Acute Pain, Acute Pain Nursing Assessment, Acute Pain Nursing Interventions, and 5 Acute Pain Nursing Care Plans.

Acute Pain, Acute Pain Nursing Assessment, Acute Pain Nursing Interventions, and 5 Acute Pain Nursing Care Plans.

This study guide is about acute pain, acute pain nursing assessment, acute pain nursing interventions, and 5 acute pain nursing care plans. Use it to create educational nursing care plans for acute pain.

Acute Pain

What is acute pain?

Acute Pain, Acute Pain Nursing Assessment, Acute Pain Nursing Interventions, and 5 Acute Pain Nursing Care Plans.
Acute Pain

Acute pain is an experience that is known to virtually all human beings. It is an unpleasant feeling that can be described as highly subjective as a person experiences it. An acute pain nursing diagnosis is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain). It can occur after surgery, injury, labor, and delivery.

The nurse has an ethical responsibility to provide adequate management of acute pain problems because it is ineffective to ask a patient to verbalize their complaints when the patient is in pain. The nurse provides support and education to clients in order to relieve pain because this helps maintain or improve the client’s level of function. It can be the sudden or slow onset of any intensity, ranging from mild to severe, and can be experienced for a few seconds, up till 6 months. Chronic pain is defined as pain that is long-term experienced for more than 6 months. The following nursing interventions for acute pain can help a nurse to provide efficient and excellent care to a patient with Acute Pain.

What are the common signs and symptoms of acute pain?

The following are the common manifestations of acute pain. Use these subjective and objective data to help guide you through the nursing assessment. Alternatively, you can check out the assessment guide for acute pain in the subsequent sections.

  • The most common characteristic of acute pain is when the patient reports or complaints about it. It is also the most common chief complaint that brings patients to their health care providers.
    • Self-report of intensity using standardized pain intensity scales (e.g., Wong-Baker FACES scale, visual analog scale, numeric rating scale)
    • Self-report of pain characteristics (e.g., aching, burning, electric shock, pins, and needles, shooting, sore/tender, stabbing, throbbing) using standardized pain scales (e.g., McGill Pain Questionnaire, Brief Pain Inventory)
  • Other signs of pain include:
    • Guarding behavior or protecting the body part
    • Facial mask of pain (e.g., grimaces)
    • Expression of pain (e.g., restlessness, crying, moaning)
  • Autonomic response to pain:
    • Profuse sweating
    • Alteration in BP, HR, RR
    • Dilation of the pupils
  • Proxy reporting pain and behavior/activity changes (e.g., family members, caregivers)

What are the expected outcomes for the nursing diagnosis of acute pain?

The following are the common nursing care planning goals and expected outcomes for Acute Pain:

  • Patient demonstrates the use of appropriate diversional activities and relaxation skills.
  • Patient describes satisfactory pain control at a level (for example, less than 3 to 4 on a rating scale of 0 to 10)
  • Patient displays improved well-being such as baseline levels for pulse, BP, respirations, and relaxed muscle tone or body posture.
  • Patient uses pharmacological and nonpharmacological pain-relief strategies.
  • Patient displays improvement in mood, coping.

Acute Pain Nursing Assessment

How can nurses access acute pain?

Acute Pain, Acute Pain Nursing Assessment, Acute Pain Nursing Interventions, and 5 Acute Pain Nursing Care Plans.
Acute Pain Nursing Assessment

Proper nursing assessment of Acute Pain is imperative for the development of an effective pain management plan. Nurses play a crucial role in the assessment of pain, use these techniques on how to assess for Acute Pain:

1. Perform a comprehensive assessment of pain. Determine the location, characteristics, onset, duration, frequency, quality, and severity of pain via assessment.
The patient experiencing pain is the most reliable source of information about their pain. Thus, assessment of pain by conducting an interview helps the nurse in planning optimal pain management strategies.

