Use this guide to formulate your nursing care plans and nursing interventions for patients experiencing acute pain.
Acute Pain.The unpleasant feeling of pain is highly subjective in nature that may be experienced by the patient. The International Association for the Study of Pain (IASP) defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Another great definition of pain is from Margo McCaffery, a nurse expert on pain, defined it as “pain is whatever the person says it is and exists whenever he says it does.”
Acute pain provides a protective purpose to make the patient informed and knowledgeable about the presence of an injury or illness. The unexpected onset of acute pain reminds the patient to seek support, assistance, and relief. It has a duration of fewer than 6 months. The physiological signs that occur with acute pain emerge from the body’s response to pain as a stressor.
Other factors such as the patient’s cultural background, emotions, and psychological or spiritual discomfort may contribute to the suffering of acute pain. In older patients, assessment of pain can be challenging due to cognitive impairment and sensory-perceptual deficits. Assessment and management of the nursing diagnosis of acute pain are the main focus of this care plan.
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:
Alteration in BP, HR, RR
Dilation of the pupils
Proxy reporting pain and behavior/activity changes (e.g., family members, caregivers)
Patient Goals for 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 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.
Nursing Care Plans for Acute Pain
Diseases, medical conditions, and related nursing care plans for Acute Pain nursing diagnosis:
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:
Perform a comprehensive assessment of pain. Determine via assessment the location, characteristics, onset, duration, frequency, quality, and severity of pain.
The patient experiencing pain is the most reliable source of information about his or her 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 help guide your 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?”
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 both help the patient and the nurse in determining 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.
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.
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?”.
Pain should be screened every time vital signs are evaluated.
Many health facilities set pain assessment as the “fifth vital sign” to pain assessment to routine vital signs assessment.
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.
Use the Wong-Baker FACES Rating Scale to determine pain intensity.
Some clients (e.g., children, language constraints) may not be able to relate to numerical pain scales may need to use the Wong-Baker Faces Rating Scale.
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.
Determine the patient’s anticipation for pain relief.
Some patients may be satisfied when pain is no longer massive; others will demand complete elimination of pain. This influences the perceptions of the effectiveness of the treatment of the treatment modality and their eagerness to engage in further treatments.
Assess the patient’s willingness or ability to explore a range of techniques aimed at controlling 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.
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 in planning for an optimal pain management.
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 be more a reflection of other methods the patient is using to cope with the pain rather than pain relief itself.
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.
Nursing Interventions for Acute Pain
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:
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 the administration of analgesics before surgery to decrease or relieve pain after surgery. The preemptive approach is also useful prior to painful procedures like wound dressing changes, physical therapy, postural drainage, etc.
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.
Provide nonpharmacologic pain management.
Nonpharmacologic methods in pain management may include physical, cognitive-behavioral strategies, and lifestyle 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’s 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.
*Cutaneous stimulation or physical interventions
Cutaneous stimulation provides pain relief that is effective 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.
Provide pharmacologic pain management as ordered.
Pain management using pharmacologic methods involves the use of 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.
*Nonopioids include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen.
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 (with the exception of acetaminophen), analgesic, and antipyretic effects. They work by inhibiting the enzyme cyclooxygenase (COX), a chemical that is activated during tissue damage, resulting in decreased synthesis of prostaglandins. NSAIDs also have a ceiling effect meaning that 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 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.
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.
Coanalgesics are medication that are not classified as a pain medication but have the properties that may reduce pain alone or in combination with other analgesics. They may also relieve other discomforts, increase the effectivity of pain medications, or reduce the pain medication’s side effects.
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 reduces the side effects of analgesics.
Evaluate the effectiveness of analgesics as ordered and observe for any signs and symptoms of side effects.
The effectiveness of pain medications must be evaluated individually by the patient since they are absorbed and metabolized differently.
References and Sources
Recommended resources and to further your study for this acute pain nursing care plan.
When you place an order with our company, we ask you to provide us with such personal information as your name, phone number, and email address. We need this data to keep you updated on the important things related to your order or account, and never share it with any third parties. We also don’t use your contact details for spamming you.
Please note that our support team may contact you using only the phone number(s) stated on our website, such +1 (248) 599-2414 and/+44 (151) 528-2636. In order to secure our mutual cooperation, please do not communicate with those who introduce themselves as essaypapers support staff and reach you from different phone numbers.
Also, remember that we never ask you to provide your credit card information via phone conversations. You should enter this information only on PayPal or Gate2Shop billing forms when making an online payment on our website. The essaypapers support administrator will send a confirmation letter to your personal order page when your payment is received.
We take care not only of your academic success, but also of your experience with us. That’s why we have made the process of placing your order as easy and fast as possible—usually, it takes no more than 2-3 minutes.
Let’s have a closer look at the simple steps you need to go through for submitting your order:
Fill in the order form.
Be sure to include specific instructions regarding your paper and to upload any of the required materials. If you have any questions while specifying your paper’s information, just click on the info sign at the end of every field name and you will see a detailed tip on what exact information is required.
Proceed with the payment.
After you are through with the order form, you will need to make a payment via a preferable system. Right after that, you will be automatically provided with your personal order page where you can track your order’s progress, provide additional requirements, and send messages to your writer or support manager.
A personal writer is assigned to your order.
Our qualified staff will choose the most suitable writer whose skills and experience match your field of study and paper’s details. In case the writer must have any particular software or literature in order to get the Nursing Assignment done, please do not forget to mention this in your initial instructions.
Your paper is completed and delivered to your personal order page.
When the writer finishes your paper, it is delivered to your personal order page as a PDF document, available for preview only. You will be able to download an editable MS Word version of the order right after you click the “Approve” button in the “Files” tab of your personal order page. If any changes are to be applied to the paper, you are always welcome to request a free revision with a new deadline for the writer (be sure to check more information about this in our revision policy).
You can check how easy the process is by going to the order page and submitting your paper details right now.
You will get the first version of your paper in a non-editable PDF format within the deadline. You are welcome to check it and inform us if any changes are needed. If everything is okay, and no amendments are necessary, you can approve the order and download the .doc file. If there are any issues you want to change, you can apply for a free revision and the writer will amend the paper according to your instructions.
If there happen to be any problems with downloading your paper, please contact our support team.
If your paper needs some changes, you can apply for a free revision that is available for 7 days after your paper is approved. To use this option, you have a “Revision” button on your personal page.
After the 7-day period, you cannot apply for a free revision, though you still can use a paid revision option. The price of such a revision will differ depending on the number of amendments needed to be done. Please contact our support team to find out how we can help you with the amendments to your paper.
If you think our writer didn’t manage to follow your instructions, and as a result, your paper is of poor quality, please contact us and we will do our best to solve the problem.
If the revisions didn’t give the desired result, you can apply for a refund. Our dispute department will process your inquiry to find out what kind of refund we can give you. To find out more, please visit our money-back guarantee page.
You can’t apply for a refund on certain stages of your order, like when the order is not finished by the writer yet.
When the paper is delivered, the “Refund” button on your personal order page becomes clickable.
On the relevant tab of your personal order page, you will also be able to choose the type of refund you’re demanding and the reason why you applying for it. As soon as you do that, our dispute department will start working on your inquiry. All kinds of refunds concerning the quality or the lateness of your paper should be requested within 14 days from the time the paper was delivered, as in 14 days your paper, will be automatically approved.
Your inquiry should be submitted by clicking the “Refund” button on your personal order page only.