Tips to overcome nausea and vomiting during pregnancy
Some tips to help you cope with "morning sickness" or nausea-vomiting during early pregnancy:
A. Eat small amounts, but often, do not eat in large quantities or portions, will only make you grow sick. Try to eat when you should eat small meals but frequently.
2. Eating foods high in carbohydrates and protein that can help overcome your nausea. Many fruit and vegetables and foods high in carbohydrates such as bread, potatoes, biscuit, etc..
3. In the morning when you wake up, do not jump to hasty wake up, try to sit first, and only slowly stood up. If you feel very sick when you wake up in the morning prepare snack or biscuit near your bed, and you can eat it before you try to stand.
4. Avoid fatty foods, oily and spicy foods that will aggravate your nausea.
5. Drink enough to avoid dehydration from vomiting. Drink water, or juice. Avoid drinks that contain caffeine and carbonates.
6. Prenatal vitamins sometimes exacerbate nausea, but you still need folate for pregnancy is. If nausea and vomiting is very severe, consult your doctor so that it can be given the best advice for vitamins that you will consume. And your doctor will probably provide a cure for nausea when necessary.
7. Vitamin B6 is effective for reducing nausea in pregnant women. Should first consult with your doctor to use.
8. Traditional Treatment: Usually, people use ginger in reducing nausea in a variety of traditional medicine. Research suggests that ginger can be used as traditional medicine to relieve nausea and safe for mother and baby. At some pregnant women who consume fresh ginger or ginger candy to help cope with her nausea.
9. Rest and relax will help you cope with nausea vomiting. Because if you stress will only aggravate your nausea. Uptake time for you! just try to rest and relax, listen to music, reading books or magazines of your favorite baby etc.. Deal with your pregnancy with happiness, because it is grace. :-)
Remember! Call your doctor if nausea and vomiting become so severe, so that you can not eat or drink anything that can lead to lack of fluids / dehydration.
Believe Morning sickness or nausea and vomiting in early pregnancy it will pass without you realizing it and this will be one exciting experience during your pregnancy, just think about the little one will be coming soon bring happiness million.
Impetigo is a highly contagious bacterial skin infection most common among pre-school children. People who play close contact sports such as rugby, American football and wrestling are also susceptible, regardless of age. Impetigo is not as common in adults. The name derives from the Latin impetere ("assail"). It is also known as school sores.
It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes. According to the American Academy of Family Physicians, both bullous and nonbullous are primarily caused by Staphylococcus aureus, with Streptococcus also commonly being involved in the nonbullous form.
Nursing Care Plan for Congenital Dislocation Of The Hip - Nursing Diagnosis for Congenital Dislocation Of The Hip
Congenital dislocation or subluxation of the hip (congenital acetabular dysplasia) is a complete or partial displacement of the femoral head out of the acetabulum. The physical signs are essential for the diagnosis of age related. In newborns the tests for instability are the most sensitive. After the neonatal period, and until the age of walking, tightness of the adductor muscles is the most reliable sign. Early diagnosis is vital for Successful treatment of this condition partially genetically determined. Various therapeutic measures, ranging from abduction splinting to open reduction and osteotomy, may be required. Following the diagnosis in the first month of life, the average treatment time in one recent series was only 2.3 months from initiation of therapy to Attainment of a normal hip. When the diagnosis was not made until 3 to 6 months of age, ten months of treatment was required to Achieve the same outcome. When the diagnosis is not made, or the treatment is not Begun until after the age of 6, a normal hip will probably not develop in any patient.(ncbi.nlm.nih.gov)
Nursing Diagnosis for Congenital Dislocation Of The Hip
Scoliosis affects 2% of women and 0.5% of men in the general population. There are many Causes of scoliosis, congenital spine deformities Including, genetic conditions, neuromuscular problems and limb length inequality. Other Causes for scoliosis include cerebral palsy, spina bifida, muscular dystrophy, spinal muscular atrophy and tumors. Over 80% of scoliosis cases, however, are idiopathic, the which means That there is no known cause. Most idiopathic scoliosis cases are found in otherwise healthy people.
Symptoms
Scoliosis can be mild, moderate or severe. The symptoms and signs of scoliosis can include:
One shoulder tilted down towards a raised hip, as if the child is Leaning sideways
Prominent ribs
A protruding shoulder blade
Tilted waist
The curve is more pronounced when the child bends forward.
Impaired Physical Mobility Nanda Definition: a nursing diagnosis approved by the North American Nursing Diagnosis Association, defined as the state in the which an individual has a Limitation in independent, purposeful physical movement of the body or of one or more extremities.
Alteration in mobility may be a temporary or more permanent problem. Most disease and rehabilitative states involve some degree of immobility (eg, as seen in strokes, leg fracture, trauma, morbid obesity, and multiple sclerosis). With the longer life expectancy for most Americans, the incidence of disease and disability Continues to grow. And with shorter hospital stays, Patients are being transferred to rehabilitation facilities or sent home for physical therapy in the home environment.