Alternatively, you can use the nursing mnemonic “PQRST” to guide you during pain assessment:

  • Provoking Factors: “What makes your pain better or worse?”
  • Quality (characteristic): “Tell me what it’s exactly like. Is it a sharp pain, throbbing pain, dull pain, stabbing, etc?”
  • Region (location): “Show me where your pain is.”
  • Severity: Ask your pain to rate pain by using different pain rating methods (e.g., Pain scale of 1-10, Wong-Baker Faces Scale).
  • Temporal (onset, duration, frequency): “Does it occur all the time or does it come and go?”

2. Assess for the location of the pain by asking to point to the site that is discomforting.
Using charts or drawings of the body can help the patient, and the nurse determines specific pain locations. For clients with a limited vocabulary, asking to pinpoint the location helps in clarifying your pain assessment – this is especially important when assessing pain in children.

3. Perform history assessment of pain
Additionally, the nurse should ask the following questions during pain assessment to determine its history: (1) effectiveness of previous pain treatment or management; (2) what medications were taken and when; (3) other medications being taken; (4) allergies or known side effects to medications.

4. Determine the client’s perception of pain.
In taking a pain history, provide an opportunity for the client to express in their own words how they view the pain and the situation to gain an understanding of what the pain means to the client. You can ask, “What does having this pain mean to you?”, “Can you describe specifically how this pain is affecting you?”.

5. Pain should be screened every time vital signs are evaluated.
Many health facilities set pain assessment as the “fifth vital sign” and should be added to routine vital signs assessment.

6. Pain assessments must be initiated by the nurse.
Pain responses are unique from each person, and some clients may be reluctant to report or voice out their pain unless asked about it.

7. Use the Wong-Baker FACES Rating Scale to determine pain intensity.
Some clients (e.g., children, language constraints) may not relate to numerical pain scales may need to use the Wong-Baker Faces Rating Scale.

 8. Investigate signs and symptoms related to pain.
Bringing attention to associated signs and symptoms may help the nurse in evaluating the pain. In some instances, the existence of pain is disregarded by the patient.

9. Determine the patient’s anticipation for pain relief.
Some patients may be satisfied when pain is no longer intense; others will demand complete elimination of pain. This influences the perceptions of the effectiveness of the treatment modality and their eagerness to engage in further treatments.

10. Assess the patient’s willingness or ability to explore a range of techniques to control pain.
Some patients may be hesitant to try the effectiveness of nonpharmacological methods and may be willing to try traditional pharmacological methods (i.e., use of analgesics). A combination of both therapies may be more effective, and the nurse has the duty to inform the patient of the different methods to manage pain.

11. Determine factors that alleviate pain.
Ask clients to describe anything they have done to alleviate the pain. These may include, for example, meditation, deep breathing exercises, praying, etc. Information on these alleviating activities can be integrated into planning for optimal pain management.

12. Evaluate the patient’s response to pain and management strategies.
It is essential to assist patients to express as factually as possible (i.e., without the effect of mood, emotion, or anxiety) the effect of pain relief measures. Inconsistencies between behavior or appearance and what the patient says about pain relief (or lack of it) may reflect other methods the patient is using to cope with the pain rather than pain relief itself.

13. Evaluate what the pain suggests to the patient.
The meaning of pain will directly determine the patient’s response. Some patients, especially the dying, may consider that the “act of suffering” meets a spiritual need.

 Acute Pain Nursing Interventions

What are the nursing interventions for acute pain?

Acute Pain, Acute Pain Nursing Assessment, Acute Pain Nursing Interventions, and 5 Acute Pain Nursing Care Plans.
Acute Pain Nursing Interventions

Nurses are not to judge whether the acute pain is real or not. As a nurse, we should spend more time treating patients. The following are the therapeutic nursing interventions for your acute pain care plan:

1. Provide measures to relieve pain before it becomes severe.
It is preferable to provide an analgesic before the onset of pain or before it becomes severe when a larger dose may be required. An example would be preemptive analgesia, which is administering analgesics before surgery to decrease or relieve pain after surgery. The preemptive approach is also useful before painful procedures like wound dressing changes, physical therapy, postural drainage, etc.

