NAMA : NOOR HIDAYAH

NIM : P07220119030

CASE 1

You are a patient diagnosed with gastritis and gastric erosion.

Aggravating factors : Heavy drinking, smoking or simply eating too much, eating something
that is either too spicy or too acidic. Medication : aspirin.

Symptoms : Vomit, bloody vomit, upset stomach, nausea, loose bowel movement.

Medication : Antacid (Mylanta)

CASE 2

You are a patient suspected with kidney stones (renal calculi)

Symptoms : Colic (a stabbing pain that comes in waves, often a few minutes apart), lower back
pain in one side, just below the ribs. Feel nauseated. Dribble waterworks.

Self-Medication : not yet taken.

CASE 3

You are the man comes to hospital with fever. You are suspected with prostatitis.

Symptoms : Painful waterworks, having a dull heavy ache in crotch (around the base of penis),
fever with temperature 37.5 C

Medication : Antibiotic, Antipyretic.

 PAIN ASSESSMENT FORM

CASE 1

A. CURRENT PAIN MEDICATION (include dosage and any side effects.)

a. Aspirin

Dosage : Applies to the following strengths: 800 mg; 500 mg; 325 mg; 81 mg; buffered 500 mg;
buffered 325 mg; buffered 81 mg; 975 mg; 650 mg; 125 mg; 600 mg; 60 mg; 300 mg; 162 mg; 1
g; 81 mg with phytosterols; 227.5 mg; 1200 mg; 162.5 mg.

Side Effects :

 Like other NSAIDs, aspirin (acetosal) causes disorders of the digestive tract such as
bleeding, ulceration, and perforation of the stomach or intestine which can be fatal.
Symptoms that appear often in the form of nausea and vomiting. If used in high doses or
for a long time, smoking, or drinking alcohol, even if used together with food will not
reduce these side effects.
 This drug is known to cause hemolytic anemia in people who have genetically deficient
glucose-6-phosphate dehydrogenase deficiency, especially in large doses and depending
on the severity of the disease.
 Large doses can cause tinnitus (ringing in the ears). dark urine, yellow eyes or skin. This
effect is only temporary.
 The most serious side effect of aspirin (acetosal) is Reye's syndrome. Although it
happens rarely, it is very fatal. Reye's syndrome is a rare but severe disease characterized
by acute encephalopathy and fatty liver. This disease can occur if children or adolescents
are given aspirin (acetosal) for a fever or other illness or infection.
 For some sensitive people, this drug can cause symptoms such as allergies, including
itching, swelling, and headaches. This reaction is caused by salicylate intolerance.
 Aspirin and other NSAIDs, such as ibuprofen, can delay healing of skin wounds.
b. Antacid (Mylanta)

Dosage :
  1 -2 measuring spoons.
 The drug is used on an empty stomach, which is between meals and before bedtime.

Side Effects :

 Simethicone is not absorbed by the body into the bloodstream, therefore it is considered
relatively safe. Side effects that can occur include reduced stool density.
 Magnesium hydroxide can cause diarrhea, while Aluminum hydroxide can cause
constipation. The combination of both can minimize these side effects.
 Magnesium hydroxide can interfere with absorption of folic acid and iron.
B. WHERE IS PATIENT’S PAIN? Have patient point to or trace area of pain. If more
than one site. Label A, B, C, D.

Patients suffering from gastritis and gastric erosion in the stomach.

C. DESCRIBE CAUSE OF PAIN, IF KNOWN.

Caused by heavy drinking, smoking or simply eating too much, eating something that is
either too spicy or too acidic

D. HOW DOES PAIN FEEL TO PATIENT?It stabbing, nagging, and agonizing.

E. INTENSITY OF PAIN (Rate on scale of 0-5)

INTENSITY
SITE A SITE B SITE C SITE D
AT PRESENT 5
ONE HOUR 3
AFTER
MEDICATION
THREE 1
HOURS
AFTER
MEDIACTION
WORST IT 0
GETS
BEST IT GETS 0

F. FREQUENCY OF PAIN (Check one for each site.)

FREQUENCY
SITE A SITE B SITE C SITE D
OCCASIONAL 
FREQUENT
CONSTANT

G. PATIENT’S VIEW OF PAIN

1. WHAT MAKES PAIN BETTER? After consuming the medicine.
2. WHAT MAKES PAIN WORSE?If you drink a lot, smoke or just eat too much, eat
something that is too spicy or too sour
3. ANY ASSOCIATED SYMPTOMS?Vomit, bloody vomit, upset stomach, nausea, loose
bowel movement.
4. ARE THERE TIMES OF THE DAYNIGHT WHEN PAIN IS WORSE? Yes, there are.
 5. WHAT HAS HELPED CONTROL PAIN IN THE PAST? When not consuming food
that triggers pain
6. WHAT IS PAIN PREVENTING PATIENT FROM DOING? Yes, because of symptoms
of the disease.
7. DOES PATIENT WANT SOMETHING DONE ABOUT PAIN? (If no, why not?) Yes,
by consuming mylanta medicine, the pain will be reduced.
8. COMMENTS : Get well soon, do not consume food that can trigger your illness.

