20/09/2019
Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than six (6) months.
The unpleasant feeling of pain is highly subjective in nature that may be experienced by the patient. Acute Pain serves a protective function to make the patient informed and knowledgeable about the presence of an injury or illness. The unexpected onset of Acute Pain reminds the patient to seek support, assistance, and relief. The physiological signs that occur with Acute Pain emerge from the body’s response to pain as stressor.
Other factors such as the patient’s cultural background, emotions, and psychological or spiritual discomfort may contribute to the suffering with Acute Pain. In older patients, assessment of pain can be challenging due to cognitive impairment and sensory-perceptual deficits. Assessment and management of Acute Pain are the main focus of this care plan.
Related Factors
Here are some factors that may be related to Acute Pain:
Pain coming from medical problems
Pain arising from emotional, psychological, spiritual, or cultural discomfort
Pain due to diagnostic procedures or medical interventions and treatments
Pain emerging from trauma
Defining Characteristics
Acute Pain is characterized by the following signs and symptoms:
Patient complains of pain
Appetite changes
Self-focused
Guarding behavior, protecting body part
Intolerant (e.g., altered time perception, withdrawal from social or physical contact)
Facial mask of pain
Autonomic responses (e.g., diaphoresis, an alteration in BP, HR, pupillary dilation; alteration in RR; pallor; nausea)
Change in muscle tone: lethargy or weakness; rigidity or tightness
Relief or distraction behavior (e.g., pacing, seeking out other people or activities)
Expressive behavior (e.g., restlessness, moaning, crying)
Hopelessness
Observed evidence of pain using standardized pain behavior checklist
For those unable to communicate; refer to the appropriate assessment tool (e.g., Behavioral Pain Scale, Neonatal Infant Pain Scale, Pain Assessment Checklist for Seniors with Limited Ability to Communicate)
Positioning to avoid pain
Protective gestures
Proxy reporting pain and behavior/activity changes (e.g., family members, caregivers)
Self-report of intensity using standardized pain intensity scales (e.g., Wong-Baker FACES scale, visual analogue scale, numeric rating scale)
Self-report of pain characteristics (e.g., aching, burning, electric shock, pins and needles, shooting, sore/tender, stabbing, throbbing) using standardized pain scales (e.g., McGill Pain Questionnaire, Brief Pain Inventory)
Goals and Outcomes
The following are the common goals and expected outcomes for Acute Pain.
Patient describes satisfactory pain control at a level less than 3 to 4 on a rating scale of 0 to 10.
Patient displays improved well-being such as baseline levels for pulse, BP, respirations, and relaxed muscle tone or body posture.
Patient uses pharmacological and nonpharmacological pain-relief strategies.
Patient displays improvement in mood, coping.
Nursing Assessment
Proper assessment of Acute Pain is imperative for the development of an effective pain management plan. Nurses play a crucial role in the assessment of pain, owing to the nature of their relationship with patients.
Assess pain characteristics:
Quality (e.g., burning, sharp, shooting)
Severity (scale of 0 or no pain to 10 or most severe pain)
Location (anatomical description)
Onset (gradual or sudden)
Duration (how long; intermittent or continuous)
Precipitating or relieving factors
Rationale ⇒ Assessment of pain experience is the first step in planning pain management strategies. The most reliable source of information about the pain is the patient.
Descriptive scales such as a visual analogue can be utilized to distinguish the degree of pain.
Assess for signs and symptoms relating to pain.
Rationale ⇒ Some people deny the existence of pain. Attention to associated signs may help the nurse in evaluating pain. An increase in BP, HR, and temperature may be present in a patient with acute pain. The patient’s skin may be pale and cool to touch. Restlessness and inability to concentrate are also some manifestations.
Assess to what degree cultural, environmental, intrapersonal, and intrapsychic factors may contribute to pain or pain relief.
Rationale ⇒ Such variables play a big role in modifying the patient’s expression of pain. Some cultures simply express feelings, whereas others hold such expression. Nevertheless, health care providers should not prejudge any patient response but rather evaluate the unique response of each individual.
Assess the patient’s willingness or ability to explore a range of techniques aimed at controlling pain.
Rationale ⇒ Other patients may be overlooking of the effectiveness of nonpharmacological methods and may be willing to try them, either with or instead of traditional analgesic medications. Often a combination of therapies (e.g., mild analgesics with distraction or heat) may be more effective. Some patients will feel uncomfortable exploring alternative methods of pain relief. However, patients need to be acquainted that there are other approaches to manage pain.
Evaluate the patient’s response to pain and management strategies.
Rationale ⇒ It is essential to assist patients express as factually as possible (i.e., without the effect of mood, emotion, or anxiety) the effect of pain relief measures. Inconsistencies between behavior or appearance and what the patient says about pain relief (or lack of it) may be more a reflection of other methods the patient is using to cope with the pain rather than pain relief itself.
Evaluate what the pain suggests to the patient.
Rationale ⇒ The meaning of pain will directly determine the patient’s response. Some patients, especially the dying, may consider that the “act of suffering” meets a spiritual need.