2. Acknowledge and accept the client’s pain.
Nurses have the duty to ask their clients about their pain and believe their reports of pain. Challenging or undermining their pain reports results in an unhealthy therapeutic relationship that may hinder pain management and deteriorate rapport.

3. Provide nonpharmacologic pain management.
Nonpharmacologic methods in pain management may include physical, cognitive-behavioral strategies, and lifestyle pain management. See methods below: 

3.1. Provide cognitive-behavioral therapy (CBT) for pain management.
These methods are used to provide comfort by altering psychological responses to pain. Cognitive-behavioral interventions include:

  • Distraction. This technique involves heightening one’s concentration upon non-painful stimuli to decrease one’s awareness and experience of pain. Drawing the person away from the pain lessens the perception of pain. Examples include reading, watching TV, playing video games, guided imagery.
  • Eliciting the Relaxation Response. Stress correlates to an increase in pain perception by increasing muscle tension and activating the SNS. Eliciting a relaxation response decreases the effects of stress on pain. Examples include directed meditation, music therapy, deep breathing.
  • Guided imagery. Involves the use of mental pictures or guiding the patient to imagine an event to distract from the pain.
  • Repatterning Unhelpful Thinking. Involves patients with strong self-doubts or unrealistic expectations that may exacerbate pain and result in failure in pain management.
  • Other CBT techniques include Reiki, spiritually directed approaches, emotional counseling, hypnosis, biofeedback, meditation, relaxation techniques.

3.2. Provide cutaneous stimulation or physical interventions
Cutaneous stimulation provides effective pain relief, albeit temporary. The way it works is by distracting the client away from painful sensations through tactile stimuli. Cutaneous stimulation techniques include:

  • Massage. When appropriate, massaging the affected area interrupts the pain transmission, increases endorphin levels, and decreases tissue edema. Massage aids in relaxation and decreases muscle tension by increasing superficial circulation to the area. Massage should not be done in areas of skin breakdown, suspected clots, or infections.
  • Heat and cold applications. Cold works by reducing pain, inflammation, and muscle spasticity by decreasing the release of pain-inducing chemicals and slowing the conduction of pain impulses. Cold is best when applied within the first 24 hours of injury while heat is used to treat the chronic phase of an injury by improving blood flow to the area and through reduction of pain reflexes.
  • Acupressure. An ancient Chinese healing system of acupuncture wherein the therapist applies finger pressure points that correspond to many of the points used in acupuncture.
  • Contralateral stimulation. Involves stimulating the skin in an area opposite to the painful area. This technique is used when the painful area cannot be touched.
  • Transcutaneous Electrical Nerve Stimulation (TENS). Is the application of low-voltage electrical stimulation directly over the identified pain areas or along with the areas that innervate pain.
  • Immobilization. Restriction of movement of a painful body part is another nonpharmacologic pain management. To do this, you need splints or supportive devices to hold joints in the position optimal for function. Note that prolonged immobilization can result in muscle atrophy, joint contracture, and cardiovascular problems. Check with the agency protocol.
  • Other cutaneous stimulation interventions include therapeutic exercises (tai-chi, yoga, low-intensity exercises, ROM exercises), acupuncture.

4. Provide pharmacologic pain management as ordered.
Pain management using pharmacologic methods involves using opioids (narcotics), nonopioids (NSAIDs), and coanalgesic drugs.

The World Health Organization (WHO) in 1986 published guidelines in the logical usage of analgesics to treat cancer using a three-step ladder approach – also known as the analgesic ladder. The analgesic ladder focuses on aligning the proper analgesics with the intensity of pain.