Mobility is also related to body changes from aging. Loss of muscle mass, reduction in muscle strength and function, stiffer and less mobile joints, affecting balance and gait changes can significantly compromise the mobility of elderly Patients. Mobility is paramount if elderly Patients are to maintain any independent living. Restricted movement affects the performance of most activities of daily living (ADLs). Elderly Patients are also at Increased risk for the complications of immobility. Nursing goals are to maintain functional ability, Prevent additional impairment of physical activity, and Ensure a safe environment.
Nursing Diagnosis and Interventions - Knowledge Deficit related to Tuberculosis
Nursing Diagnosis for TB Tuberculosis: Knowledge Deficit: about the conditions, actions, and prevention related to inaccurate and incomplete information.
Expected outcomes are:
Said understanding the disease process / prognosis and treatment needs.
Nursing Interventions Knowledge deficit related to Tuberculosis:
Assess the patient's ability to learn.
Identification of symptoms should be reported to the nurse.
Provide written instructions and information.
Encourage clients not to smoke.
Assess how TB is transmitted
Rationalization:
Learning depends on emotional and physical readiness and improved at the individual stages.
Can show progress or reactivation of disease or drug effects that require further evaluation.
Written information for patients given the lower barriers to large amounts of information.
Although smoking does not stimulate the recurrence of TB but increased respiratory dysfunction.
Assess respiratory function, eg, breath sounds, speed, rhythm, depth and use of accessory muscles.
Note the ability to remove mucous / coughing effective: note the character, amount of sputum, presence of hemoptysis.
Give the patient or the semi-Fowler position higher. Help the patient to cough and deep breathing exercises.
Clean secretions from the mouth and trachea: suction as needed.
Collaboration with the medical team in the provision of drugs.
Rrationalization:
Decrease in breath sounds may indicate atelectasis.
Expenditure is difficult when the secretions are very thick. Bloody sputum or blood thick bright due to lung damage or injury and may require evaluation bronkal.
Position to help maximize lung expansion and reduce respiratory effort.
Vaginal discharge is a problem that has long been a problem for women. Not many women who know what a vaginal discharge, and sometimes underestimate the problem of vaginal discharge. Though Vaginal discharge can not be taken lightly, as a result of vaginal discharge can be very fatal if treated late.
Vaginal discharge or Fluor Albus is a condition where excess fluid out of the vagina. Vaginal discharge can be divided into 2 parts whitish normal (physiological) and vaginal discharge abnormal (pathological). Whiteness is not a disease (physiological) can occur on any girl. Discharge is usually clear, colorless, odorless and does not itch. This amount of fluid discharge can be a little or a lot, occurred before and after menstruation, when sexually aroused or when you're stressed. Sometimes we also experience vaginal discharge that teenagers just before puberty, usually the symptoms will go away by itself.
But if the discharge from the vagina is not clear, yellowish white, gray to greenish, thick, smelling like rotten eggs or rancid, itching and more numerous, it is likely that whiteness is not normal. Some of the causes of abnormal vaginal discharge caused by infection is usually accompanied by itching in the vagina and around the outer vaginal lips. Which often cause vaginal discharge include bacteria, viruses, fungi or parasites also. If not treated the infection can spread and cause inflammation of the urinary tract, causing the pain when the patient is urinating.
Vaginal discharge can be prevented by:
Keeping the genital hygiene, cleaning the vagina with clean running water by wiping from front to back.
Minimize the use of antiseptic soap because it can interfere with vaginal pH balance.
Time to change pads at least 3 times a day.
Choosing the right underwear, not wearing pants that are tight and absorb perspiration.
Avoiding risk factors for infection such as sexual promiscuity, as well as regular gynecological examinations.
Vaginal discharge is term given to biological fluids contained within or expelled from the vagina.
While most discharge is normal and can reflect the various stages of a woman's cycle, some discharge can be a result of an infection, such as a sexually transmitted disease.
Common Causes of Vaginal Discharge
Often using tissue, while washing the female, after urinating or defecating.
Wearing tight underwear from synthetic materials.
Often use a dirty toilet.
Not change the panty liner.
Rinsing the vagina from the wrong direction. Namely from the anus toward the vagina towards the front.
Often exchanged briefs / towels with others.
Less maintain the cleanliness of the vagina.
Exhaustion.
Stress.
Not immediately replace the pads during menstruation.
Wearing any soap to wash the vagina.
Not leading a healthy lifestyle (eat irregularly, never exercise, slept less).
Living in the humid tropics.
Environmental sanitation is dirty.
Often with warm water bath and heat. The fungus that causes vaginal discharge is more likely to grow in warm conditions.
Acute otitis media is often preceded by respiratory tract infections such as sore throats / colds that spread to the middle ear through the eustachian channel.
When the bacteria through the eustachian, the bacteria can cause infections of the channel. So that there was swelling around the channel, channel blockage, and the coming of the white blood cells to fight bacteria.