DATE20 Februari 2020SIGNATURE OF ASSESSOR

Signature and Time

PAIN ASSESSMENT Imprint Patient Identification or Write-in

information Below

Patient’s Name : Mr. X

Medical Record No. 01

CASE 2

A. CURRENT PAIN MEDICATION (include dosage and any side effects.)

Self-Medication : not yet taken.

For kidney stone disease, can consume drugs : Calcusol.

Dosage : Calcusol dosage is 2 capsules twice a day for 1-3 consecutive weeks. If the condition
has subsided, then the dose is 1 capsule 3 times a day and continued with a dose of 2 × 1 capsule
a day. In order to prevent kidney stones, Calcusol dosage is 1 capsule 1-2 times daily. Use
Calcusol in accordance with the dose, so that treatment goals can be achieved. It is recommended
to consume lots of water during Calcusol therapy.

Side Effects : The use of Calcusol can have side effects if you experience problems with
hypersensitivity or overdose. Calcusol side effects in allergic sufferers are allergic reactions.
Allergic reactions are characterized by headaches, stomach aches, nausea, vomiting, shortness of
breath, skin rashes, itching, and swollen face. Calcusol kidney stone medication that is used in
excess can trigger headaches and nausea. Stop using Calcusol immediately and seek medical
help so that side effects can be treated immediately before they develop more severe.

B. WHERE IS PATIENT’S PAIN? Have patient point to or trace area of pain. If more
than one site. Label A, B, C, D.

Pain is in the lower back on one side, just below the rib cage.

C. DESCRIBE CAUSE OF PAIN, IF KNOWN.

 Kidney stones can be triggered by a variety of conditions, such as lack of drinking water,
excess weight, or due to side effects of operations on the digestive organs. Stone deposits in the
kidneys can be caused by food or other underlying health problems. Based on its type, kidney
stones are divided into four, namely calcium stones, uric acid stones, struvit stones, and cystine
stones.

D. HOW DOES PAIN FEEL TO PATIENT? It stabbing.

E. INTENSITY OF PAIN (Rate on scale of 0-5)

INTENSITY
SITE A SITE B SITE C SITE D
AT PRESENT 5
ONE HOUR 4
AFTER
MEDICATION
THREE 4
HOURS
AFTER
MEDIACTION
WORST IT 2
GETS
BEST IT GETS 0

F. FREQUENCY OF PAIN (Check one for each site.)

FREQUENCY
SITE A SITE B SITE C SITE D
OCCASIONAL
 FREQUENT 
CONSTANT

G. PATIENT’S VIEW OF PAIN

1. WHAT MAKES PAIN BETTER?After consuming the medicine and if kidney stone
disease is not yet in a severe stage many drink plenty of water and maintain your diet.
2. WHAT MAKES PAIN WORSE? When kidney stone disease hardens in the body and
gets worse.
3. ANY ASSOCIATED SYMPTOMS?Colic (a stabbing pain that comes in waves, often a
few minutes apart), lower back pain in one side, just below the ribs. Feel nauseated.
Dribble waterworks.
4. ARE THERE TIMES OF THE DAYNIGHT WHEN PAIN IS WORSE? Yes, only a few
minute.
5. WHAT HAS HELPED CONTROL PAIN IN THE PAST? When drinking lots of water.
6. WHAT IS PAIN PREVENTING PATIENT FROM DOING?Yes, because of symptoms
of the disease and stabbing pain.
7. DOES PATIENT WANT SOMETHING DONE ABOUT PAIN? (If no, why not?) Yes,
if kidney stones are still not in a severe stage, then we can drink lots of water to relieve
pain. and if it's already severe, come to the hospital for medical treatment.
8. COMMENTS. Get well soon. Quickly consult a hospital so that they can be treated
medically and the disease can be cured

DATE 20 Februari 2020 SIGNATURE OF ASSESSOR

Signature and Time

PAIN ASSESSMENT Imprint Patient Identification or Write-in

information Below

Patient’s Name : Mrs. K

Medical Record No. 02

CASE 3

A. CURRENT PAIN MEDICATION (include dosage and any side effects.)

a. Antibiotic : This treatment is the most prescribed for prostatitis. The doctor will give
treatment options according to the type of bacteria that causes the infection. If you have
severe symptoms, you may need injection antibiotics.