  • Step 1: For mild pain (1 to 3 pain rating), the WHO analgesic ladder suggests the use of nonopioid analgesics with or without coanalgesics. If pain persists or increases despite providing full doses, then proceed to the next step.
  • Step 2: For moderate pain (4 to 6 pain rating), opioid, or a combination of opioid and nonopioid is administered with or without conanalgesics.
  • Step 3: For severe pain (7 to 10), the opioid is administered and titrated in ATC scheduled doses until the pain is relieved.

4.1. Provide nonopioids including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, as ordered.
NSAIDs work in peripheral tissues. Some block the synthesis of prostaglandins, which stimulate nociceptors. They are effective in managing mild to moderate pain. All NSAIDs have anti-inflammatory (except for acetaminophen), analgesic, and antipyretic effects. They work by inhibiting the enzyme cyclooxygenase (COX), a chemical activated during tissue damage, resulting in decreased synthesis of prostaglandins. NSAIDs also have a ceiling effect. Once the maximum analgesic benefit is achieved, additional amounts of the same drug will not produce more analgesia and may risk the patient for toxicity.

Common side effects of NSAIDs include heartburn or indigestion. There is also a possibility of forming a small stomach ulcer due to platelet aggregation. To prevent these side effects, clients should be taught to take NSAIDs with food and a full glass of water.

Common NSAIDs include:

  • Aspirin. It can prolong bleeding time and should be stopped a week before a client undergoes any surgical procedure. Should never be given to children below 12 years of age due to the possibility of Reye’s syndrome. May cause excessive anticoagulation if the client is taking warfarin.
  • Acetaminophen (Tylenol). May have serious hepatotoxic side effects and possible renal toxicity with high dosages or with long-term use. Limit acetaminophen usage to 3 grams per day.
  • Celecoxib (Celebrex). Is a COX-2 inhibitor that has fewer GI side-effects than COX-1 NSAIDs.

4.2. Administer opioids as ordered.
Opioids are indicated for severe pain and can be administered orally, IV, PCA systems, or epidurally.

  • Opioids for moderate pain. These include codeine, hydrocodone, and tramadol (Ultram) which are combinations of nonopioid and opioid.
  • Opioids for severe pain. These include morphine, hydromorphone, oxycodone, methadone, and fentanyl. Most of these are controlled substances due to potential misuse. These drugs are indicated for severe pain, or when other medications fail to control pain.

4.3. Administer coanalgesics (adjuvants), as ordered.
Coanalgesics are medications that are not classified as pain medication but have properties that may reduce pain alone or in combination with other analgesics. They may also relieve other discomforts, increase the effectiveness of pain medications, or reduce the pain medication’s side effects. Commonly used coanalgesics include: 

  • Antidepressants. Is a common coanalgesic that helps in increasing pain relief, improve mood, and reduce excitability.
  • Local Anesthetics. These drugs block the transmission of pain signals and are used for pain in specific areas of nerve distribution.
  • Other coanalgesics. Include anxiolytics, sedatives, antispasmodics to relieve other discomforts. Stimulants, laxatives, and antiemetics are other coanalgesics that reduce the side effects of analgesics.

5. Manage acute pain using a multimodal approach.
A multimodal approach is based on using two or more distinct methods or drugs to enhance pain relief (rather than resorting to opioid use or other pain management strategies alone). Different combinations of analgesic medications, adjuvants, and procedures can act on different sites and pathways in an additive or synergistic fashion. Combining medications and techniques allows the lowest effective dose of each drug to be administered, resulting in reduced side effects.

6. Administer analgesia before painful procedures whenever possible.
Doing so will help prevent pain caused by relatively painful procedures (e.g., wound care, venipunctures, chest tube removal, endotracheal suctioning, etc.).

7. Perform nursing care during the peak effect of analgesics. 
Oral analgesics typically peak in 60 minutes, intravenous analgesics in 20 minutes. Performing nursing tasks during the peak effect of analgesics optimizes client comfort and compliance in care.

8. Evaluate the effectiveness of analgesics as ordered and observe for any signs and symptoms of side effects.
The patient’s effectiveness of pain medications must be evaluated individually since they are absorbed and metabolized differently.