White blood cells will fight the bacterial cells at the expense of their own, at least to form pus in the middle ear. Tissue swelling around the eustachian cells causes mucus produced when cells multiply mucus and pus, hearing can be impaired because the eardrum and small bones connecting the ear drum with the hearing organ in the inner ear to move freely. Too much fluid, finally able to tear the eardrum because of the pressure.
Nursing Care Plan for Osteomyelitis : Nursing Diagnosis for Osteomyelitis and Nursing Interventions for Osteomyelitis
Osteomyelitis is an infection of the bone. It can be caused by a variety of microbial agents (most common in staphylococcus aureus) and situations, including:
An open injury to the bone, such as an open fracture with the bone ends piercing the skin.
An infection from elsewhere in the body, such as pneumonia or a urinary tract infection that has spread to the bone through the blood (bacteremia, sepsis).
A minor trauma, which can lead to a blood clot around the bone and then a secondary infection from seeding of bacteria.
Bacteria in the bloodstream bacteremia (poor dentition), which is deposited in a focal (localized) area of the bone. This bacterial site in the bone then grows, resulting in destruction of the bone. However, new bone often forms around the site.
A chronic open wound or soft tissue infection can eventually extend down to the bone surface, leading to a secondary bone infection.
Symptoms of osteomyelitis
The symptoms of osteomyelitis can include:
Pain and/or tenderness in the infected area
Swelling and warmth in the infected area
Fever
Nausea, secondarily from being ill with infection
General discomfort, uneasiness, or ill feeling
Drainage of pus through the skin
Additional symptoms that may be associated with this disease include:
Excessive sweating
Chills
Lower back pain (if the spine is involved)
Swelling of the ankles, feet, and legs
Changes in gait (walking pattern that is a painful, yielding a limp)
Nursing Diagnosis for Osteomyelitis
Acute pain related to inflammation and swelling
Impaired Physical Mobility related to pain and limitation of the load weight
Risk for Infection
Targets to be achieved:
Pain is reduced
Improvement of physical mobility within the limits of therapeutic
Infection control
Nursing interventions for Osteomyelitis
1. Immobilization of the affected area with a splint to reduce pain and muscle spasms.
2. Joints above and below the affected area should be made so that still can be moved according to the range yet gently. The wound itself is sometimes very painful and must be handled carefully and slowly.
3. Elevate the affected area to reduce swelling and discomfort.
4. Monitor the affected extremity neurovascular status.
5. Do pain management techniques such as massage, distraction, relaxation, hypnosis to reduce pain perception and collaboration with medical for providing analgesic.
6. Protect your bones by means of immobilization and avoid stress on the bone because bones become weak due to the infection process.
Nursing Care Plan for Tonsillitis - NursingDiagnosisforTonsillitis
Tonsillitis refers to inflammation of the pharyngeal tonsils.The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils.The tonsils are lymph nodes, or oval-shaped masses of lymph gland tissue, located on both sides of the throat. An infection of the tonsils is called tonsillitis.
There are several variations of tonsillitis: acute, recurrent, and chronic tonsillitis and peritonsillar abscess. This swelling is usually caused by either a viral or bacterial infection. Tonsillitis is the name given to swollen, red, and tender tonsils.
Tonsillitis is usually a self-limiting condition, ie it gets better without treatment, and generally there are no complications.Tonsillitis is extremely common in children and young people but it can occur at any age. The characteristics of the disease are pain in the throat and trouble swallowing.
Tonsillitis usually begins with sudden sore throat and painful swallowing.
5 Nursing Diagnosis for Tonsillitis
1. Acute pain related to the presence of inflammation in tosil.
· Review the signs of verbal expressions of anxiety.
Rational: the level of anxiety may develop panic that can stimulate the sympathetic with the release of catecholamines lead to increased cardiac demand for oxygen.
· Accompany the client during the period of high anxiety, give strength, use it at ease.
Rational: the sense of empathy is a treatment and may increase the client's coping abilities.
· Orient the client with routine procedures and activities that are expected.
Rational: orientation can reduce anxiety.
· Give the client an opportunity to express his concerns.
Rational: to eliminate ketegangang to the concerns that are not expressed.
· Do the approach and communication.
Rational: to foster mutual trust.
· Give the opportunity to accompany the person closest to the client.
Rational: to improve safety on the client.
· Provide an explanation of the disease, causes and treatment to be performed.
Rational: to provide assurance about the action steps that will be provided so that clients and families to get clear information.
Client will experience increased comfort and decreased pain.
Client will express positive feelings about himself.
Client will perform activities of daily living within normal limits.
Client will maintain adequate food intake.
Client will maintain joint mobility and range of motion.
Client will demonstrate integrity intact skin.
Client will show the steps to prevent injury.
Nursing Intervention for Osteoporosis
Explain all treatments, tests, and procedures. For example, if the patient underwent surgery, explain all procedures and preoperative and postoperative care for patients and their families.
Make sure the client and his family clearly understand the prescribed drug regimen. Tell them how to recognize a significant adverse reactions. Instruct them to immediately report it.
