- Physiological pain
- Medical treatment
- Medical procedure/ equipment
- Mental pain
- Cultural distress
- Religious/spiritual distress
- Emotional distress
Subjective Data: patient’s feelings, perceptions, and concerns. (Symptoms)
- Patient reports pain
Objective Data: assessment, diagnostic tests, and lab values. (Signs)
- Verbalizes pain on a numeric scale as a three or higher
- Frequent grimacing/ crying
- Guarding of the affected area
- Tense and rigid body posture
- Rocking back and forth/ restlessness
- Abnormal vital signs
- Increased blood pressure
- Increased heart rate
- Increased respirations
- Decreased activity/ ADLs
- Seeking attention/pleading
- The patient will reach a tolerable pain level
- The patient will verbalize non-pharmacological strategies to relieve pain
- The patient will show an increased comfort level
- The patient will exhibit an increased activity level
- The patient will notify a healthcare team member when pain exceeds the pain acceptance level.
Nursing Assessment for Acute Pain
|Assess the patient’s pain level by using the appropriate pain assessment tool. |
Some patients are unable to self-report pain. In that case, other pain assessment tools should be used. Examples are
Wong-Baker Facial Grimace Scale
Neonatal/Infant Pain Scale (NIPS)
Behavioral Pain Scale (BPS)
Nonverbal Pain Scale (NVPS)
These assessment tools are used for patients who cannot verbally express their pain for various reasons: impaired mentation, mechanical intubation, language barriers, and other circumstances. The NIPS is used on infants to assess and treat pain.
|For the verbal, self-reporting patient, assess these pain characteristics: |
Severity (numeric pain scale 1 to 10)
Quality (stabbing, aching, dull)
Onset /Duration (does the pain come and go, how long does it last at a time)
Location (where is the pain located, is it generalized pain)
Radiation (does the pain radiate to other places in the body; back, arm, jaw)
Aggravating factors (exercise, rest, activity)
Relieving factors (non-pharmacologic measures vs. pharmacologic measures)
All these aspects allow for an individualized treatment plan. In addition, pain treatment can be more targeted the more information is known about the pain characteristics.
|Assess pain routinely with vital signs and perform a follow-up assessment after treatment. |
Pain is often considered the fifth vital sign. Frequent assessment is necessary at designated times and as needed. Pain can change after procedures, activity, or other treatments such as wound dressing changes. Follow-up assessments are vital because it reveals if the treatment was effective or if adjustments to the care plan are necessary.
|Discuss expectations about pain relief and have the patient decide on an acceptable pain score. |
Often pain cannot be eliminated. For example, after surgery, the patient can expect postoperative pain. The goal is to control pain as much as possible.
|Ask the patient about previous experiences with pain, the response to treatment, and the response to pain medication. |
Knowing about pain relief measures that worked in the past helps guide treatment in the future.
|Consider medications the patient is currently taking. |
Pain medication that the patient takes at home due to chronic pain needs to be taken into consideration. Someone that takes pain medicine daily has a different treatment plan for pain management than someone that does not have chronic pain from previous injury or health conditions. Accurate medication reconciliation helps prevent drug-drug interactions, dosage errors, and other adverse instances.
|Consider the patient’s cultural and societal norms in terms of expression of pain. |
Emotions, such as happiness and sadness but also pain, are expressed very differently in various cultures. Some cultures express pain very openly, and others do not. Therefore, frequent pain assessment and communication are key.
Nursing Interventions for Acute Pain
|Administer pain medication as ordered. |
Treating pain appropriately during the hospital stay facilitates the healing process.
|Anticipate the need for pain medication for optimal pain management. |
Administering pain medication before painful procedures or activities, such as exercise or dressing changes, helps reduce the pain during these activities and makes it more tolerable.
|Provide other analgesics between narcotic doses, if ordered. |
Medications such as muscle relaxants or non-narcotic pain medication can be an effective addition to the existing treatment plan. These medications may be scheduled or PRN orders.
|Respond to pain medicine requests quickly.|
It might seem as if it takes much longer to receive pain medication during painful episodes than it actually does. These feelings, alongside feelings of anxiety and fear, make the experience worse. Pain medication administration, therefore, should be a priority task.
|Determine whether the pain medication was effective after administration. |
If the current ordered pain medication is not adequate, the physician may adjust analgesic treatment.
|Arrange nursing tasks in a way, so they are distributed throughout the entire shift.|
Enough time between painful activities and procedures allows the patient to rest and recover for the next task. This system of sufficient recovery time after activities ensures appropriate pain control and may increase compliance.
|Make the patient aware of the side effects of pain medications. |
Opioid medications can cause nausea, pruritus, and constipation. Awareness may help counteract these side effects early by reporting symptoms and with preventative bowel stimulation and antiemetic treatment.
|Assess sedation level and respiratory status routinely. |
Any patient on opioid medication is at risk for opioid-induced respiratory depression. To prevent these incidents, nurses are to use the Pasero-Opioid-Induced Sedation Scale (POSS). This tool is used to identify over sedation early.
Provide non-pharmacological pain relief
|Assist with guided imagery exercises. |
Visualization exercises help distract from painful sensations and focus on pleasant imagined ones.
|Offer distraction with reading, television, music, games, or conversations. |
These techniques also help with distraction by concentrating on pleasant stimuli.
|Teach breathing/relaxation exercises. |
These techniques are supposed to help the patient achieve a state of calm that will help reduce tensions and pain.
|Encourage the use of heat or cold treatments if ordered. |
Heat applications can help soothe and relax stiff muscles and joints, whereas cold compresses can numb and reduce inflammatory pain.
|Assist the patient with frequent position changes at least every two hours and as needed. |
Lying or sitting in the same position for a long time may cause tense muscles, stiff joints, and pain at pressure points. Changing positions helps relieve pressure and reduce pain.
|Consider PCA if the patient is a candidate. |
PCA management includes:
Monitoring the amount of opioids delivered in contrast to the patient’s reports of pain.
If dosage demands are frequent, the dosage might need to be adjusted to cover the patient’s pain.
Monitoring for oversedation and other complications.
Signs of excessive sedation are respiratory depression and hemodynamic changes. Other complications are nausea and constipation.
Patient Education for Acute Pain
|Teach about the importance of taking pain medication to maintain a certain comfort level. |
Taking pain medicine early prevents pain from becoming unbearable. However, it can be difficult to control pain once it becomes too intense. Consistent pain control helps with a steady recovery.
|Provide written instructions about opioid pain medication. |
For some patients, it might be the first time taking opioid analgesics. Having a reference on hand, especially after discharge, facilitates following medication regimens.
|Emphasize the use of a combination of pharmacological and non-pharmacological pain relief. |
Non-pharmacological pain relief can be used in addition to pharmacological pain relief for better pain control.
|If a PCA is in use, emphasize that only the patient can press the button to deliver pain medication. |
Discouraging family members from pressing the button prevents unnecessary doses and reduces toxic effects from opioids.
More Care Plans
References and Resources:
Potter, P., & Perry, A. (2013). Fundamentals of nursing (8th ed.). Elsevier.