5 Acute Pain Nursing Care Plans

What are some of the available nursing care plans for acute pain?

Acute Pain Nursing Care Plan 1

Nursing Diagnosis: Acute Pain related to hip fracture secondary to fall, as evidenced by pain score of 10 out of 10, guarding sign on the affected limb, restlessness, and irritability

Desired Outcome: The patient will report a pain score of 0 out of 10.

Interventions Rationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the pain he/she is experiencing. To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesic pain medications as prescribed. To provide pain relief to the patient.
Ask the patient to re-rate his/her acute pain 30 minutes to an hour after administering the analgesic. To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals. To promote pain relief and patient comfort without the risk of overdose.
Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises. To promote optimal patient comfort and reduce anxiety/ restlessness.
Refer the patient to a pain specialist if ordered by the medical provider. To enable to patient to receive more information and specialized care in pain management if needed.

Acute Pain Nursing Care Plan 2

Nursing Diagnosis: Deficient Knowledge related to acute pain management as evidenced by the patient’s verbalization of “I want to know more how to relieve my pain.”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of his/her acute pain and its management.

Interventions Rationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits). To address the patient’s cognition and mental status towards pain management and to help the patient overcome blocks to learning.
Explain what his/her pain management program entails (e.g. medications, relaxation techniques, related physiotherapy, or exercises). Avoid using medical jargon and explain in layman’s terms. To provide information on his/her pain management program.
Explain to the patient the details of the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to treat acute pain. Ask the patient to repeat or demonstrate the self-administration details to you. To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Educate the patient about non-pharmacological methods for acute pain such as imagery, distraction techniques, recommended exercises, and relaxation techniques. To reduce stress and to promote optimal pain relief without too much dependence on pharmacological means.

Acute Pain Nursing Care Plan 3

Nursing Diagnosis: Activity intolerance related to acute pain as evidenced by pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness, and generalized weakness

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate an increase in activity levels.

Interventions Rationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. To create a baseline of activity levels and mental status related to acute pain, fatigue, and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest. To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest.
Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to the physiotherapy / occupational therapy team as required. To provide more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.

Acute Pain Nursing Care Plan 4

Nursing Diagnosis: Acute Pain related to infection secondary to pleurisy as evidenced by pain score of 10 out of 10, pain upon inhalation, shortness of breath

Desired Outcome: The patient will have a pain score of 0 out of 10.

Interventions Rationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10 and describe the pain he/she is experiencing. To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesic pain medications as prescribed. Administer antibiotics as prescribed. To provide pain relief to the patient. To treat the underlying infection.
Ask the patient to re-rate his/her acute pain 30 minutes to an hour after administering the analgesic. To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals. To promote pain relief and patient comfort without the risk of overdose.
Elevate the head of the bed and encourage the patient to sit in semi Fowler’s position. Encourage pursed-lip breathing and deep breathing exercises. To relieve shortness of breath and help in lung expansion. To promote optimal patient comfort and reduce anxiety/ restlessness.
Refer the patient to a pain specialist as required. To enable to patient to receive more information and specialized care in pain management if needed.

Acute Pain Nursing Care Plan 5

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decreasing food intake secondary to acute pain as evidenced by weight loss, poor muscle tone, and lack of appetite

 Desired Outcome: The patient will be able to achieve weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

Intervention Rationale
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short-term and long-term goals of weight gain. To effectively monitor the patient’s daily nutritional intake and progress in weight goals.
Administer analgesics as prescribed To provide pain relief as acute pain may result in disinterest in eating and eventual lack of proper nutrition.
Instruct the patient to avoid carbonated beverages and gas-producing food. To reduce abdominal distention which can worsen acute pain.
Refer the patient to the dietitian. To provide more specialized care for the patient in terms of nutrition and diet.

With the use of the nursing care plans above, the patient will be able to experience pain relief, or reduced pain level, and will be able to perform his/her activities of daily living optimally.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.

 

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