Stressed the need for regular gynecological examinations. Also instructed him to immediately report abnormal vaginal bleeding, to detect the hormone estrogen.
If clients take calcium supplements, encouraging liberal fluid intake to help maintain adequate urine output and thus avoid kidney stones, hypercalcemia, and hypercalciuria.
Tell the client to report the immediate pain, especially after trauma.
Explain kliien and osteoporosis in the family so that they can act to prevent fractures.
Instruct patient to eat foods rich in calcium. Explain that the type II osteoporosis can be prevented with adequate calcium intake and regular exercise. Hormonal and fluoride treatments can also help prevent osteoporosis.
Strengthen the patient's efforts to adapt, and shows how his condition has improved or stabilized. Necessary, refer to an occupational therapist or health care professionals to help with daily activities at home.
Nursing Diagnosis : Deficient Fluid Volume - Nursing Care Plan for Peritonitis
Deficient Fluid Volume NANDA Definition: Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium
Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localised or generalised, and may result from infection (often due to rupture of a hollow organ as may occur in abdominal trauma or appendicitis) or from a non-infectious process.
Nursing Interventions Deficient Fluid Volume - Nursing Care Plan for Peritonitis
Independent:
1. Monitor vital signs, note the presence of hypotension (including postural changes), tachycardia, tachypnea, fever. Measure CVP if any.
Rational: To assist in the evaluation of the degree of fluid deficit / effectiveness of fluid replacement therapy and response to treatment.
2. Maintain adequate intake and output and then connect with the body weight daily.
Rationale: Demonstrates overall hydration status.
3. Rehydration / resuscitation fluid
Rationale: To meet the need of fluid in the body (homeostasis).
4. Measure specific gravity of urine
Rationale: Demonstrates changes in hydration status and renal function.
5. Observation of skin / mucous membranes for dryness, turgor, note peripheral edema / sacral.
Rational: Hypovolemia, fluid displacement, and lack of nutrition aggravate skin turgor, adding tissue edema.
6. Eliminate the danger signs / smells from environment. Limit intake of ice cubes.
Rational: Lowering the gastric stimulation and vomiting response.
7. Change positions frequently give skin care with often, and keep the bed dry and free of folds.
Rational: tissue edema and circulatory disturbance tends to damage the skin.
Collaboration:
1. Monitor laboratory examinations, eg Hb / hematocrit, electrolytes, protein, albumin, BUN, creatinine.
Rationale: Provides information about hydration and organ function.
2. Give the plasma / blood, fluids, electrolytes.
Rational: Charge / maintain circulating volume and electrolyte balance. Colloid (plasma, blood) to help move the water into the area by increasing intravascular osmotic pressure.
3. Keep fasting with nasogastric aspiration / intestinal
Rational: Lowering intestinal hyperactivity, and loss from diarrhea.
Altered epidermis and/or dermis: Invasion of body structures, destruction of skin layers (dermis), and disruption of skin surface (epidermis).
Acne
Acne is an infection of the skin, caused by changes in the sebaceous glands. The most common form of acne is called acne vulgaris, which means common acne. The redness comes from the inflammation of the skin in response to the infection.
Oils from the glands combine with dead skin cells to block hair follicles. Under the blocked pore, oil builds up. Skin bacteria can then grow very quickly. This infection makes the skin become swollen and red, which becomes visible.
The face, chest, back, and upper arms are most common places for acne to happen.
Acne is common during puberty, when a person is turning from a child into an adult, because of high levels of hormones. Acne becomes less common as people reach adulthood.
1. Encourage clients to avoid all forms of friction (touched, scratched by hand) on the skin.
Rational: Preventing the spread of bacteria that can worsen the infection in the skin lesions.
2. Instruct the patient to be able to treat the skin with a clean and correct.
Rational: the right skin care reduces the risk of accumulation of dirt on the skin.
3. Motivation of patients to keep taking the drugs and foods that contain enough nutrients.
Rational: To expedite the healing process.
4. Observations of erythema and palpated for warmth around the area.
Rational: The warmth is a sign of infection.
5. Collaboration of topical antibiotics.
Rational: To inhibit the growth of bacteria.
Confusion in mental picture of one's physical self Defining Characteristics: Nonverbal response to actual or perceived change in structure and/or function; verbalization of feelings that reflect an altered view of one's body in appearance, structure, or function; verbalization of perceptions that reflect an altered view of one's body in appearance, structure, or function; behaviours of avoidance, monitoring, or acknowledgment of one's body.
Acne
Acne is a skin condition that affects millions of people worldwide. Everybody suffers from acne at some point of their age and it spoils their skin therefore, people want a natural and permanent solution to cure acne.
This disease is technically called acne vulgaris and it affects millions of people from all over the world, mostly teenagers. Nearly everyone suffers at some point from outbreaks of pimples in their lives and most people consult a dermatologist in order to help them with this unaesthetic disease. As stated before, there are several types of acne, however one of the worst types of them all is with no doubt cystic acne.
