ACUTE PAIN
Defination:
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); sudden or slow onset
of any intensity from mild to severe with an anticipated or predictable end and
a duration of less than 6 months
Related factors:
Injuring agents (biological, chemical, physical, psychological)
Defining Characteristics:
Subjective
·
Verbal or coded report [may be less
from clients younger than age 40, men, and some cultural groups]
·
Changes in appetite and eating
·
[Pain unrelieved and/or increased
beyond tolerance]
Objective
·
Guarded/protective behavior ; antalgic
position/gestures
·
Facial mask; sleep disturbance (eyes
lack luster , beaten look, fixed or scattered movement, grimace)
·
Expressive behavior (restlessness,
moaning, crying, vigilance, irritability,
sighing)
·
Distraction behavior (pacing, seeking
out other people and/or activities, repetitive activities)
·
Autonomic alteration in muscle tone
(may span from listless [flaccid] to rigid)
·
Autonomic responses (diaphoresis; blood
pressure, respiration, pulse change; pupillary
dilation)
·
Self-focusing
·
Narrowed focus (altered time perception,
impaired thought process, reduced interaction with people and environment)
·
[Fear/panic]
Expected outcomes:
The patient will
• Rate pain on a scale of 1–10.
• Articulate factors that
intensify pain and will modify behaviors accordingly.
• State and carry out appropriate
interventions for relief of pain.
• Decrease amount and frequency
of pain medication needed.
• Express feeling of comfort and
relief from pain.
• Perform relaxation exercises at
bedtime.
Interventions And Rationales:
Determine: Assess descriptive characteristics of
pain, including location, quality and intensity on a scale of 1–10, temporal
factors and sources of relief; pain tolerance; ethnicity; attitude and values. Descriptions
about the particulars of pain will help determine what goals are realistic for
the patient.
Perform: Make changes in the environment at the
patient’s suggestion that will promote sleep. This allows patient to
have an active role in treatment.
Apply heat or cold as
prescribed to minimize or relieve pain. Reposition patient and
use pillows to splint or support painful areas, as appropriate to
reduce muscle spasm and to redistribute pressure on body parts. Administer
analgesic medications in a collaborative mode with the patient when alternative
methods are not sufficient to make the pain tolerable. Gaining the
patient’s trust and involvement helps ensure compliance and make reduce
medication intake.
Provide patient with
sleep aids, such as pillows, bath before sleep, and reading materials. Milk and
some high-protein snacks, such as cheese and nuts, contain L-tryptophan and are
also sleep promoters. Personal hygiene and prebedtime rituals promote
sleep in some patients. Comfort measures act as distracters from pain, reduce
muscle tension or spasm, and redistribute pressure on body parts.
Inform: Teach patient relaxation techniques such as guided imagery, deep
breathing, meditation, aromatherapy, and progressive muscle relaxation.
Practice with the patient frequently and especially at bedtime. Purposeful
relaxation efforts usually help promote sleep.
Instruct patient to
eliminate or reduce caffeine and alcohol intake and avoid foods that interfere
with sleep (e.g., spicy foods). Foods and beverages containing caffeine
consumed fewer than 4 hours before bedtime may interfere with sleep. Alcohol
disrupts normal sleep, especially when ingested immediately before
retiring.
Attend: Listen to patient’s description of pain. Allow time for the patient to
talk about his or her frustration. Listening attentively gives the
patient a feeling that the nurse is interested. It also helps determine
progress in alleviating the pain.
Ask patient each day
to describe the quality of his or her sleep. Discomfort associated with
pain may prevent the patient from sleeping well.
Encourage activities
that provide distraction, such as reading, crafts, television, and visits to
help patient focus on non-pain-related matters.
Manage: When possible, allow patient to use alternative pain treatments common
in his or her culture (such as acupuncture) as a substitute or a complement to
Western treatments to promote nonpharmacologic pain management
Refer to case manager/social worker to ensure that follow-up is
provided.
Reference
DeJong, A. E.,
& Gamel, C. (2006, June). Use of simple relaxation technique in burn care:
Literature review. Journal of Advanced Nursing, 54(6), 710–721
COMMENTS