Acute Pain: Nursing Diagnosis and Comprehensive Care Plan

Acute pain, a common yet critical health concern, is defined as an unpleasant sensory and emotional experience linked to actual or potential tissue damage. Unlike chronic pain, acute pain is typically short-lived, often resolving within three months as the underlying cause heals. For healthcare professionals, especially nurses, understanding and effectively managing acute pain is paramount to patient comfort and recovery. This article delves into the intricacies of acute pain, providing a comprehensive overview for creating effective nursing care plans.

Understanding Acute Pain: Causes, Symptoms, and Impact

Acute pain serves as a crucial warning system, signaling injury or illness. Its onset can be sudden, such as after trauma, or gradual, arising from conditions like infections. Recognizing the causes and manifestations of acute pain is the first step in providing targeted and effective nursing care.

Causes of Acute Pain

Acute pain is primarily triggered by tissue damage, which can be categorized by the type of injury agent involved:

Physical Injury: This is the most commonly recognized cause of acute pain, resulting from mechanical trauma such as fractures, lacerations, burns, or surgical incisions. These injuries directly damage tissues and activate pain receptors.
Biological Injury: Infections from bacteria, viruses, or fungi can cause significant tissue inflammation and damage, leading to acute pain. Conditions like cellulitis, appendicitis, or pneumonia are examples where biological agents induce pain.
Chemical Injury: Exposure to caustic or toxic substances can result in chemical burns or internal tissue damage, causing intense acute pain. Ingestion of harmful chemicals or skin contact with irritants are examples.
Psychological Factors: While less direct, psychological distress like anxiety and fear can exacerbate or even manifest as acute pain. These factors can lower pain thresholds and amplify the perception of pain.
Exacerbation of Existing Conditions: Acute pain can also arise from a sudden worsening of a pre-existing medical condition, such as a flare-up of arthritis or a sickle cell crisis.

Understanding the specific cause of acute pain is crucial for determining the appropriate nursing interventions and pain management strategies.

Signs and Symptoms of Acute Pain

Recognizing the signs and symptoms of acute pain is essential for timely intervention. These indicators can be broadly classified into subjective (patient-reported) and objective (nurse-assessed) data.

Subjective Data (Patient Reports):

Verbal Reports: The most direct indicator is the patient’s spoken description of their pain, including location, intensity, quality, and duration.
Pain Expressions: Non-verbal cues such as crying, moaning, grimacing, or restlessness can indicate pain, especially in patients who have difficulty verbalizing.
Unpleasant Sensations: Patients may describe their pain using various terms like “sharp,” “dull,” “burning,” “throbbing,” “aching,” or “stabbing,” reflecting the diverse nature of pain experiences.

Objective Data (Nurse Assessments):

Vital Sign Changes: Significant alterations in vital signs, such as increased heart rate, elevated blood pressure, rapid breathing, and sweating, can be physiological responses to acute pain.
Appetite and Eating Pattern Changes: Pain can suppress appetite and disrupt normal eating habits.
Sleep Pattern Disturbances: Acute pain frequently interferes with sleep, leading to insomnia or frequent awakenings.
Guarding Behaviors: Patients may exhibit protective behaviors like guarding the painful area, assuming a fetal position, or limited movement to minimize discomfort.

Comprehensive assessment, incorporating both subjective and objective data, provides a holistic understanding of the patient’s pain experience.

Alt Text: A nurse attentively listens to a patient describing their pain, highlighting the importance of verbal reports in subjective pain assessment for accurate nursing diagnosis and care plan development.

Expected Outcomes and Nursing Assessment for Acute Pain Management

Effective nursing care planning for acute pain focuses on achieving specific, measurable, achievable, relevant, and time-bound (SMART) outcomes. These outcomes guide interventions and provide a framework for evaluating the effectiveness of the care plan.

Expected Outcomes for Patients with Acute Pain:

Pain Relief Report: The patient will verbally report a satisfactory level of pain relief.
Pain Scale Reduction: The patient will rate their pain on a numerical pain scale (e.g., 0-10) at a level that is acceptable and manageable for them, ideally moving towards a 0/10 rating.
Vital Signs within Normal Limits: The patient will exhibit vital signs (heart rate, blood pressure, respiratory rate) within their normal baseline range, indicating reduced physiological stress from pain.
Restored Appetite and Sleep: The patient will verbalize a return to their normal appetite and sleep patterns, reflecting improved comfort and overall well-being.

