PAIN
assessment and Management
Berman et al.(2022). Kozier and Erb's Fundamentals of Nursing:Concepts, Process, and Practice(Vols 1). Pearson Education
South Asia Pte Ltd. pp 651-689..
Hinkle et al. (2022). Brunner and Suddarth’s Textbook of Medical-Surgical Nursing (Vol 1). Philadelphia: Lippincott Williams &
Wilkins. pp 196-221.
Learning
Objectives:
1.Describe factors that can affect a
1 person’s perception of and reaction
to pain.
2.Describe pharmacologic and
2 nonpharmacologic pain control
interventions.
3.Discuss the various types of surgery
3 according to the purpose, degree of
urgency, and degree of risk.
PAIN TYPES OF PAIN
Is an unpleasant sensory
1. LOCATION
and emotional experience
associated with actual or 2. DURATION
potential tissue damage.
3. INTENSITY
The 5th vital sign
"Whatever the 4. ETIOLOGY
experiencing person says it
is, existing whenever he
says it does"(McCaffery).
1. Referred
Appear to arise in different
PAIN areas to other parts of the
body.
e.g.: cardiac pain maybe felt
in the shoulder or left arm
TYPES OF PAIN 2. Visceral
Pain arising from organs or
hollow viscera is often
1. LOCATION perceived in the area
remote from the organ
causing the pain.
1. Acute Pain
When pain lasts only through the
expected recovery period,
PAIN whether it is sudden or slow
onset, regardless of its intensity.
2. Chronic Pain
Also known as persistent pain, is
prolonged, usually recurring or
TYPES OF PAIN lasting 3 moths or longer, and
interferes with functioning
3. Cancer Pain
2. DURATION May result from the direct effects
of the disease and its treatment,
or it may be unrelated
maybe acute or chronic
1. Mild Pain
Pain in the 1-3 range.
PAIN
2. Moderate Pain
A rating of 4-6
TYPES OF PAIN
3. Severe Pain
3.INTENSITY Pain reaching 7-10
1. NOCICEPTIVE PAIN
Nociceptive pain is a type of pain
caused by damage to body tissue.
PAIN Nociceptive pain feels sharp, aching,
or throbbing. It's often caused by an
external injury, like stubbing your toe,
having a sports injury, or a dental
procedure.
2. SOMATIC PAIN
Originates in the skin, muscles, bone,
TYPES OF PAIN
or connective tissue.
e.g: the sharp sensation of a paper
cut
4.ETIOLOGY 3. NEUROPATHIC PAIN
Is associated with damaged or
malfunctioning nerves due to illness
(e.g., injury (e.g.: phantom limb pain)
CONCEPTS ASSOCIATED WITH PAIN
1. Pain threshold 2. Pain Tolerance
Is the least amount of Is the maximum amount of
stimuli that is needed painful stimuli that a person is
for a person to label a willing to withstand without
sensation as pain. seeking avoidance of the pain or
relief.
May vary slightly from Pain tolerance varies
person to person, and considerably from person to
may be related to age, person, even within the same
gender, or race, but it person at different times and in
changes little in the different circumstances. For
same individual over example, a woman may tolerate
time. a considerable amount of labor .
CONCEPTS ASSOCIATED WITH PAIN
Nociception
The physiologic process related to pain perception
CONCEPTS ASSOCIATED WITH PAIN
Nociception
The physiologic process related to pain perception
Bradykinin - a powerful Prostaglandin - These
TRANSDUCTION
vasodilator is released at the site compounds sensitize the pain
¨When a pain threshold has of an injury receptors and enhance the
been reached and there is increases capillary permeability effects of bradykinin and
injured tissue, substances that causes the release of histamine.
stimulate the pain receptors inflammatory chemicals such as Substance P - act as a
called nociceptors, are histamine. stimulant to the nociceptors
released.
These two chemicals (bradykinin involved in the inflammatory
and histamine) cause the area response of the tissues.
¨These pain receptors can be
stimulated by serotonin, to redden, swell, and become known to be a
histamine, prostaglandin, tender. neurotransmitter that
bradykinin and substance P. Bradykinin also stimulates the enhances the movement of
release of prostaglandins. impulses across the nerve
Serotonin- a major component synapse from the primary
¨Ibuprofen and local of the inflammatory chemical afferent neuron to the
anesthetic can decrease pain. milieu and contributes to the second-order neuron
pain of tissue injury.
