NURSING DIAGNOSIS: Pain, acute/chronic
May be related to
- Injuring agents (biological, chemical, physical, psychological)
- Chronic physical disability
Possibly evidenced by
- Verbal/coded report; preoccupation with pain
- Changes in appetite/eating, weight; sleep patterns; altered ability to continue desired activities; fatigue
- Guarded/protective behavior; distraction behavior (pacing/repetitive activities, reduced interaction with others)
- Facial mask; expressive behavior (restlessness, moaning, crying, irritability); self-focusing; narrowed focus (altered time perception, impaired thought process)
- Alteration in muscle tone (varies from flaccid to rigid)
- Autonomic responses (diaphoresis, changes in BP, respiration, pulse); sympathetic mediated responses (temperature, cold, changes of body position, hypersensitivity)
Desired Patient Outcomes:
- Report pain is relieved/controlled.
- Verbalize methods that provide relief.
- Follow prescribed pharmacological regimen.
- Demonstrate use of relaxation skills and diversional activities as indicated.
Desired Family Outcomes:
- Cooperate in pain management program.
4 End of Life Care Nursing Care Plan (NCP)
Pain — Hospice Care Nursing Care Plan (NCP): Nursing Interventions & Rationale
| Nursing Interventions | Rationale |
| Perform a comprehensive pain evaluation, including location, characteristics, onset/duration, frequency, quality, severity (e.g., 0–10 scale), and precipitating/aggravating factors. Note cultural issues impacting reporting and expression of pain. Determine patient’s acceptable level of pain. | Provides baseline information from which a realistic plan can be developed, keeping in mind that verbal/behavioral cues may have little direct relationship to the degree of pain perceived. Note: Often patient does not feel the need to be completely pain-free but is able to be more functional when pain is at lower level on the pain scale. |
| Determine possible pathophysiological/psychological causes of pain | Pain is associated with many factors that may be interactive and increase the degree of pain experienced. |
| Assess patient’s perception of pain, along with behavioral and psychological responses. Determine patient’s attitude toward/use of pain medications and locus of control (internal/external). | Helps identify patient’s needs and pain control methods found to be helpful or not helpful in the past. Note:Individuals with external locus of control may take little or no responsibility for pain management. |
| Encourage patient/family to express feelings/concerns about narcotic use. | Inaccurate information regarding drug use/fear of addiction or oversedation may impair pain control efforts. |
| Verify current and past analgesic/narcotic drug use (including alcohol). | May provide insight into what has/has not worked in the past or may impact therapy plan. |
| Assess degree of personal adjustment to diagnosis, such as anger, irritability, withdrawal, acceptance. | These factors are variable and often affect the perception of pain/ability to cope and need for pain management. |
| Discuss with SO(s) ways in which they can assist patient and reduce precipitating factors. | Promotes involvement in care and belief that there are things they can do to help. |
| Identify specific signs/symptoms and changes in pain requiring notification of healthcare provider/medical intervention. | Unrelieved pain may be associated with progression of terminal disease process, or be associated with complications that require medical management. |
| Involve caregivers in identifying effective comfort measures for patient, e.g., use of nonacidic fluids, oral swabs/lip salve, skin/perineal care, enema. Instruct in use of oxygen/suction equipment as appropriate. | Managing troubling symptoms such as nausea, dry mouth, dyspnea, constipation can reduce patient’s suffering and family anxiety, improving quality of life and allowing patient/family to focus on other issues. |
| Demonstrate/encourage use of relaxation techniques, e.g., guided imagery, tapes/music, meditation. | May reduce need for/can supplement analgesic therapy, especially during periods when patient desires to minimize sedative effects of medication. |
| Monitor for/discuss possibility of changes in mental status, e.g., agitation, confusion, restlessness. | Although causes of deterioration are numerous in terminal stages, early recognition and management of the psychological component is an integral part of pain management. |
| Establish pain management plan with patient, family, and healthcare provider, including options for management of breakthrough pain. | Inadequate pain management remains one of the most significant deficiencies in the care of the dying patient. A plan developed in advance increases patient’s level of trust that comfort will be maintained, reducing anxiety. |
| Schedule/administer analgesics as indicated to maximal dosage. Notify physician if regimen is inadequate to meet pain control goal. | Helps maintain “acceptable” level of pain. Modifications of drug dosage/combinations may be required. |
| Instruct patient, family/caregiver in use of IV pump (PCA) for pain control. | When patient controls dosage and administration of medication, pain relief is enhanced and quality of life improved. |