These expected outcomes are patient-centered and focus on improving their quality of life and functional ability while managing acute pain.

Comprehensive Nursing Assessment for Acute Pain

A thorough nursing assessment is the cornerstone of effective pain management. It involves gathering subjective and objective data across physical, psychosocial, emotional, and diagnostic domains. Key aspects of the nursing assessment for acute pain include:

1. Pain Characteristics Assessment (PQRST): This systematic approach helps nurses comprehensively evaluate the patient’s pain experience.

P – Provocation/Palliation:
- What were you doing when the pain started? Understanding the onset and triggering factors helps identify potential causes and aggravating factors.
- What makes the pain better or worse? Identifying relieving and exacerbating factors guides non-pharmacological and pharmacological interventions. Consider factors like position, activity, stress, medications, and therapies.
Q – Quality:
- Describe your pain. Encourage patients to use descriptive words (sharp, dull, burning, stabbing, crushing, throbbing, etc.) to characterize the pain sensation. This helps differentiate between nociceptive and neuropathic pain.
R – Region/Radiation:
- Where is your pain located? Does it spread anywhere? Pinpointing the location and radiation pattern assists in identifying the source of pain and potential underlying pathology.
S – Severity/Scale:
- On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain imaginable, how would you rate your pain? Utilizing pain scales (numerical, visual analog, categorical) provides a quantifiable measure of pain intensity, allowing for tracking over time and treatment effectiveness.
- How does the pain affect your daily activities? Assessing the functional impact of pain is crucial for setting realistic pain management goals.
T – Timing:
- When did the pain start? How long does it last? Is it constant or intermittent? Understanding the temporal pattern of pain helps in anticipating pain exacerbations and tailoring medication schedules.
- Does the pain occur at specific times of day or night? Diurnal variations in pain can provide clues about the underlying cause and guide timing of interventions.

2. Pain Rating Scales: Utilizing standardized pain scales is essential for consistent and objective pain assessment. Common scales include:

Numerical Rating Scales (NRS): Patients rate their pain on a 0-10 scale.
Visual Analog Scales (VAS): Patients mark a point on a line representing pain intensity from “no pain” to “worst pain.”
Categorical Scales: Use descriptive words or faces (like the Wong-Baker FACES Pain Scale for children or non-verbal patients) to represent pain levels.

Alt Text: Illustration of various pain scales including numerical rating scale (NRS), visual analog scale (VAS), and faces pain scale, emphasizing their role in quantifying and monitoring pain intensity for effective nursing care and pain management plans.

3. Identify Underlying Cause: Determining the etiology of pain is crucial for targeted treatment. Pain often results from injury, surgery, trauma, or underlying medical conditions. Addressing the root cause is the most effective way to alleviate pain.

4. Differentiate Pain Types: Distinguishing between nociceptive pain (caused by tissue damage) and neuropathic pain (caused by nerve damage) is vital as they often require different management approaches.

5. Identify Aggravating Factors: Assess cultural, environmental, interpersonal, and psychological factors that may influence pain perception and tolerance. Loud environments, stress, and anxiety can exacerbate pain.

6. Observe Signs and Symptoms: Monitor for both behavioral (guarding, restlessness) and physiological (vital sign changes) signs of pain.

7. Assess Non-Pharmacological Method Use: Inquire about the patient’s experience and willingness to use non-pharmacological pain relief methods (e.g., heat/cold, relaxation techniques, massage).

8. Assess Pain Relief Expectations: Discuss the patient’s expectations for pain relief to align goals and enhance treatment adherence. Realistic goals are essential, especially when complete pain elimination may not be achievable.

9. Consider Age and Developmental Stage: Age and developmental stage influence pain perception and reporting. Age-appropriate pain assessment tools and communication strategies are necessary, especially for children and older adults.

Nursing Interventions for Acute Pain Management

Nursing interventions for acute pain are multifaceted, encompassing pharmacological and non-pharmacological strategies aimed at relieving pain, improving function, and enhancing patient comfort.

1. Pharmacological Interventions: Administering Analgesics

Appropriate analgesic administration is a cornerstone of acute pain management. Medications are selected based on pain severity and type, following the World Health Organization (WHO) pain ladder approach when applicable.