Nursing Interventions and Rational - Disturbed Body Image related to Acne :
1. Encourage clients to express their feelings and perceptions about the effects of the disease.
Rational: By expressing feelings, can reduce the psychological burden.
2. Encourage individuals to ask the problem, management, development and health prognosis.
Rational: To assess patients' knowledge level and can provide new inputs that are beneficial to recovery
3. Provide reliable information and confirmed the information given.
Rational: Increasing patient knowledge, so that a healthy behavior and prevent the development of more severe disease.
4. Encourage you to share with the people about the values and things that are important to them
Rational: By expressing, sharing, can reduce the psychological burden.
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Assess comprehensively about pain, including: location, characteristics and the onset, duration, frequency, quality, intensity / severity of pain, and precipitation factors.
Observation of non-verbal cues of discomfort, especially in the inability to communicate effectively.
Give analgesics in accordance with the recommendation.
Use therapeutic communication so that patients can express pain.
Assess the patient's cultural background.
Determine the impact of the expression of pain on quality of life: sleep patterns, appetite, activity of cognition, mood, relationships, jobs, role responsibility
Assess the individual's experience of pain, a family with chronic pain
Evaluation of the effectiveness of the actions that have been used to control pain.
Provide support to patients and families.
Provide information about pain, such as: the causes, how long the case, and precautions.
Control of environmental factors that may affect patient response to discomfort (such as room temperature, irradiation, etc.).
Instruct patient to monitor his own pain.
Teach the use of non-pharmacological techniques (such as relaxation, guided imagery, music therapy, distraction, application of heat and cold, massase).
Evaluate the effectiveness of measures to control the pain.
Modification of pain control measures based on patient response.
Increase the sleep / rest.
Instruct the patient to discuss precisely the experience of pain.
Tell your doctor if action is not successful or event of a complaint.
Inform other healthcare team / family members as non-pharmacological measures carried out, for a preventive approach.
Monitor patients for pain management convenience.
Provision of Analgesic
Determine the location of pain, characteristics, quality, and severity before treatment.
Give the right medicine to the principle 5.
Check the history of drug allergy.
Involve the patient in the electoral analgesics to be used.
Select the appropriate analgesic / analgesic combination of more than one if it has been prescribed.
Make a selection of analgesics based on the type and severity of pain.
Monitor vital signs before and after administration of analgesics.
Monitor adverse drug reactions and medication.
Document the response after the administration of analgesics and their side effects.
Perform actions to reduce analgesic effects (constipation / stomach irritation).
Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.
Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has four different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites.
Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and intravenous fluids and blood transfusion for more severe cases. The incidence of dengue fever has increased dramatically since the 1960s, with around 50–100 million people infected yearly. Early descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the early 20th century. Dengue has become a global problem since the Second World War and is endemic in more than 110 countries. Apart from eliminating the mosquitoes, work is ongoing on a vaccine, as well as medication targeted directly at the virus. wikipedia
Hyperthermia
Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability or death.
The most common causes are heat stroke and adverse reactions to drugs. Heat stroke is an acute condition of hyperthermia that is caused by prolonged exposure to excessive heat or heat and humidity. The heat-regulating mechanisms of the body eventually become overwhelmed and unable to effectively deal with the heat, causing the body temperature to climb uncontrollably. Hyperthermia is a relatively rare side effect of many drugs, particularly those that affect the central nervous system. Malignant hyperthermia is a rare complication of some types of general anesthesia.
Hyperthermia can be created artificially by drugs or medical devices. Hyperthermia therapy may be used to treat some kinds of cancer and other conditions, most commonly in conjunction with radiotherapy.
Hyperthermia differs from fever in the mechanism that causes the elevated body temperatures: a fever is caused by a change in the body's temperature set-point.
The opposite of hyperthermia is hypothermia, which occurs when an organism's temperature drops below that required for normal metabolism. Hypothermia is caused by prolonged exposure to low temperatures and is also a medical emergency requiring immediate treatment. wikipedia
Acute Pain NANDA Definition: Pain is whatever the experiencing person says it is, existing whenever the person says it does (McCaffery, 1968); an 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 <6 months (NANDA).
Defining Characteristics:
Subjective
Pain is always subjective and cannot be proved or disproved. A client's report of pain is the most reliable indicator of pain (Acute Pain Management Guideline Panel, 1992). A client with cognitive ability who can speak or point should use a pain rating scale (e.g., 0 to 10) to identify the current level of pain intensity (self-report) and determine a comfort/function goal (McCaffery, Pasero, 1999).
Objective
Expressions of pain are extremely variable and cannot be used in lieu of self-report. Neither behavior nor vital signs can substitute for the client's self-report (McCaffery, Ferrell, 1991, 1992; McCaffery, Pasero, 1999). However, observable responses to pain are helpful in clients who cannot or will not use a self-report pain rating scale. Observable responses may be loss of appetite and inability to deep breathe, ambulate, sleep, or perform activities of daily living (ADLs). Clients may show guarding, self-protective behavior, self-focusing or narrowed focus, distraction behavior ranging from crying to laughing, and muscle tension or rigidity. In sudden and severe pain, autonomic responses such as diaphoresis, blood pressure and pulse changes, pupillary dilation, or increases or decreases in respiratory rate and depth may be present.