CONCEPTS ASSOCIATED WITH PAIN
¨Three types of stimuli that excite corresponding types of nociceptors:
CONCEPTS ASSOCIATED WITH PAIN
Nociception
The physiologic process related to pain perception
1.TRANSDUCTION
¨When a pain threshold has
been reached and there is
injured tissue, substances that
stimulate the pain receptors
called nociceptors, are
released.
¨These pain receptors can be
stimulated by serotonin,
histamine, prostaglandin,
bradykinin and substance P.
¨Ibuprofen and local
anesthetic can decrease pain.
CONCEPTS ASSOCIATED WITH PAIN
Nociception
The physiologic process related to pain perception
1. TRANSMISSION OF IMPULSE
2. TRANSMISSION
FROM THE PERIPHERAL
¨The 2nd process of NERVE FIBERS TO THE
nociception, transmission of SPINAL CORD (SC).
pain, includes three (3)
segments: C fibers- larger, unmyelinated
nerve fibers, dull aching pain
A delta – smaller, myelinated
Substance P - serves as a
fibers, sharp, localized pain
neurotransmitter, enhancing
the movement of the
impulses across the nerve Messages come out of the spinal
synapse from the primary cord and travel via motor nerves
afferent neuron to the to the arm muscles, causing the
second-order-neuron in the arm to withdraw quickly.
dorsal horn of the SC. This is an automatic reflex that
does not involve the brain or
conscious thought
CONCEPTS ASSOCIATED WITH PAIN
Nociception
The physiologic process related to pain perception
2. FROM THE SC TO BRAIN STEM
TRANSMISSION
AND THALAMUS VIA THE
SPINOTHALAMIC
¨The 2nd TRACT.
process of
nociception, transmission of
pain,pain
includes three
signals are (3)
also sent
segments:
upwards in the spinal cord via
the Spinothalamic tract (amongst
others) to an area in the brain
Substance P - serves as a
stem (base of the brain) called
neurotransmitter, enhancing
the the thalamus. of the
movement
3. TRANSMISSION
impulses across theOFnerve
synapse from the
INFORMATION primary
TO THE BRAIN
afferent neuron
¤Further to occurs
processing the in the
second-order-neuron in the
thalamus with signals being sent
dorsal
to horn
areasofcontrolling
the SC. blood
pressure, heart rate, breathing,
and emotions.
OPIOIDS CAN DECREASE PAIN
CONCEPTS ASSOCIATED WITH PAIN
Nociception
The physiologic process related to pain perception
3. PERCEPTION
¨When the client becomes
conscious of the pain.
Pain perception is the sum
of complex activities in the
CNS that may shape the
character & intensity of pain
perceived and give meaning
to the pain.
COGNITIVE-BEHAVIORAL
THERAPY & approaches such
as distraction & imagery
have been developed based
on evidence that brain
processes can influence pain
perception.
CONCEPTS ASSOCIATED WITH PAIN
Nociception
The physiologic process related to pain perception
4. MODULATION
Neurons send signal back to
dorsal horn of SC.
Causes release of
endogenous opioids,
serotonin and
norepinephrine (NE) - can
inhibit or reduce ascending
painful impulses in the
dorsal horn.
¨Tricyclic antidepressant -
can relieve pain by blocking
the resorption of NE and
serotonin making them
more available.
¨GATE CONTROL THEORY
In 1965, Melzack and Wall
proposed the gate control the-
ory.
According to this theory,
peripheral nerve fibers( A-delta
or C) carrying pain to the
spinal cord can have their input
modified at the spinal cord level
before transmission to the
brain.
¨GATE CONTROL THEORY
I¨Synapses in the dorsal horns act as
gates that close to keep impulses from
reaching the brain or open to permit
impulses to ascend to the brain.
¨According to the gate control theory:
small-diameter nerve fibers
(A-delta or C)carry pain
stimuli through a gate..
large diameter nerve fibers (A-
beta) going through the same gate
can inhibit the transmission of
those pain impulses-that is, close the
gate.
