CU-QMS-NURSING-0017
CAPITOL UNIVERSITY
Name of Student: _________________________________________________
Name of Patient: _________________________________________________
ASSESSMENT DATA
(Subjective & Objective Cues)
Subjective:
The patient states “I can feel
abdominal pain that radiates to my
back and I loss my appetite”
Objective:
 Yellowing of skin and the
whites of the eyes (jaundice)
 Itchy skin
 unintended weight loss
Lab results:
 Light-colored stools
 Dark-colored urine
NURSING DIAGNOSIS
(Problem and Etiology)
Acute Pain related to inflammatory
process of the pancreas
COLLEGE OF NURSING
Date of Assignment: ________________________________
Ward: ____________________ Bed No. ________________
NURSING CARE PLAN
GOALS AND
OBJECTIVES
Within 6 hr of intervention,
the patient’s subjective
perception of discomfort
decreases, and it is controlled
within 24 hr, as documented
by pain scale. Nonverbal
indicators, such as grimacing
and splinting of abdominal
muscles, are absent or
diminished.
NURSING INTERVENTIONS AND EVALUATION
RATIONALE
Assess for and document the degree and The patient will:
character of the patient’s  Report pain is
discomfort. Devise a pain scale with the controlled.
patient, rating discomfort on  Follow prescribed
a scale of 0 (no pain) to 10 (worst pain). therapeutic
Rationale: Pain characteristics may signal regimen.
varying problems. Baseline and subsequent  Demonstrate use of
use of a pain scale helps methods that
determine effectiveness of pain relief. provide relief.
Assess the patient’s previous responses to
pain and previously effective
pain relief measures.
Rationale: The patient’s previous history of
pain and how well it was managed
influence perceptions and trust in present
pain relief measures.
Maintain bedrest during acute attack.
Provide quiet, restful environment.
Rationale: Decreases metabolic rate and GI
stimulation and secretions, thereby reducing
pancreatic activity.
Provide alternative comfort measures (back
rub), encourage relaxation techniques
(guided imagery, visualization), quiet
diversional activities (TV, radio).
Rationale: Promotes relaxation and enables
 patient to refocus attention; may enhance
coping.

Administer analgesics in timely manner

(smaller, more frequent doses).
Rationale: Severe and prolonged pain can
aggravate shock and is more difficult to
relieve, requiring larger doses of
medication, which can mask underlying
problems and complications and may
contribute to respiratory depression.
Issue: 05 April 2006 Revision Code : 003

CU-QMS-NURSING-0018