Nursing Care Plan for Acute Pain

Acute Pain Pathophysiology

Acute pain is a sudden discomfort that typically lasts three to six months. It can serve as a warning of disease, illness, or traumatic event. Some examples include: a burn, cut, or broken bone.

Acute pain might be mild and last just a moment, or it might be severe and last for weeks or months. In most cases, acute pain disappears when the underlying cause of the pain has been treated. It usually occurs in response to tissue injury and results from activating peripheral pain receptors and their specific A-delta and C-sensory nerve fibers (nociceptors).

• Nociceptive pain (pain caused by tissue injury) may be somatic or visceral
• Somatic pain receptors are located in the skin, subcutaneous tissue, fascia and other connective tissues.
• Visceral pain is due to an obstruction of a hollow organ or deep connective tissue

Causes

• Injury or trauma (biological, chemical, or physical)
• Illness or disease
• Surgery
• Muscle tears & strains
• Burns

Symptoms

• Aching
• Burning
• Sharpness
• Stabbing
• Radiating
• Throbbing
• Sweating
• Pupil dilation

Subjective (Patient May Report)

• The patient reports their own level of pain based on a pain scale
• The pain can cause disturbances in eating, sleeping, appetite, and activities of daily living.

Objective

• Vital sign changes
• Guarding behavior (covering affected areas with hands or arms)
• Expressions on the face (grimacing)
• Increased blood pressure
• Increased heart rate

Risk Factors

• Diabetes
• LV dysfunction
• Factors that affect acute pain management such as: age, sex, race/ethnicity, pain severity, comorbidities (including mental health and substance use), genetic factors.

Acute Pain Nursing Intervention

Assessment

Monitor the patient’s vital signs and administer medications that don’t interfere with other serious conditions.

Cardiac Function

• Possible myocardial ischemia 
• Increased heart rate

Respiratory function

• When opioids are administered, respirations may decrease, and synergistic effects with anesthetic drugs may develop.
• Increased respiratory rate with increased pain

Neurologic and Sensory Functions

• Distressing feelings and emotions
• Inflammation of sensory nerves 

Visual Appearance & Labs

• Inconsistencies between behavior or appearance and what the patient says about pain relief (or lack of it)
• Anxiety

Nursing Diagnosis for Acute Pain

Assessment 

Distinguish between chronic and acute pain using a numeric pain scale. Consider factors such as age, sex, race/ethnicity, pain severity, comorbidities (including mental health and substance use), and genetic factors.

Rationale

Physical examination from head to toe to identify the source of the severe discomfort. The patient may require considerably greater pain medication.

Care Plan & Planning

• Plans for treating acute pain should always be unique to the patient. 
• Evaluate the patient’s pain-related contributing variables, the suitability of the planned interventions, and efficient ways to gauge the patient’s reaction.
• Accurately capture current data, highlight possible requirements or dangers, and base findings on evidence-based methods.

Nursing Actions & Care Note for Acute Pain 

Perform

• Nursing care during the peak effect of analgesics. 
• A complete assessment at least once per shift or according to your institutional policies.  
• Determine if there are other symptoms, ask about the characteristics of their pain (PQRSTU questions), and perform a physical examination as needed.
• FLACC scale on those patients who cannot verbalize their pain rating
• Gentle range of motion exercises to see what movements trigger the pain. 

Provide

• Nonopioids including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, as ordered.
• Pharmacologic pain management as ordered.
• Cutaneous stimulation or physical interventions such as massage, and positioning
• Cold and heat therapy
• Mind and body techniques such as yoga, purposeful breathing
• Measures to relieve pain before it becomes severe. Educate the patient to report pain before it becomes severe

Avoid

• Administering analgesic medications intramuscularly.
• Medical jargon. 
• Carbonated drinks and gas-producing foods.