¨GATE CONTROL THEORY
The pain gate in the spinal cord can be
shut in several different ways:
1. Stimulation of touch fibers
2. Release of endogenous opioids
3. Electrical stimulation
4. Morphine and other opioid drugs
5. Normal and excessive sensory
stimuli
6. Cerebral cortex and thalamic
inhibition of pain
FACTORS AFFECTING THE
PAIN EXPERIENCE
1. Ethnic and
Cultural Values
2. Developmental
Stage
3. Environment and
support people
4. Previous Pain
Experiences
5. Meaning of Pain
NURSING MANAGEMENT
Assessment
1. Pain History
2. Observation of
Behavioral and
Physiological
Responses
3. Daily Pain diary
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY Each person's pain
1. LOCATION experience is unique
2. PAIN INTENSITY OR RATING SCALES The client is the best
3. PAIN QUALITY
interpreter of the pain
4. PATTERN
5. PRECIPITATING FACTORS experience
6. ALLEVIATING FACTORS
7. ASSOCIATED SYMPTOMS
8. EFFECT ON ACTIVITIES OF DAILY LIVING
9. COPING RESOURCES
10. AFFECTIVE RESPONSES
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
Specific Location - ask the client to
1. LOCATION point the site of the discomfort.
2. PAIN INTENSITY OR RATING SCALES
3. PAIN QUALITY multiple pain sites -(symbol) with an X
4. PATTERN
5. PRECIPITATING FACTORS
6. ALLEVIATING FACTORS Child - needs to understand their
7. ASSOCIATED SYMPTOMS vocabulary (e.g.: "tummy")
8. EFFECT ON ACTIVITIES OF DAILY
parents can help in interpreting
LIVING
9. COPING RESOURCES
10. AFFECTIVE RESPONSES Documenting - body landmarks
e.g.: proximal, distal, medial, ateral,
diffuse
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
The SINGLE MOST IMPORTANT indicator
of the existence and intensity of pain -----
1. LOCATION
2. PAIN INTENSITY "the client's REPORT of pain.
3. PAIN QUALITY PAIN ASSESSMENT SCALES
4. PATTERN ADULT
5. PRECIPITATING FACTORS Numerical Rating Scale (NRS)
6. ALLEVIATING FACTORS Visual Analog Scale (VAS)
7. ASSOCIATED SYMPTOMS Pain Assessment in Advanced Dementia Scale
8. EFFECT ON ACTIVITIES OF DAILY (PAINAD)
LIVING PEDIATRICS
9. COPING RESOURCES Faces, Legs, Activity, Cry and Consolability (FLACC)
10. AFFECTIVE RESPONSES Wong-Baker Faces scale
Numerical Rating Scale (NRS)
Visual Analog Scale (VAS)
PAIN INTENSITY
PAIN INTENSITY
The total score ranges from 0-10 points. A possible interpretation of the scores is 0-3
(Mild pain), 4-6 (moderate pain), 7-10 (severe pain)
PAIN INTENSITY
Assess pain for children between the ages of 2 months and 7 years or individuals that are
unable to communicate their pain. The level of response for each observation is given a
numerical value rating from “0” to “2,” with “0” being the most comfortable with no pain and “2”
being the most painful, which results in a total score between “0” and “10.”
PAIN INTENSITY
WONG - BAKER FACIAL GRIMACE SCALE
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION Descriptive adjectives help people
2. PAIN INTENSITY communicate the quality of pain.
3. PAIN QUALITY
4. PATTERN
5. PRECIPITATING FACTORS
6. ALLEVIATING FACTORS "it is important to record the description
7. ASSOCIATED SYMPTOMS
of pain VERBATIM"
8. EFFECT ON ACTIVITIES OF DAILY "
LIVING
9. COPING RESOURCES
10. AFFECTIVE RESPONSES
PAIN QUALITY
TERM SENSORY WORDS AFFECTIVE WORDS
PAIN
Searing Unbearable
Scalding Killing
Sharp Intense
Piercing Torturing
Drilling Agonizing
Wrenching Terrifying
Shooting Exhausting
Burning Suffocating
Crushing Frightful
Penetrating Punishing
Miserable
HURT Hurting Heavy
Pricking
Pressing Throbbing
Tender
PAIN QUALITY
TERM SENSORY WORDS AFFECTIVE WORDS
ACHE
Numb Annoying
Cold Nagging
Flickering Tiring
Radiating Troublesome
Dull Gnawing
Sore Uncomfortable
Aching Sickening
Cramping Tender
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION Includes time of onset , duration
2. PAIN INTENSITY
3. PAIN QUALITY
and recurrence or intervals without
4. PATTERN pain.
5. PRECIPITATING FACTORS
6. ALLEVIATING FACTORS
7. ASSOCIATED SYMPTOMS
8. EFFECT ON ACTIVITIES OF DAILY
LIVING
9. COPING RESOURCES
10. AFFECTIVE AFFECTIVE RESPONSES
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION Certain activities precedes pain
2. PAIN INTENSITY
3. PAIN QUALITY
4. PATTERN These observations can help prevent
5. PRECIPITATING FACTORS
pain and determine its cause.
