Pain is a highly subjective state in which a variety of unpleasant sensations and a wide range of distressing factors may be experienced by the sufferer. Pain may be a symptom of injury or illness. Pain may also arise from emotional, psychological, cultural, or spiritual distress. Pain can be very difficult to explain, because it is unique to the individual; pain should be accepted as described by the sufferer. Pain assessment can be challenging, especially in elderly patients, where cognitive impairment and sensory-perceptual deficits are more common.
Related factors:
Bio-pathophysiological
(Pregnancy)
Related to uterine contractions during labor
Related to trauma to the perineum during labor and
birth
Related to uterine involution and breast swelling
Related to tissue trauma and reflex muscle spasm:
(Musculoskeletal Disorders)
Fractures
contractures
spasm
arthritis
Spinal cord disorders
(Impaired visceral)
heart
liver
hepatic
intestine
pulmonary
cancer
vascular disorders
vasospasm
occlusion
phlebitis
Vasodilatation (headache)
Related to inflammatory
nerve
tendons
joints
muscle
Related to fatigue, malaise and or pruritus
Infectious diseases (rubella, chicken pox)
hepatitis
pancreatitis
Linked to the impact of cancer
Related to abdominal cramps, diarrhea, and vomiting
Related to inflammation and smooth muscle
kidney stones
gastrointestinal infections
action
Related to tissue trauma and reflex muscle spasm:
operation
accident
burn
Diagnostics: venous puncture, Scan invasive, biopsy
Related to nausea and vomiting
chemotherapy
anesthesia
situational
Related to fever
Related to the immobilization / position that is not appropriate
Related to excessive activity
Related to pressure points (splints are tight, elastic bandage)
Related to an allergic response
Related to chemical irritants
Related to the needs for independence are not met
Maturisional
Babies: colic
Infant and early childhood: growing teeth
Childhood: an injury, grow flowers
Adolescents: Headache, chest pain, dysmenorrhoea
Subjective Data:
- Communication (verbal or use of code) about the pain that is described.
- Behavior very carefully, protection.
- Self-focus.
- Narrowing the focus (the change time perception, impaired thought processes).
- Behavioral distraction (moaning, crying, pacing, looking for someone else, anxiety).
- Facial expressions of pain (dull eyes, looking tired, grimacing)
- Changes in muscle tone (not simmering until stiff)
- Autonomic responses (diaphoresis, changes in blood pressure and pulse), dilated pupils, changes in breathing frequency.
Expected outcomes:
Individuals will
- Shows that other people confirm that there is pain.
- Shows a reduction in pain after doing a satisfactory reduction of pain.
- Identify the sources of pain.
- Identify activities that will increase and decrease pain.
- Describing the comfort of others during experience pain.
Nursing Intervention:
1. Increase knowledge of
a. Explain the causes pain to the individual, if known.
b. Linking how long pain will last, if known.
c. Describe the examination and diagnostic procedures in detail with the discomfort and the sensation will be felt, and the estimated duration of pain occur.
2. Provide accurate information to reduce fear.
3. Connect your acceptance of individual response to pain.
a. Recognizing the existence of pain.
b. Listened with rapt attention on the pain.
c. Showed that the pain you are because you want to understand better (not to determine if the pain is really there).
4. Assess families to know the concept of error handling or painful.
5. Discuss the reasons why individuals may experience an increase or decrease in pain (eg pain, increasing fatigue, distraction reduce pain).
a. Encourage family members to tell each other personally think prihatinnya.
b. Assess whether painful family dispute and discuss the impact on individuals who experience pain.
c. Encourage families to continue to give attention even though pain is not shown.
6. Provide an opportunity for individuals to rest during the day and time to sleep is not disturbed at night.
7. Talk with individuals and families use distraction therapy, along with other methods to reduce pain.
8. Teach methods of distraction for acute pain, with regular breathing.
9. Teach noninvasive pain reduction
a. relaxation
- Instruct the techniques to reduce skeletal muscle tension, which can reduce pain intensity.
- Increase relaxation back massage, massage, bath or hot water.
- Teach relaxation techniques specifically
b. stimulation of cutaneous
- Talk with the various individual methods stimulate the skin and its effect on pain.
- Discuss each of the following methods and guard action:
Hot water bottle
Electric heating pads
Warm water baths
Moist heat bag
The sunshine
Blanket of plastic over the area of pain for a hot body (eg, knee, elbow)
- Discuss each of the following methods and guard action:
Cold towel (wrung)
Cold water immersion
icepack
Cold jelly bag
ice massage
- Explain the benefits of therapeutic massage and preparation mentol / back massage.
10. Give the individual deduction optimal pain with analgesics.
11. After the subtrahend pain, back 30 minutes later to assess their effectiveness.
12. Provide accurate information to align the concept of error in the family (eg, addiction, doubt about the pain).
13. Give the individual an opportunity to discuss the fear, anger, and frustration in place, difficulty understanding the situation.
14. Encourage individuals to discuss the experience of pain.