VII.

NURSING CARE PLANS Nursing Diagnosis: Chronic pain related to disease process- metastasis to bone Scientific Analysis: We can also classify pains by their causes. One group includes chronic pain associated with structural disease such as metastatic cancer, sickle-cell anemia, or rheumatoid arthritis. This group is usually characterized by prolonged episodes of pain alternating with pain-free intervals, or unremitting pain waxing and waning in severity. In these cases, the successful treatment of the pain is closely allied to treating the disease. ( The Dana Guide to Brain Health,A Practical Family Reference from Medical Experts by Floyd E. Bloom, M.D.;)

Cues Subjective: panagsa na lang ni mo sakit akong kabukugan as verbalized by the patient.

Objectives After 8 hours of nursing intervention the client will be able to: >report minimal pain relief or control with minimal interference with activities of daily

Interventions >Determine pain history, for example, location of pain,frequency, duration, and intensity using a rating scale (scale of 010), or verbal rating scaleno pain to excruciating pain; and relief

Rationale >Pain of more than 6 months duration constitutes chronic pain, which may affect therapeutic choices. Recurrent episodes of acute pain can occur within chronic pain, requiring increased level

Evaluation After 8 hours of nursing interventions the client verbalized understanding and assumed responsibility of following prescribed pharmacological regimen to reduce pain.

Objective:

living

Pain scale of 6/10 vital signs: T: 36.5 P: 73 R: 12 BP: 120/70 >demonstrate use of relaxation skill and diversional activities as indicated for individual situaiona. >follow prescribed pharmacological regimen

measures used. Believe clients report.

of intervention. >Pain may occur near the end of the dose interval, indicating need for higher dose or shorter dose interval. Pain may be precipitated by identifiable triggers, or occur spontaneously, requiring use of short half-life agents for rescue or supplemental doses.

>Determine timing and precipitants of breakthrough pain when using around-theclock agents, whether oral, intravenous (IV), topical, transmucosal, epidural, or patch medications.

>A wide range of >Evaluate painful effects of particular therapies, such as discomforts are common such as incisional pain, burning

surgery, radiation, chemotherapy, or biotherapy. Provide SO about what to expect.

skin, low back pain, mouth sores, or headaches, depending agent being used. Pain is also associated with invasive procedures to diagnose or treat cancer.

information to client and on the procedure or

>Promotes relaxation >provide nonpharmacological comfort measures such as massage, repositioning, and back rub; as well as diversional activities, such as music, reading, and helps refocus attention.

and TV.

>Enables client to >Encourage use of stress management skills and complementary therapies such as relaxation techniques, visualization, guided imagery, biofeedback, laughter, music, aromatherapy, and Therapeutic Touch. participate actively in nondrug treatment of pain and enhances sense of control. Pain produces stress and, in conjunction with muscle tension and internal stressors, increases clients focus on self, which in turn increases the level of pain.

>May decrease inflammation, muscle

>provide cutaneous stimulation, such as heat and cold packs, or massage.

spasms, reducing associated pain.

Nursing Diagnosis: Fatigue related to decrease oxygen demand in the blood secondary to extravascular hemolysis of RBS as brought by metastasis of tumor in the bone Scientific Analysis: Hemolytic anemia is an end result of conditions that lead to hemolysis. Hemolysis, the premature destruction of erythrocytes, can result from physical damage, intrinsic membrane defects, abnormal Hb, erythrocytes enzymatic defects, immune destruction of RCs by macrophages, or hypersplenism. (Joyce Black pg 2021) Cues Subjective: Kapoy akong lawas ilihok-lihok as verbalized by the client. Objectives: >lack of energy Objectives After 8 hours of nursing interventions the client will be able to: >identify basis of fatigue and individual areas of control >perform ADLs and > Determine presence/ degree of sleep disturbances. > Assess vital signs Interventions Rationale > To evaluate fluid status and cardiopulmonary response. > Fatigue can be a consequence of, and/or substances, are known Evaluation After 8 hours o f nursing interventions the client able to: >Identified basis of fatigue and individual areas of control >performed ADLS and

>sleep disturbance >drowsy

participate in desired activities at level of ability >verbalize understanding about fatigue > participate in the recommended treatment program >Note presence of additional concerns >Review medication regimen/use

to cause/or exacerbated by sleep deprivation. > Certain medications, including prescription are known to cause and/or exacerbate fatigue. > To assist in evaluating impact on clients life.

participate in desired activities at level of ability >verbalized understanding about fatigue >participated in the recommended treatment program