6. ALLEVIATING FACTORS
7. ASSOCIATED SYMPTOMS
8. EFFECT ON ACTIVITIES OF DAILY
LIVING
9. COPING RESOURCES
10. AFFECTIVE RESPONSES
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION Nurses must ask clients to describe
2. PAIN INTENSITY
3. PAIN QUALITY
anything that they have done to
4. PATTERN alleviate the pain (e.g.: home
5. PRECIPITATING FACTORS
remedies).
6. ALLEVIATING FACTORS
7. ASSOCIATED SYMPTOMS
8. EFFECT ON ACTIVITIES OF DAILY
LIVING
9. COPING RESOURCES Explore- relief was obtained or not
10. AFFECTIVE RESPONSES
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION Also included in the clinical
2. PAIN INTENSITY
3. PAIN QUALITY
apppraisal of pain are associated
4. PATTERN symptoms such as nausea, vomiting,
5. PRECIPITATING FACTORS
dizziness and diarrhea.
6. ALLEVIATING FACTORS
7. ASSOCIATED SYMPTOMS
8. EFFECT ON ACTIVITIES OF DAILY These symptoms may relate to the
LIVING
9. COPING RESOURCES onset of pain or they may result from
10. AFFECTIVE RESPONSES the presence of pain.
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION The nurse should ask the client to
2. PAIN INTENSITY
3. PAIN QUALITY
describe how the pain has affected
4. PATTERN the following aspects of life:
5. PRECIPITATING FACTORS
6. ALLEVIATING FACTORS
Sleep Appetite • Concentration •
7. ASSOCIATED SYMPTOMS Work/school . Interpersonal
EFFECT ON ACTIVITIES relationships Marital relations/sex Home
OF DAILY LIVING activities Driving/walking • Leisure
9. COPING RESOURCES
10.AFFECTIVE RESPONSES activities • Emotional status (mood,
irritability, depression, anxiety).
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION Everyone exhibits personal ways of
2. PAIN INTENSITY
3. PAIN QUALITY
coping with pain.
4. PATTERN
5. PRECIPITATING FACTORS Strategies may include seeking quiet and
6. ALLEVIATING FACTORS solitude, learning about their condition,
7. ASSOCIATED SYMPTOMS
8. EFFECT ON ACTIVITIES OF DAILY
pursuing interesting or exciting
LIVING activities (for distraction), saying prayers
9. COPING RESOURCES (or engaging in other meaningful rituals),
10.AFFECTIVE RESPONSES
or socializing (with family,
friends, support groups, etc.).
NURSING MANAGEMENT
Assessment
A. PAIN HISTORY
1. LOCATION Affective responses vary according
2. PAIN INTENSITY
3. PAIN QUALITY
to the situation,the degree and
4. PATTERN duration of pain, the interpretation of
5. PRECIPITATING FACTORS
it, and many other factors.
6. ALLEVIATING FACTORS
7. ASSOCIATED SYMPTOMS
The nurse needs to explore
8. EFFECT ON ACTIVITIES OF DAILY
LIVING the client’s feelings of anxiety, fear,
9.COPING RESOURCES exhaustion, level
10.
AFFECTIVE RESPONSES of function, depression, or a sense of
failure.
ASSESSMENT INTERVIEW Pain History
• Precipitating factors: What triggers the pain or makes it
worse?
What measures or methods have you found helpful in reducing
or relieving the pain? What pain medications do you use?
• Quality: Tell me what your discomfort feels like.
• Region/Radiation: Where is your discomfort? Ask client to
point to the location and document the exact location (e.g., left
lower abdomen instead of abdominal pain).
Do you feel the pain moving to other parts of the body? If yes,
where?