Related Factors:
Actual or potential tissue damage (mechanical [e.g., incision or tumor growth], thermal [e.g., burn], or chemical [e.g., toxic substance])
·Uses a pain rating scale to identify current level of pain intensity and determines a comfort/function goal (if client has cognitive abilities)
·Describes how unrelieved pain will be managed
·Reports that the pain management regimen relieves pain to a satisfactory level with acceptable or manageable side effects
·Performs activities of recovery with a reported acceptable level of pain (if pain is above the comfort/function goal, takes action that decreases pain or notifies a member of the health care team)
·States an ability to obtain sufficient amounts of rest and sleep
·Describes a nonpharmacological method that can be used to control pain
NIC Interventions (Nursing Interventions Classification) Suggested NIC Labels
·Conscious Sedation
·Patient-Controlled Analgesia (PCA) Assistance
Nursing Interventions and Rationales
·Determine whether client is experiencing pain at the time of the initial interview. If so, intervene at that time to provide pain relief. The intensity, character, onset, duration, and aggravating and relieving factors of pain should be assessed and documented during the initial evaluation of the patient (American Pain Society Quality of Care Committee, 1995; JCAHO, 2000).
·Ask client to describe past experiences with pain and effectiveness of methods used to manage pain, including experiences with side effects, typical coping responses, and how he or she expresss pain. A number of concerns (barriers) may affect patients' willingness to report pain and use analgesics (Ward et al, 1993).
·Describe adverse effects of unrelieved pain. Numerous pathophysiological and psychological morbidity factors may be associated with pain (McCaffery, Pasero, 1999; Page, Ben-Eliyahu, 1997; Puntillo, Weiss, 1994).
·Tell client to report location, intensity (using a pain rating scale), and quality when experiencing pain. The intensity of pain and discomfort should be assessed and documented after any known pain-producing procedure, with each new report of pain, and at regular intervals (American Pain Society Quality of Care Committee, 1995; JCAHO, 2000).
·Determine client's current medication use. To aid in planning pain treatment, obtain a medication history (Acute Pain Management Guideline Panel, 1992).
·Explore the need for both opioid (narcotic) and non-opioid analgesics. Pharmacological interventions are the cornerstone of pain management (Acute Pain Management Guideline Panel, 1992; McCaffery, Pasero, 1999).
·Obtain a prescription to administer a non-opioid (acetaminophen, Cox-2 inhibitor, or a nonsteroidal antiinflammatory drug [NSAID]), unless contraindicated, around the clock (ATC). NSAIDs act mainly in the periphery to inhibit the initiation of pain impulses (Dahl, Kehlet, 1991). Unless contraindicated, all patients with acute pain should receive a non-opioid ATC (Acute Pain Management Guideline Panel, 1992). The analgesic regimen should include a non-opioid, even if pain is severe enough to require the addition of an opioid (Jacox et al, 1994; McCaffery, Pasero, 1999).
·Obtain a prescription to administer opioid analgesia if indicated, especially for severe pain. Opioid analgesics are indicated for the treatment of moderate to severe pain (Jacox et al, 1994; McCaffery, Pasero, 1999).
·Administer opioids orally or intravenously, not intramuscularly. Use a preventive approach to keep pain at or below an acceptable level. Provide PCA and intraspinal routes of administration when appropriate and available. The least invasive route of administration capable of providing adequate pain control is recommended. The intramuscular (IM) route is avoided because of unreliable absorption, pain, and inconvenience. The intravenous (IV) route is preferred for rapid control of severe pain. For ongoing pain, give analgesia ATC. PRN dosing is appropriate for intermittent pain (Jacox et al, 1994; McCaffery, Pasero, 1999).
·Discuss client's fears of undertreated pain, overdose, and addiction. A number of concerns may affect clients' willingness to report pain and use opioid analgesics (Ward et al, 1993). Because of the many misconceptions regarding pain and its treatment, education about the ability to control pain effectively and correction of myths about the use of opioids should be included as part of the treatment plan (Jacox et al, 1994; McCaffery, Pasero, 1999). Addiction is extremely unlikely after patients use opioids for acute pain (Acute Pain Management Guideline Panel, 1992).
·When opioids are administered, assess pain intensity, sedation, and respiratory status at regular intervals. Opioids may cause respiratory depression because they reduce the responsiveness of carbon dioxide chemoreceptors located in the respiratory centers of the brain. Because even more opioid is required to produce respiratory depression than is required to produce sedation, patients with clinically significant respiratory depression are usually also sedated. Respiratory depression can be prevented by assessing sedation and decreasing the opioid dose when the patient is arousable but has difficulty staying awake (McCaffery, Pasero, 1999; Pasero, McCaffery, 1994).