Non-opioid analgesics: For mild to moderate pain, medications like acetaminophen (paracetamol) and nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen) are commonly used.
Opioid analgesics: For moderate to severe pain, opioids such as morphine, fentanyl, oxycodone, and hydrocodone may be prescribed. Opioids should be used judiciously, especially in acute pain, with careful monitoring for side effects.
Adjuvant analgesics: For specific types of pain, such as neuropathic pain, adjuvant medications like antidepressants (e.g., amitriptyline, duloxetine) and anticonvulsants (e.g., gabapentin, pregabalin) may be used.

2. The Pain Ladder Approach: The WHO pain ladder is a three-step guideline for cancer pain management that can be adapted for acute pain:

Step 1 (Mild Pain): Non-opioid analgesics (NSAIDs, acetaminophen).
Step 2 (Moderate Pain): Weak opioids (e.g., codeine, tramadol) or combination analgesics (opioid + non-opioid).
Step 3 (Severe Pain): Strong opioids (e.g., morphine, fentanyl, hydromorphone).

3. Patient-Controlled Analgesia (PCA): For patients requiring intravenous opioid analgesia, PCA pumps allow self-administration of pain medication within prescribed limits. PCA provides patients with a sense of control and can improve pain management satisfaction. Nurse assessment of patient suitability for PCA is crucial.

4. Re-evaluation of Pain: Regularly reassess pain intensity and relief after interventions, typically within 30 minutes to an hour for parenteral medications and within an hour for oral medications, to evaluate effectiveness and adjust the care plan as needed.

5. Patient Education on Pain Management: Educate patients about their pain medications, including proper timing of doses (especially before pain-provoking activities), potential side effects, and non-pharmacological strategies. Empowering patients with knowledge enhances self-management and adherence.

6. Elicit Patient Feedback: Encourage patients to provide feedback on the effectiveness of pain interventions. This feedback loop is essential for tailoring the care plan to individual needs and preferences.

7. Prompt Response to Pain Reports: Respond promptly to patient reports of pain to alleviate anxiety and build trust. Timely intervention is crucial, especially when pain is severe or escalating.

8. Promote Rest: Fatigue can exacerbate pain. Create a restful environment with reduced noise and light to promote sleep and relaxation, which can contribute to pain relief.

9. Non-Pharmacological Therapies: Integrate non-pharmacological pain management techniques:

Relaxation and Breathing Exercises: Deep breathing, guided imagery, and progressive muscle relaxation can reduce muscle tension and anxiety, thereby alleviating pain.
Music Therapy: Listening to calming music can divert attention from pain and promote relaxation.
Heat and Cold Therapy: Applying heat packs or cold compresses can reduce pain and inflammation in certain conditions.
Massage: Gentle massage can relieve muscle tension and improve circulation, providing pain relief.
Distraction: Engaging patients in activities that divert their attention from pain, such as reading, watching movies, or playing games.
Acupressure/Acupuncture: These traditional therapies may provide pain relief by stimulating specific points on the body.

Alt Text: A healthcare professional guides a patient through relaxation and breathing exercises, showcasing non-pharmacological pain management techniques for promoting tranquility and reducing pain as part of a comprehensive nursing care plan.

10. Stimuli Removal: Identify and remove or minimize environmental stimuli that may aggravate pain, such as loud noises or bright lights.

11. Side Effect Monitoring: Closely monitor for side effects of pain medications, especially opioids, such as sedation, respiratory depression, nausea, vomiting, and constipation. Implement preventative measures and manage side effects promptly.

12. Anticipate Pain Relief Needs: Proactive pain management is more effective than reactive management. Anticipate pain triggers (e.g., dressing changes, physical therapy) and administer analgesics preemptively when appropriate.

13. Referral to Therapies: Consider referrals to physical therapy for musculoskeletal pain and occupational therapy to adapt daily activities to minimize pain.

14. Compress Application: Apply cold compresses for swelling and inflammation and warm compresses for muscle stiffness and cramps, as appropriate.

15. RICE for Minor Injuries: For minor musculoskeletal injuries, implement RICE (Rest, Ice, Compression, Elevation) protocol.