ASSESSMENT INTERVIEW Pain History
• Severity: On a scale of 0 to 10, with ‘0’ representing no pain
(substitute the term client uses e.g., ‘no burning’) and ‘10’
representing the worst pain imaginable (e.g., ‘burning sensation’),
how would you rate the degree of discomfort you are in right now?
• Timing:
a. Time of onset: When did or does the pain start?
b. Duration: How long have you had it, or how long does it
usually last?
c. Constancy: Do you have pain-free periods? And for how long?
• Understanding: What does experiencing this pain mean to you?
Does it signal something about the future or the past? What
worries or scares you the most about your pain?
ASSESSMENT INTERVIEW Pain History
• Associated symptoms: Do you have any other symptoms
(e.g., nausea, dizziness, shortness of breath) before, during,or after
your pain?
• Coping resources: What do you usually do to deal with pain?
• Affective response: How does the pain make you feel?
Anxious? Depressed? Frightened? Tired? Burdensome?
• Past pain experience: Tell me about past pain experiences you
have had and what was done to relieve the pain.
• Effects on ADLs: How does the pain affect your daily life?
(e.g., eating, working, sleeping, & social and recreational activities)?
NURSING MANAGEMENT
Assessment
B. OBSERVATION OF BEHAVIORAL
AND PHYSIOLOGICAL RESPONSES
A client’s self-report is an important! Nonverbal responses:
Not all clients, however, are able to 1. Facial expression
self-report. 2. Vocalizations
3. Immobilization of the body or a
This group, referred to as “nonverbal” part
clients, includes: 4. Purposeless body movements
1. The very young; 5. Behavioral changes
2. Individuals who are cognitively 6. Rhythmic body movements or
impaired,critically ill, or comatose; and
rubbing
some individuals at end of life.
NURSING MANAGEMENT
Assessment
B. OBSERVATION OF BEHAVIORAL
AND PHYSIOLOGICAL RESPONSES
A client’s self-report is an important!
Physiologic responses vary with the The body does not sustain the
origin and duration of the pain. increased sympathetic function
over a prolonged period and,
Early in the onset of acute pain (v/s is therefore, the sympathetic
elevated). nervous system adapts,causing
the responses to be less evident
or even absent.
NURSING MANAGEMENT
Assessment
C. DAILY PAIN DIARY
A client’s self-report is an important! The record could include the following:
For clients who experience chronic 1. • Time of onset of pain
pain, a daily diary may help the client 2. • Activity or situation
3. • Physical pain character (quality)
and healthcare provider identify pain
and intensity level (0–10)
patterns and factors that worsen or 4. • Emotions experienced and
resolve the pain experience. intensity level (0–10)
5. • Use of analgesics or other relief
The recorded data in the diary provide measures (intervention)
6. • Pain rating after intervention
the basis for developing or modifying
taken
the plan for care. 7. • Comments.
NURSING MANAGEMENT
Diagnosing
EXAMPLES OF SUCH NURSING DIAGNOSES FOLLOW:
Mild acute pain/moderate acute pain/severe
acute pain, or chronic pain related to
________________
Impaired coping related to prolonged continuous
back pain, ineffective pain management, and
inadequate support systems
Altered physical mobility related to pain and
inflammation Secondary to arthritic pain in
knee and ankle joints
Impaired sleep related to increased pain
perception at night.
NURSING MANAGEMENT
Planning
When planning, nurses need to choose
pain relief measures appropriate for the
client, based on the assessment data and
input from the client or support people.
Nursing interventions may include a
variety of pharmacologic and non-
pharmacologic strategies.
NURSING MANAGEMENT
Implementing
Nursing management of pain consists of both independent and
collaborative nursing actions.
Independent nursing actions
Example: ______________
Collaborative nursing actions?
Example: ______________
NURSING MANAGEMENT
Implementing
BARRIERS TO PAIN MANAGEMENT
NURSING MANAGEMENT
Implementing
BARRIERS TO PAIN MANAGEMENT
Over the last 20 years, opioid misuse and abuse has become an
increasing problem in our society (Assil,2016). The Centers for
Disease Control and Prevention(CDC, 2018) provided data that
showed the rise in opioid overdose deaths occurred in three
distinct waves (1990, 2010 and 2013).
The CDC’s Guideline for Prescribing Opioids for Chronic Pain
(2017;CDC, n.d.) provides 12 recommendations grouped into 3 areas:
(1) determining when to initiate or continue opioids for chronic pain;
(2) opioid selection, dosage,duration, follow-up, & discontinuation;
(3 )assessing risk and addressing harms of opioid use.