·Review client's flow sheet and medication records to determine overall degree of pain relief, side effects, and analgesic requirements during the past 24 hours. Systematic tracking of pain appears to be an important factor in improving pain management (Faries et al, 1991; JCAHO, 2000).
·Administer supplemental opioid doses as needed to keep pain ratings at or below an acceptable level. A PRN order for supplementary opioid doses between regular doses is an essential backup (American Pain Society, 1999).
·Obtain prescriptions to increase or decrease opioid doses as needed; base prescriptions on client's report of pain severity and response to the previous dose in terms of relief, side effects, and ability to perform the activities of recovery. Increase or decrease the dose of opioid based on assessment of the patient's response. Patients' responses, and therefore their requirements, vary widely, so it is less important to focus on the amount given than on the response (McCaffery, Pasero, 1999; Pasero, McCaffery, 1994).
·When client is able to tolerate oral analgesics, obtain a prescription to change to the oral route; use an equianalgesic chart to determine initial dose. (See Appendix E for an equianalgesic chart.) The oral route is preferred because it is the most convenient and cost-effective (Jacox et al, 1994). Use of equianalgesic doses when switching from one opioid or route of administration to another will help to prevent loss of pain control from underdosing and side effects from overdosing (McCaffery, Pasero, 1999).
·In addition to use of analgesics, support client's use of nonpharmacological methods to control pain, such as distraction, imagery, relaxation, massage, and heat and cold application. Cognitive-behavioral strategies can restore the clients' sense of self-control, personal efficacy, and active participation in own care (Jacox et al, 1994).
·Teach and implement nonpharmacological interventions when pain is relatively well controlled with pharmacological interventions. Nonpharmacological interventions should be used to supplement, not replace, pharmacological interventions (Acute Pain Management Guideline Panel, 1992).
·Plan care activities around periods of greatest comfort whenever possible. Pain diminishes activity (Jacox et al, 1994; McCaffery, Pasero, 1999).
·Ask client to describe appetite, bowel elimination, and ability to rest and sleep. Administer medications and treatments to improve these functions. Obtain a prescription for a peristaltic stimulant to prevent opioid-induced constipation. Because there is great individual variation in the development of opioid-induced side effects, these side effects should be monitored and, if their development is inevitable (e.g., constipation), prophylactically treated. Opioids cause constipation by decreasing bowel peristalsis (Jacox et al, 1994; McCaffery, Pasero, 1999).
Geriatric
·Always take the elderly client's reports of pain seriously and ensure that the pain is relieved. In spite of what many professionals and clients believe, pain is not an expected part of normal aging (McCaffery, Pasero, 1999).
·When assessing pain, speak clearly, slowly, and loudly enough for client to hear; repeat information as needed. Be sure client can see well enough to read pain scale (use enlarged scale) and written materials.
·Handle client's body gently. Allow client to move at own speed.
·Use acetaminophen and NSAIDs with low side-effect profiles such as choline and magnesium salicylates (Trilisate) and diflunisal (Dolobid), and watch for side effects, such as GI disturbances and bleeding problems. Elderly people are at increased risk for gastric and renal toxicity from NSAIDs (Griffin et al, 1991; Acute Pain Management Guideline Panel, 1992).
·Avoid or use with caution drugs with a long half-life, such as the NSAID piroxicam (Feldene), the opioids methadone (Dolophine) and levorphanol (Levo-Dromoran), and the benzodiazepine diazepam (Valium). The higher prevalence of renal insufficiency in the elderly than in younger persons can result in toxicity from drug accumulation (American Pain Society, 1999; Acute Pain Management Guideline Panel, 1992; McCaffery, Pasero, 1999).
·Use opioids with caution in the elderly client. The elderly are more sensitive to the analgesic effects of opioid drugs because they experience a higher peak effect and a longer duration of pain relief. Reduce the initial recommended adult starting opioid dose by 25% to 50%, especially if the client is frail and debilitated; then increase the dose if safe and necessary (Acute Pain Management Guideline Panel, 1992).
·Avoid the use of opioids with toxic metabolites, such as meperidine (Demerol) and propoxyphene (Darvon, Darvocet), in elderly clients. Meperidine's metabolite, normeperidine, can produce CNS irritability, seizures, and even death; propoxyphene's metabolite, norpropoxyphene, can produce both CNS and cardiac toxicity. Both of these metabolites are eliminated by the kidneys, making meperidine and propoxyphene particularly poor choices for elderly clients, many of whom have at least some degree of renal insufficiency (Acute Pain Management Guideline Panel, 1992; McCaffery, Pasero, 1999).
Multicultural
·Assess pain in a culturally diverse client using a self-report 0 to 10 numerical pain rating scale or the Wong Baker Faces pain rating scale. Have scale translated into client's native language if necessary.. Inadequate pain management is widespread, especially among minority groups, and a major reason is the failure to assess pain properly. The more cultural differences between patient and nurse, the more difficult it is for the nurse to assess and treat pain. Self-report of pain is the single most reliable indicator of pain, regardless of culture (McCaffery, 1999; McCaffery, Pasero, 1999).
