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Acute Pain

The patient presented with acute pain related to a physical injury as evidenced by headache, photophobia, distraction, irritability, crying, restlessness, bulging of fontanelles, sensitivity to light, and facial grimace. The FLACC scale was 7/10. Interventions included non-pharmacological pain management, monitoring vital signs, providing comfort measures, encouraging parental presence, using puppets to demonstrate procedures, and administering analgesics as needed. The goal was to reduce the FLACC scale from 7/10 to 2/10 within 1 hour of interventions, which was partially met after 1 hour with a reduction to 3/10.

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20 views2 pages

Acute Pain

The patient presented with acute pain related to a physical injury as evidenced by headache, photophobia, distraction, irritability, crying, restlessness, bulging of fontanelles, sensitivity to light, and facial grimace. The FLACC scale was 7/10. Interventions included non-pharmacological pain management, monitoring vital signs, providing comfort measures, encouraging parental presence, using puppets to demonstrate procedures, and administering analgesics as needed. The goal was to reduce the FLACC scale from 7/10 to 2/10 within 1 hour of interventions, which was partially met after 1 hour with a reduction to 3/10.

Uploaded by

Adha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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ASSESSMEN DIAGNO PLANNI INTERVENTIO RATIONALE EVALUAT

T SIS NG NS ION
Subjective: Acute Within  Obtain  Provides Goal
“Masakit po Pain 1hr of patient’s baseline partially
ulo niya at related to nursing or data and met. After
naiirita siya” Physical interventi significant informat 1hr of an
as verbalized Injury ons, the other’s ion effective
by the Agent as patient’s assessmen about nursing
patient’s evidenced FLACC t of pain need for, intervention
mother. by scale will to include and s, the
Headache, be location, effective patient’s
Objective: Photopho alleviated characteris ness of FLACC
 Headac bia, from 7/10 tics, onset, intervent scale was
he Distractio to 2/10. duration, ion. lessened
 Lethar n frequency, from 7/10 to
gic Behaviors quality,  Alteratio 3/10.
 Irritabl , and and ns from
e Changes intensity. normal
 Crying in Vital  Monitor maybe
 Restles signs vital signs signs of
sness infection
 Bulgin  To help
g of  Provide alleviate
fontane non- d the
lles pharmacol pain.
 Sensiti ogical
vity to pain
light manageme
 Facial nt:
grimac -Quiet  To
e environme comfort
 FLAC nt child.
C -Comfort
Scale: measures
7/10 (back rub,  To
change enhance
 PULSE
position, understa
O2:
use of nding
95%
hot/cold and
 PR:
compress) reduce
166
 Encourage level of
bpm
the anxiety
 RR: 34
presence and fear.
cpm
of parent  To
 Temp: during maintain
39.8 ℃ painful acceptab
procedure. le level
 Use of pain.
puppets to
demonstra
te
procedure
for child.
 Administe
r
analgesics
as
indicated.

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