurse Skills: How to Write a Badass Nursing Care Plan

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