CHAPTER 46 / Pain Management 1223
CRITICAL THINKING CHECKPOINT
Mrs. Lundahl underwent abdominal surgery approximately 6 hours ago.
She has a 15-cm midline incision that is covered with a dry and intact
surgical dressing. Upon assessing Mrs. Lundahl you note that she is per-
spiring, lying in a rigid position, holding her abdomen, and grimacing.
Her blood pressure is 150/90, heart rate 100, and respiratory rate 32.
When asked to rate her pain on a scale of 0 to 10, Mrs. Lundahl rates
her pain as 5 as long as she remains perfectly still. There is a sharp area
of pain at her incision; however, the most bothersome pain is crampy
and dull, like she was “kicked in the stomach” with severe exacerbations
that come in unpredictable waves.
1. What conclusions, if any, can be drawn about Mrs. Lundahl’s pain
status?
2. Does Mrs. Lundahl’s rating her pain as 5 mean that she is not ex-
periencing pain severe enough to warrant intervention?
3. What type of pain is Mrs. Lundahl experiencing?
4. What interventions, in addition to pain medication, may be use-
ful in reducing Mrs. Lundahl’s pain?
5. How will you know if your interventions have been effective in
reducing Mrs. Lundahl’s pain?
See Critical Thinking Possibilities in Appendix A.
NURSING CARE PLAN Acute Pain
ASSESSMENT DATA NURSING DIAGNOSIS DESIRED OUTCOMES*
Nursing Assessment
Mr. C. is a 57-year-old businessman who was admitted to the sur-
gical unit for treatment of a possible strangulated inguinal hernia.
Two days ago he had a partial bowel resection. Postoperative or-
ders include NPO, intravenous infusion of D51/2 NS at 125 cc/hr
left arm, nasogastric tube to low intermittent suction. Mr. C. is in a
dorsal recumbent (supine) position and is attempting to draw up
his legs. He appears restless and is complaining of abdominal
pain (7 on a scale of 0–10).
Acute Pain related to tissue in-
jury secondary to surgical inter-
vention (as evidenced by
restlessness; pallor; elevated
pulse, respirations, and systolic
blood pressure; dilated pupils;
and report of 7/10 abdominal
pain)
Pain Control [1605] as evi-
denced by often demonstrating
ability to
■Use analgesics appropriately
■Use nonanalgesic relief
measures
■Report uncontrolled
symptoms to health care
professional
Pain Level [2102] As evi-
denced by mild to no
■Reported pain
■Protective body positioning
■Restlessness
■Pupil dilation
■Perspiration
■Change in BP, HR, R from
normal baseline data
Physical Examination
Height: 188 cm (6′3′′)
Weight: 90.0 kg (200 lb)
Temperature: 37°C (98.6°F)
Pulse: 90 BPM
Respirations: 24/minute
Blood pressure: 158/82 mm Hg
Skin pale and moist, pupils di-
lated. Midline abdominal inci-
sion, sutures dry and intact.
Diagnostic Data
Chest x-ray and urinalysis neg-
ative, WBC 12,000
continued on page 1224
CLINICAL ALERT
The statement “Please tell me how I can best help you control your pain”
sends a couple of subtle messages that are an important part of treat-
ment planning and evaluation of care. First, it places the ownership and
responsibility for controlling pain on the client. Second, it acknowledges
that the client may be the best judge of what is needed, respecting the
cultural meaning of pain and acceptable ways of expressing/controlling
pain. Third, it establishes the nurse’s role in helping the client be more
comfortable and in control of his or her condition. ■
If outcomes are not achieved, the nurse and client need to ex-
plore the reasons before modifying the care plan. The nurse
might consider the following questions:
■Is adequate analgesic being given? Would the client benefit
from a change in dose or in the time interval between doses?
■Were the client’s beliefs, expectations, and values about pain
therapy considered?
■Did the client understate the pain experience for some reason?
■Were appropriate instructions provided to allay misconcep-
tions about pain management?
■Did the client and support people understand the instructions
about pain management techniques?
■Is the client receiving adequate support for both physical
pain and emotional distress?
■Has the client’s physical condition changed, necessitating
modifications in interventions?
■Should selected intervention strategies be reevaluated?
See the Nursing Care Plan and the Concept Map.
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