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Diagnosis Acute Pain r/t physical injury agents, tissue damage.

Assessment 1) 2) 3) 4) Verbal reports of sharp pain in left hip area, radiating, unrelieved at 10/10. Unable to maintain any weight bearing. Refused 2 physical therapy sessions on postoperative day 3 due to pain. Pulse rate is tachycardic at 96.

Planning Goal: Patient will achieve pain control within 48 hours. Outcomes: Patient will report pain level <3 by 24 hours. Patient will perform activities of recovery or ADLs while maintaining a pain level <3 within 48 hours. Implementation Administer Morphine Sulfate 2mg IV every 4 hours as needed for pain. Monitor for adverse effects. Review pain flowsheet and medication administration record to evaluate effectives of pain relief, previous 24-hour opioid requirements, and occurrence of adverse effects. Rationale: Systematic tracking of pain was an important factor in improving pain management and making adjustments to the pain management regime (Faries et al, 1991) If pain is constant, a dose of an immediate-release opiod should be administered every 4 hours ATC. If pain remains uncontrolled after 24 hours, increase the routine dose by an amount equal to the total dose of opiod administered during the previous 24 hours, or by 25% to 50% of mild-moderate pain, and 50% to 100 % for severe pain (NCL, 2007). Administer Tylenol 500 mg PO every 4-6 hours as needed. Manage acute pain using a multimodal approach. Rationale: Multimodal analgesia combines two or more medications, or methods, from different pharmacological classes that target different mechanisms along the pain pathway, including opioid, nonopioid, and adjuvant analgesics (Pasero, 2003a, 2009a). Specifically, an acute pain multimodal regime may include an opioid, acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID), an anticonvulsant, a local anesthetic, or combinations (Pasero, 2007, 2009a). The advantage of this approach is that the lowest effective dose of each drug can be administered,

resulting in fewer or less severe adverse effects such as over sedation and respiratory depression (Pasero, 2003a; Parvizi et al, 2007; APS, 2008; Polomano, Rathmall et al, 2008). Explain to the client the pain management approach, including pharmacological and nonpharmacological interventions, the assessment and reassessment process, potential adverse effects, and the importance of prompt reporting of unrelieved pain. Rationale: One of the most important steps toward improved control of pain is a better client understanding of the nature of pain, its treatment, and the role the client needs to play in pain control (APS, 2008). In addition to administering analgesics, support the client's use of nonpharmacological methods to help control pain, such as distraction, imagery, relaxation, and application of heat and cold. Rationale: Cognitivebehavioral strategies can restore the client's sense of self-control, personal efficacy, and active participation in his or her own care (Lassetter, 2006; APS, 2008). Evaluation Outcome #1 Goal Met. Patient reported pain level <3/10within stated 24 hour period. Goal Partially Met: Patient reported pain level remained at 5/10 during the 24 hour period. Goal Not Met: Patient reports unrelieved pain at 10/10. Outcome #2 Goal Met. Patient performed activities of recovery while maintaining a pain level <3 within 48 hours. Goal Partially Met: Patient was able to ambulate to nurses station and bathroom but unable to complete physical therapy within 48 hours. Goal Not Met: Patient refused physical therapy sessions and refused to get out of bed within 48 hours. References:

Ackley, B., & Ladwig, G. (2010). Nursing diagnosis handbook: A guide to planning care (9th ed.). St. Loius, MO: Mosby, Inc. The American Pain Society (APS): (2008). Principles of analgesic use in acute and chronic pain, ed 6, Glenview, IL: The Society.

Breivik H, Borchgrevink PC, Allen SM et al. (2008). Assessment of pain, Br J Anaesth 101(1):1724. Faries JE, Mills DS, Goldsmith KW et al. (1991). Systematic pain records and thir impact on pain control, Cancer Nurs 14(6): 306. Lassetter JH. (2006). The effectiveness of complementary therapies on the pain experience of hospitalized children, J Holist Nurs 24(3):196211. Parvizi J, Reines D, Steege J et al. (2007). CSI: investigating acute postoperative pain: improving outcomes and clinical horizons. Accessed July 6, 2009. Pasero C. (2003). Multimodal balanced analgesia in the PACU, J Perianesth Nurs 18(4):265268. Pasero C. (2009). Challenges in pain assessment, J Perianesth Nurs 24(1):5054. Pasero C, Manworren RCB, McCaffery M. (2007). IV Opioid range orders, Am J Nurs 107(2):5259. Pasero C, McCaffery M.(2004). Comfort-function goals: a way to establish accountability for pain relief, Am J Nurs 104(9):7778. Polomano RC, Rathmell JP, Krenzischek DA et al. (2008). Emerging trends and new approaches to acute pain, Pain Manage Nurs 9(Suppl 1):3341. Potter, P.A. Perry, A.G. (2008). Fundamentals of nursing. 7th ed. St. Louis: Mosby Elsevier. Stubhaug A, Breivik H. (2007). Prevention and treatment of hyperalgesia and persistent pain after surgery. In Brevik H, Shipley M, editors: Pain, best practice and research compendium, London: Elsevier.