Administer

• Opioids as ordered.
• Coanalgesics (adjuvants), as ordered. 
• Analgesia before painful procedures whenever possible.
• Oxygen, use a nasal cannula or mask as indicated. Observe the oxygen saturation levels

Monitor

• Side effects, adverse reactions, or drug interactions when administering narcotics or other pain medications.
• Patient pain levels every two hours until it falls below 3

Encourage

• Deep breathing
• Progressive activity
• Exercise
• Reducing sedentary activities

Goals and Outcomes

• Improved vitals such as baseline levels for pulse, BP, respirations, and relaxed muscle tone or body posture.
• A pain reduction to 3 to 4 on a standardized pain scale within 1 to 2 hours of receiving analgesics.
• Demonstrate pain relief by maintaining stable vital signs and avoiding muscle tension and restlessness.
• Patient reports a satisfactory pain level using the numeric pain scale, maintains baseline vitals, uses non-pharmaceutical and pharmaceutical pain relief strategies effectively.
• FLACC scale or other pain measurement tools used will be decreased on patient who cannot verbalize pain

Acute Pain Post Intervention Evaluation & Monitoring

Monitor

• Patient correctly taking ordered drugs.
• Continuous cardiac monitoring and assess cardiac arrhythmias.
• Vital signs before medication and after medication as per institutional policy.
• Serial biomarkers with twelve lead ECGs for patients with chest pain
• Heart rate and blood pressure throughout a pain episode and when administering medicine.
• Response and adverse effects to administered drugs.
• Signs of addiction or tolerance. 

Future goals 

• A decrease in pain levels within 24 hours after receiving pain medication. 
• Demonstrate the use of appropriate diversional activities and relaxation skills.
• Patient uses pharmacological and nonpharmacological pain-relief strategies.
• Patient displays improvement in mood, and coping.
• Increase in activities of daily living (ADLs) with pain control

Prevention

• Analgesics may be administered into the surgical site, or nerves to the site may be kept blocked in the initial postoperative phase.

Supplemental Material for Acute Pain

Client case (example)

In an example client case, the client is a 92-year old woman who was admitted to the hospital with acute pain. She has been experiencing nausea and vomiting for several days prior to admission. 

Patient’s HCP suspected diverticulitis, but did not want to undergo an endoscopy. Patient is given IV hydromorphone for pain management. Due to nausea and vomiting, she is given acetaminophen via suppository.

Questions About Acute Pain

Here we’re answering your most pressing questions about acute pain.

What Are the Types of Pain?

Acute pain – Easy to diagnose temporarily and lasts 3-6 months caused by bodily damage and is usually sharp or dull.

Chronic pain – lasts more than three months requires long-term care & treatment conditions such as arthritis, cancer, and fibromyalgia are tied to chronic pain.

Neuropathic pain – caused by nerve damage can happen after surgery difficult to treat compared to other types of pain

Nociceptive pain – caused by tissue damage, such as fractured bones usually throbbing or sharp. 

• Somatic pain – pain receptors in skin, subcutaneous tissue, fascia and other connective tissue
• Visceral pain – obstruction of hollow organ or deep connective tissue

Radicular pain – caused by compression on nerve roots, injury or disease in the spine

Is acute pain a priority nursing diagnosis?

Yes. It should be one of the first priorities.

Acute pain is a priority nursing diagnosis because it can interfere with a patient’s physical ability. It’s one of the most common reasons/types of pain for hospitalization,  

It can indicate a serious condition or injury  

What are the eight Characteristics of Pain?

1. Timing – When did the paint start and is it constant?
2. Location – Where exactly is the pain?
3. Quality – What kind of pain is being experienced?
4. Severity – How severe is the pain (on a scale of 1-10)
5. Setting – Where exactly was the patient when the pain started?
6. Aggravating or alleviating factors – What makes the pain worse (or better)? 
7. Associated factors – Is the patient experiencing any other (possibly associated) symptoms?
8. Patient perception – What might be causing this pain? Has it been experienced before?

Find our other nursing care plans here

References

https://www.emed.theclinics.com/article/S0733-8627(04)00146-4/pdf#relatedArticles

https://nightingale.edu/blog/nursing-care-plan/

https://milnepublishing.geneseo.edu/nursingcare/chapter/management-of-pain-and-physical-symptoms/

https://health.ucdavis.edu/livinghealthy/topic/pain-management/acute-pain-verses-chronic-pain.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540572/ https://nursingcecentral.com/lessons/nursing-interventions-for-acute-pain-management/

https://nursingcecentral.com/lessons/nursing-interventions-for-acute-pain-management/