NURSING DIAGNOSIS: Pain, acute
May be related to
- Surgical interruption/manipulation of tissues/muscles
- Postoperative edema
Possibly evidenced by
- Reports of pain
- Narrowed focus; guarding behavior; restlessness
- Autonomic responses
Desired Outcomes
Pain Control (NOC)
- Report pain is relieved/controlled.
- Demonstrate use of relaxation skills and diversional activities appropriate to situation.
Acute Pain — Thyroidectomy Nursing Care Plan (NCP): Nursing Interventions & Rationale
| Nursing Interventions | Rationale |
| Assess verbal/nonverbal reports of pain, noting location, intensity (0–10 scale), and duration. | Useful in evaluating pain, choice of interventions, effectiveness of therapy. |
| Place in semi-Fowler’s position and support head/neck with sandbags or small pillows. | Prevents hyperextension of the neck and protects integrity of the suture line. |
| Maintain head/neck in neutral position and support during position changes. Instruct patient to use hands to support neck during movement and to avoid hyperextension of neck. | Prevents stress on the suture line and reduces muscle tension. |
| Keep call bell and frequently needed items within easy reach. | Limits stretching, muscle strain in operative area. |
| Give cool liquids or soft foods, such as ice cream or popsicles. | Although both may be soothing to sore throat, soft foods may be tolerated better than liquids if patient experiences difficulty swallowing. |
| Encourage patient to use relaxation techniques, e.g., guided imagery, soft music, progressive relaxation. | Helps refocus attention and assists patient to manage pain/discomfort more effectively. |
| Administer analgesics and/or analgesic throat sprays/lozenges as necessary. | Reduces pain and discomfort; enhances rest. |
| Provide ice collar if indicated. | Reduces tissue edema and decreases perception of pain. |