Unit 3

Concepts and Challenges in Patient Management

Case Study: Applying Concepts from NANDA, NIC, and NOC

A Patient With Debilitating Pain
Mr. Southers is a 48-year-old man who sustained a back injury in a work-related incident. He reports severe shooting pains
in his lower back and both buttocks. Mr. Southers is not a candidate for surgery and has undergone physical therapy with little
improvement in his pain. He reports that the pain makes it impossible for him to return to his former job, work around the
house, or obtain enjoyment from leisure activities. He has been referred to a pain clinic for management.

Turn to Appendix C to see a concept map that illustrates the

relationships that exist between the nursing diagnoses,
interventions, and outcomes for the patient's clinical
problems.

Nursing Classifications and Languages

NOC
Nursing
Outcomes
Return to
functional
baseline status,
stabilization of,
NANDA NIC or improvement
Nursing Diagnoses Nursing Interventions in:

Chronic Pain—Unpleasant sensory and Pain Management Pain Level

emotional experience arising from actual or —Alleviation of pain or —Severity of
potential tissue damage or described in reduction in pain to a observed or
terms of such damage; sudden or slow level of comfort that is reported pain
onset of any intensity from mild to severe, acceptable to the patient
constant or recurring, without an
anticipated or predictable end and a
duration of greater than 6 months

Risk for Powerlessness—At risk for Medication Comfort

perceived lack of control over a situation Management Level—Extent
and/or one's ability to significantly affect an —Facilitation of safe and of positive
outcome effective use of perception of
prescribed or over-the- physical and
counter medicine psychological

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Simple Relaxation Pain Control

Therapy—Use of —Personal
techniques to encourage actions to control
and elicit relaxation for pain
the purpose of
decreasing undesirable
signs and symptoms such
as pain, muscle tension,
or anxiety

Simple Guided Pain:

Imagery—Purposeful Disruptive
use of imagination to Effects
achieve relaxation and/or —Severity of
direct attention away from observed or
undesirable sensations reported
disruptive effects
of chronic pain
on daily
functioning

Emotional Support Pain: Adverse

—Provision of Psychological
reassurance, acceptance, Response
and encouragement —Severity of
during times of stress observed or
reported adverse
responses to
physical pain

Self-Esteem
Enhancement
—Assisting a patient to
increase his or her
personal judgment of
self-worth

P.257
NANDA International (2005). Nursing diagnoses: Definitions & classification 2005–2006. Philadelphia: North American Nursing
Diagnosis Association.
Dochterman, J. M. & Bulechek, G. M. (2004). Nursing interventions classification (NIC) (4th ed.). St. Louis: Mosby.
Iowa Outcomes Project (2004). In Moorhead, S., Johnson, M. & Maas, M. (2004). Nursing outcomes classification (NOC) (3rd
ed.). St. Louis: Mosby.
Dochterman, J. M. & Jones, D. A. (2003). Unifying nursing languages: The harmonization of NANDA, NIC, and NOC.
Washington, D.C.: American Nurses Association.

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