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Need/Nursing Scientific Nursing

Objective Rationale Evaluation


Diagnosis/Cues Analysis Intervention
Acute pain Physical pain is the After 8 hours Independent: ♦ After 8
related to unpleasant feeling of nursing hours of
disease process common to a headache interventions, ♦ Assess reports of pain, ♦ To provide base line nursing
and a stubbed toe. It the patient including information. interventions,
typically consists of will: location and intensity (scale the patient
OBJECTIVE: -demonstrate of was
negative affect and
♦ Facial use of 0-10). able to:
aversion, and has relaxation skills,
grimacing -demonstrate
location, duration, other
♦ Irritability ♦ Observe nonverbal use of
intensity and a ♦ Pain is unique to each
♦ Guarding of methods to cues. relaxation
distinctive quality. patient.
the affected promote skills,
Pain is often One may encounter varying
areas. comfort and to other
accompanied by other descriptions because of
relieve pain. methods
individualized
bodily feelings (e.g., to promote
perceptions. Non verbal
nausea, fatigue), cues may
comfort and
negative emotions to
♦ Explore alternative pain aid in evaluation of pain and
(e.g., fear, anxiety, relieve pain.
relief measure like relaxation effectiveness of therapy.
anger, irritability, technique, breathing
grief, depression), and techniques and guided ♦ Cognitive behavioral
cognitive impairment imagery. interventions
(e.g., attention and may reduce reliance on
working memory pharmacological therapy
deficits).Pain is ♦ Carefully position affected and
whatever the part. enhance patient’s sense of
experiencing person control.
says it is, existing ♦ Apply local massage gently
whenever he says it to ♦ Reduces discomfort, and
does.Pain is part of the affected areas. risk for injury.
body's defense system,
triggering a reflex ♦ Encourage range of motion ♦ Help reduce muscle
reaction to retract from exercises. tension.
a painful stimulus, and
helps adjust behavior
to increase avoidance ♦ Maintain adequate fluid ♦ Prevents joint stiffness
intake. and
of that particular
Collaborative: Possible contracture
harmful situation in the formation.
future.
♦ Administer medication as
indicated like analgesics and ♦ Dehydration increases
antibiotics. sickling
And corresponding pain.

♦ Analgesics reduces pain

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