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Alteration in Comfort: Pain

(_) Actual (_) Potential

Related To:
[Check those that apply]

(_) Musculoskeletal disorder (_) Immobility/improper positioning


(_) Visceral disorder (_) Pressure points
(_) Cancer (_) Pregnancy
(_) Information (_) Fear
(_) Trauma (_) Anxiety/stress
(_) Diagnostic test (_) Over activity
(_) Other:_____________________________
____________________________________
____________________________________

As evidenced by:
[Check those that apply]

Major:
(_) Pt. reports or demonstrates discomfort.
(Must be present)
Minor: (_) Autonomic response to acute pain:

(May be present)
• Increased BP, P, R

• Diaphoresis

• Dilated pupils

• Guarding

• Facial mask of pain

• Crying/moaning

• Abdominal heaviness

• Cutaneous irritation
Date & Plan and Outcome Target Nursing Interventions Date
Sign. [Check those that apply] Date: [Check those that apply] Achieved:
The patient will: (_) Assess characteristics of
(_) Experience relief of pain pain: location, severity on a
A.E.B. scale of 1-10, type, frequency,
Verbal reports of relief of pain precipitating factors, and
Less autonomic responses to relief factors.
pain (_) Eliminate factors that
(_) Other: precipitate pain: e.g.:
__________________
________________________
(_) Offer analgesics q___ hrs
prn (according to physician
order).
(_) Teach patient to request
analgesics before pain
becomes severe.
(_) Explore non-
pharmacological methods for
reducing pain/promoting
comfort:
Back rubs
Slow rhythmic breathing
Repositioning
Diversional activities such as
music, TV, etc.
(_) Other: ________________
________________________
________________________
________________________

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