·Administer analgesics on a preventive basis to keep pain ratings at or below an acceptable level. Regardless of the patient's cultural background, pain rated at (4 on a 0 to 10 pain rating scale interferes significantly with daily function. Perceived quality of life appears to be comparable across cultures, with pain ratings of >6 interfering markedly with a person's ability to enjoy life (McCaffery, 1999; McCaffery, Pasero, 1999).
·Assess for the influence of cultural beliefs, norms, and values on the client's perception and experience of pain. The client's experience of pain may be based on cultural perceptions (Leininger, 1996).
·Assess for the role of fatalism on the client's beliefs regarding their current state of comfort. Fatalistic perspectives in some African-American and Latino populations involve the belief that you cannot control your own fate and influence your health behaviors (Philips, Cohen, Moses, 1999; Harmon, Castro, Coe, 1996).
·Incorporate folk health care practices and beliefs into care whenever possible. Incorporating folk health care beliefs and practices into pain management care increased compliance with the treatment plan (Juarez, Ferrell, Borneman, 1998).
·Use a family-centered approach when working with Latino, Asian American, African-American, and Native American clients. Involving family in pain management care increased compliance with the treatment regimen (Juarez, Ferrel, Borneman, 1998).
·Use culturally relevant pain scales (e.g., the Oucher scale) to assess pain in the client. Culturally diverse clients may express pain differently than clients from the majority culture. The Oucher scale has African-American and Hispanic versions and is used to assess pain in children (Beyer, Denyes, Villarruel, 1992).
·Ensure that directions for medications are available in the client's language of choice and are understood by client and caregiver. Bilingual instructions for medications increased compliance with the pain management plan (Juarez, Ferrell, Borneman, 1998).
·Validate the client's feelings and emotions regarding current health status. Validation lets the client know the nurse has heard and understands what was said, and it promotes the nurse-client relationship. (Stuart, Laraia, 2001;Giger, Davidhizer, 1995).
Home Care Interventions
·Review with client and caregivers the cause(s) of pain and the medical regimen specific to the cause. Assess client knowledge and teach disease process as necessary. Compliance with the medical regimen for diagnoses involving pain improves the likelihood of successful management (Humphrey, 1994).
·Develop a full medication profile, including medications prescribed by all physicians and all over-the-counter medications. Assess for drug interactions. Instruct client to refrain from mixing medications without physician approval. Pain medications may significantly impact or be impacted by other medications and may cause severe side effects. Some combinations of drugs are specifically contraindicated (Jacox et al, 1994).
·Assess client and family knowledge of side effects and safety precautions associated with pain medications (e.g., use caution when operating machinery when opioids are initiated or dose has been increased). The cognitive effects of opioids usually subside within a week of initial dosing or dose increases (McCaffery, Pasero, 1999). The use of long-term opioid treatment does not appear to affect neuropsychological performance. Pain itself may deteriorate performance of neuropsychological tests more than oral opioid treatment (Sjogren et al, 2000).
·If administering medication using highly technological methods, assess home for necessary resources (e.g., electricity), and ensure that there will be responsible caregivers available to assist client with administration. Some routes of medication administration require special conditions and procedures to be safe and accurate (McCaffery, Pasero, 1999).
·Assess knowledge base of client and family for highly technological medication administration. Teach as necessary. Be sure clients know when, how, and who to contact if analgesia is unsatisfactory. Appropriate instruction in the home increases the accuracy and safety of medication administration (McCaffery, Pasero, 1999).
Client/Family Teaching
·NOTE: To avoid the negative connotations associated with the words drugs and narcotics, use the words pain medicine when teaching clients.
·Provide written materials on pain control such as the Agency for Health Care Policy and Research (AHCPR) pamphlet, Pain Control: Patient Guide.
·Discuss the various discomforts encompassed by the word pain, and ask client to give examples of previously experienced pain. Explain pain assessment process and purpose of the pain rating scale.
·Teach client to use the pain rating scale to rate intensity of past or current pain. Ask client to set a comfort/function goal by selecting a pain level on the rating scale that makes it easy to perform recovery activities (e.g., turn, cough, deep breathe). If pain is above this level, client should take action that decreases pain or notify a member of the health care team. (See Appendix E for information on teaching clients to use the pain rating scale.)
·Demonstrate medication administration and use of supplies and equipment. If PCA is ordered, determine client's ability to press appropriate button. Remind client and staff that the PCA button is for patient-only use.
·Reinforce importance of taking pain medications to keep pain under control.
·Reinforce that taking opioids for pain relief is not addiction and that addiction is very unlikely to occur.
·Demonstrate use of appropriate nonpharmacological approaches for controlling pain, such as heat, cold, distraction techniques, relaxation breathing, visualization, rocking, stroking, music, and television.