NURSING MANAGEMENT
Implementing
BARRIERS TO PAIN MANAGEMENT
The National Academies of Sciences, Engineering, and Medicine
(2017) reports four strategies, each with a variety of approaches,
to address the opioid epidemic while meeting the needs of clients.
These strategies include the following:
1. Restricting the supply of opioids.
2. Influencing prescribing practices.
3. Reducing demand.
4. Reducing harm. (One of the approaches for this strategy is to
expand access to naloxone, an opioid antagonist,to reverse
overdose.
NURSING MANAGEMENT
Implementing
BARRIERS TO PAIN MANAGEMENT
Another barrier to effective pain management is the fear of
becoming addicted. Both nurses and clients oftenhold this fear
1. Tolerance occurs when the client’s opioid dose, over time, leads
to a decreased sensitivity to the drug’s analgesic effect.
2. Physical dependence is an expected physical response when a
client who is on long-term opioid therapy has the opioid
significantly reduced or withdrawn.
3. Addiction is a chronic, relapsing, treatable disease influenced by
genetic, developmental, and environmental factors. Research
NURSING MANAGEMENT
Implementing
KEY STRATEGIES IN PAIN MANAGEMENT
Another barrier to effective pain management is the fear of
becoming addicted. Both nurses and clients oftenhold this fear
1. Acknowledging and Accepting Clients’ Pain.
2. Assisting Support People.
3. Reducing Misconceptions About Pain.
4. Reducing Fear and Anxiety.
5. Preventing Pain
NURSING MANAGEMENT
Implementing
KEY STRATEGIES IN PAIN MANAGEMENT
Preemptive analgesia
is the administration of analgesics before surgery to decrease
or relieve pain after surgery and reduce the need for opioid
pain control.
Multimodal analgesia
combines analgesics from two or more drug classes and a
variety of delivery approaches for the analgesics that result
in reducing, and often eliminating, the need for opioids.
This is also referred to as opioid-sparing therapy.
NURSING MANAGEMENT
Implementing Pharmacologic
NURSING MANAGEMENT
Implementing Pharmacologic
An ADJUVANT is a medication
that is not classified as a pain
medication.
However, adjuvants have
properties that may reduce pain
alone or in combination with
other analgesics,relieve other
discomforts, potentiate the effect
of pain medications, or reduce
the pain medication’s side effects
NURSING MANAGEMENT
Implementing Pharmacologic
OPIOID SIDE EFFECTS
When administering any analgesic, the nurse must review
adverse effects. Adverse effects of the opioids typically
include:
1. sedation
2. respiratory depression
3. nausea
4. vomiting
5. constipation
6. urinary retention
7. blurred vision
8. sexual dysfunction.
NURSING MANAGEMENT
Implementing Pharmacologic
Clinical Alert!
OPIOID SIDE EFFECTS
The most concerning adverse effect of opioids is RESPIRATORY
DEPRESSION (e.g., 8 breaths per minute or less),
SAFETY ALERT!
Assessing for sedation and respiratory status is critical
during the first 12 to 24 hours after starting opioid therapy.
The most critical period is during the peak effect of the first
dose(15 minutes if administered IV; first hour after IM, oral,
route).
NURSING MANAGEMENT
Implementing Non-Pharmacologic
Nonpharmacologic pain management consists of a
variety of physical, cognitive–behavioral, and lifestyle
pain management strategies that target the body, mind,
spirit,and social interactions (Table 30.6).
NURSING MANAGEMENT
Implementing Non-Pharmacologic
NURSING MANAGEMENT
Implementing Non-Pharmacologic
NURSING MANAGEMENT
Implementing Non-Pharmacologic
NURSING MANAGEMENT
Evaluating
The goals established in the planning phase are evaluated
according to specific desired outcomes, also established in
that phase.
If outcomes are not achieved, the nurse and client need to
explore the reasons before modifying the care plan.
Evaluation of the client’s pain therapy includes the
response of the client, the changes in the pain, and the
client’s perceptions of the effectiveness of the therapy.
Ongoing verbal or written feedback from the client and
family is integral to this process.
MRS.
MRS.RUSSEL
RUSSELZ.Z.PANTALEON
PANTALEON
PROFESSOR,
PROFESSOR,NURNURC303
C303
