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    NCP Acute Pain

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    Mimi Nacor
    The client presented with acute pain from a first degree burn on the leg. A nursing assessment found the client reporting an 8/10 pain that radiated down the leg and was relieved by rest. Physical signs included facial grimacing and irritability. The short term goal was to reduce the client's pain to 4/10 within 2 hours with interventions like comfort measures, distraction, and as-needed analgesics. The long term goal was to reduce the pain to 2/10 within 8 hours with continued nursing care.

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    NCP Acute Pain

    Uploaded by

    Mimi Nacor
    3K views2 pages
    The client presented with acute pain from a first degree burn on the leg. A nursing assessment found the client reporting an 8/10 pain that radiated down the leg and was relieved by rest. Physical signs included facial grimacing and irritability. The short term goal was to reduce the client's pain to 4/10 within 2 hours with interventions like comfort measures, distraction, and as-needed analgesics. The long term goal was to reduce the pain to 2/10 within 8 hours with continued nursing care.

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    The client presented with acute pain from a first degree burn on the leg. A nursing assessment found the client reporting an 8/10 pain that radiated down the leg and was relieved by rest. Physical signs included facial grimacing and irritability. The short term goal was to reduce the client's pain to 4/10 within 2 hours with interventions like comfort measures, distraction, and as-needed analgesics. The long term goal was to reduce the pain to 2/10 within 8 hours with continued nursing care.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3K views2 pages

    NCP Acute Pain

    Uploaded by

    Mimi Nacor
    The client presented with acute pain from a first degree burn on the leg. A nursing assessment found the client reporting an 8/10 pain that radiated down the leg and was relieved by rest. Physical signs included facial grimacing and irritability. The short term goal was to reduce the client's pain to 4/10 within 2 hours with interventions like comfort measures, distraction, and as-needed analgesics. The long term goal was to reduce the pain to 2/10 within 8 hours with continued nursing care.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Assessment Nursing Inference Planning Intervention Rationale Evaluation

    Diagnosis
    Subjective: Acute pain 1st degree burn Short-term Goal: ASSESSMENT: STG:
    “Masakit lahat nung related to ↓ After 2  Perform a  To assess etiology and Goal met as
    nasunug sakin”, as damaged free Exposed dermis hours of comprehensive degree of severity of evidenced by a
    verbalized by the client. nerve endings ↓ progressive nursing assessment of pain to the problem. pain scale of 4
    secondary to Damage to the free interventions, the include location, out of 10.
    burn. nerve endings client will be able characteristics, onset,
    Objective: ↓ to relieve pain from frequency, quality and LTG:
     Pain scale of 8 out Hypersensitivity of a pain scale of 8 to severity. Goal met as
    of 10 nerve endings 4.  Assess client’s vital signs.  To obtain baseline evidenced by a
     Pricking pain ↓ data, v/s are usually pain scale of 2
    radiating from the Transmission of Long-term Goal: altered during out of 10.
    burned leg pain impulses into After 8  Accept patient’s episodes of acute pain.
    downward. the brain hours of continuous description of pain.  Pain is a subjective
     Pain relieved at ↓ nursing interven- experience and cannot
    rest Pain perception tions, the client will  Encourage verbalization be felt by others.
     (+) facial grimace be able to reduce of feelings about pain.  To assist patient to
     (+)restlessness pain from a scale of explore methods for
     (+) irritability 8 to 2.  Provide client a calm and control of pain.
     Protective quiet environment.  To limit stress to a
    behaviour over  Provide comfort minimum level.
    the area measures (back rub,  To provide
    change in position etc.) nonpharmacological
     Provide diversional pain management.
    activities (listening to  To relieve pain by
    music, socialization etc) distracting pain
     Provide recreational perception.
    activities (playing cards,  To relieve pain by
    etc.) distracting pain
    COLLABORATIVE: perception.
     Provide client/client’s
    relative health
    teachings:
     Inform about existing  To increase
    conditions. awareness.
     Inform conditions  To prevent
    that requires aggravation of
    attention of health condition.
    care providers.
     Encourage splinting  To minimize pain.
    during cough and
    ambulation.
     Encourage to  To decrease
    minimize strenuous tension to the
    activities. painful area.
     Encourage adequate  To prevent fatigue.
    rest periods.
     Encourage high  To hasten tissue
    caloric and high repair.
    CHON diet.
     Encourage proper  To prevent
    hygiene. infection.
     Advice proper  To follow-up
    referral. condition once
    outside the
    hospital.
     Administer analgesics as  To maintain
    ordered by the doctor. acceptable level of
    pain using the
    pharmacological way.

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