Dosage : You will need to take antibiotics for 4-6 weeks but it will take longer for prostatitis
to be more chronic and ongoing

Side Effects : Feeling sick, Bloating and other digestive disorders, Diarrhea. About 1 in 15
people have an allergic reaction to antibiotics, specifically penicillin and cephalosporins.
Meksipun rare, but this allergic reaction can cause a serious allergic condition of
anaphylaxis, which is a medical emergency.

b. Antipyretic (Paracetamol)

Dosage : Conditions: Fever and mild to moderate pain

Adults: 500-1000 mg, 3-4 times a day. The maximum dose is 4000 mg per day.

Children (maximum dose is 4 times a day)

3- <6 months: 60 mg.

6 months - <2 years: 120 mg.

2- <4 years: 180 mg.

4- <6 years: 240 mg.

6- <8 years: 240-250 mg.

8- <10 years: 360-375 mg.

10- <12 years: 480-500 mg.

12-16 years: 480-750 mg.

 Condition: Fever and mild to moderate pain (rectal medicine)

Children (given once every 4-6 hours, or 4 times a day according to conditions)

3 months - <1 year: 60-125 mg.

1- <5 years: 125-250 mg.

5-12 years: 250-500 mg

Condition: Post immunization fever (oral or rectal medicine)

Children (2-3 months): 60 mg once a day. If needed, a second dose can be given after the
next 4-6 hours

Side Effects : Fever, Itchy skin rashes appear, sore throat, Sprue appears, back pain, body
feels weak, skin or eyes are yellowish, bruises appear on the skin, urine is cloudy or bleeding,
black stools or bloody stools.

If consumed excessively, paracetamol can cause an overdose, with symptoms such as:
Abdominal pain, loss of appetite, nausea or vomiting, diarrhea, cold sweat.

B. WHERE IS PATIENT’S PAIN? Have patient point to or trace area of pain. If more
than one site. Label A, B, C, D.

Having a dull heavy ache in crotch.

 C. DESCRIBE CAUSE OF PAIN, IF KNOWN.

Bacterial prostatitis is usually caused by a bacterial infection of E. coli. If the bacteria are
not removed with antibiotics because they hide in the prostate, prostatitis can come back
repeatedly and is difficult to treat. This condition is called chronic bacterial prostatitis. In
addition, other causes include: Immune system disorders, Nervous system disorders, Wounds on
the prostate or around the prostate, Various sexually transmitted diseases that can cause
prostatitis, including chlamydia and gonorrhea.

D. HOW DOES PAIN FEEL TO PATIENT? It nagging and agonizing.

E. INTENSITY OF PAIN (Rate on scale of 0-5)

INTENSITY
SITE A SITE B SITE C SITE D
AT PRESENT 5
ONE HOUR 4
AFTER
MEDICATION
THREE 3
HOURS
AFTER
MEDIACTION
WORST IT 2
GETS
BEST IT GETS 0

F. FREQUENCY OF PAIN (Check one for each site.)

FREQUENCY
SITE A SITE B SITE C SITE D
 OCCASIONAL
FREQUENT
CONSTANT 

G. PATIENT’S VIEW OF PAIN

1. WHAT MAKES PAIN BETTER?After consuming the medicine.
2. WHAT MAKES PAIN WORSE? When urinating and walking
3. ANY ASSOCIATED SYMPTOMS?Painful waterworks, having a dull heavy ache in
crotch (around the base of penis), fever with temperature 37.5 C
4. ARE THERE TIMES OF THE DAYNIGHT WHEN PAIN IS WORSE? Nothing.
5. WHAT HAS HELPED CONTROL PAIN IN THE PAST?Reducing consumption of
spicy or acidic foods and caffeinated or alcoholic drinks, Drink plenty of water to help
get rid of bacteria in the prostate through urine, Avoid activities that can cause prostate
irritation, such as prolonged sitting or biking.
6. WHAT IS PAIN PREVENTING PATIENT FROM DOING?Yes, because of symptoms
of the disease and stabbing pain.
7. DOES PATIENT WANT SOMETHING DONE ABOUT PAIN? (If no, why not?) No,
because if you have contracted the disease to severe can only be treated in the hospital.
8. COMMENTS. Get well soon. Quickly consult a hospital so that they can be treated
medically and the disease can be cured.

DATE22 Februari 2020SIGNATURE OF ASSESSOR

Signature and Time

PAIN ASSESSMENT Imprint Patient Identification or Write-in

information Below

Patient’s Name : Miss F

Medical Record No.03