Nursing Care Plans for Acute Pain: Examples and Diagnostic Statements

Nursing care plans provide a structured framework for individualized patient care. For acute pain, care plans focus on accurate nursing diagnoses, patient-centered goals, and evidence-based interventions. Here are examples of nursing care plan diagnoses and interventions for various acute pain scenarios:

Care Plan #1: Post-Operative Orthopedic Pain

Diagnostic Statement: Acute pain related to orthopedic surgical procedure of the left lower extremity secondary to bone fracture and inflammation, as evidenced by heart rate of 112 bpm, guarding of the left lower extremity, reports of pain, and pain scale of 8/10.
- Expected Outcomes:
  - Patient will report a reduced pain scale from 8 to less than 3/10 within 4 hours.
  - Patient will verbalize increased pain tolerance with movement by the end of the shift.
  - Patient will ambulate independently with tolerable pain by the end of the shift.
  - Patient will appear well-rested by the end of the shift.
- Interventions:
  - Administer prescribed analgesics as ordered and educate patient on medication regimen.
  - Re-evaluate pain level 30 minutes after interventions.
  - Educate patient on pain management strategies, including pharmacological and non-pharmacological methods.
  - Combine pharmacological and non-pharmacological therapies.
  - Assess pain characteristics using PQRST.
  - Determine patient’s stage of healing and expected pain trajectory.
  - Assess nighttime pain patterns.
  - Assess comfort level with non-pharmacological methods.
  - Determine need for PCA.

Care Plan #2: Acute Bronchitis Pain

Diagnostic Statement: Acute pain related to acute bronchitis secondary to viral infection, as evidenced by patient reports of chest and throat soreness, pain scale of 8/10, lack of appetite, and grimacing while coughing and speaking.
- Expected Outcomes:
  - Patient will report decreased pain scale from 8 to less than 3/10 within 4 hours of nursing interventions.
  - Patient will verbalize decreased pain when breathing within 4 hours of nursing interventions.
  - Patient will manifest respiratory rate within normal limits within 2 hours of nursing interventions.
  - Patient will appear well-rested by the end of the shift.
- Interventions:
  - Administer antitussive medication as ordered.
  - Solicit patient feedback on pain interventions.
  - Teach proper coughing and breathing exercises.
  - Administer corticosteroids cautiously as prescribed.
  - Assess pain characteristics.
  - Observe cough characteristics.
  - Identify viral etiology.

Care Plan #3: Pain Related to Psychological Distress

Diagnostic Statement: Acute pain related to psychological distress secondary to anxiety and fear, as evidenced by patient verbalizing pain, moaning and crying, narrowed focus and altered passage of time, and pallor.
- Expected Outcomes:
  - Patient will demonstrate a reduction in crying within 1 hour of nursing interventions.
  - Patient will report a decreased pain scale of less than 3/10 within 4 hours of nursing interventions.
  - Patient will appear well-rested at the end of the shift.
- Interventions:
  - Provide presence and reassurance.
  - Allow for rest periods in a quiet environment.
  - Promote non-pharmacological approaches like music therapy and relaxation techniques.
  - Determine contributing psychosocial factors.
  - Identify pain triggers related to anxiety and fear.
  - Assess psychological and emotional status.

Care Plan #4: Chemical Burn Pain

Diagnostic Statement: Acute pain related to skin and tissue damage secondary to chemical burns, as evidenced by patient reports of burning pain rated 6/10, restlessness when lying down, and antalgic positioning to avoid pressure on the back.
- Expected Outcomes:
  - Patient will report pain less than 3/10 pain scale within 4 hours of nursing interventions.
  - Patient will verbalize relief of pain within 4 hours of nursing interventions.
  - Patient will appear well-rested at the end of the shift.
- Interventions:
  - Advise patient to avoid further chemical stimuli.
  - Decontaminate affected area with water irrigation.
  - Administer analgesics and monitor effectiveness.
  - Educate patient on when to seek medical attention for chemical exposure.
  - Assess extent of affected area.
  - Assess patient expectations for pain relief.
  - Note presence of blisters.

Care Plan #5: Diabetic Neuropathy Pain

Diagnostic Statement: Acute pain related to nerve damage secondary to diabetic neuropathy as evidenced by reports of burning sensation to lower extremities and positioning to ease pain.
- Expected Outcomes:
  - Patient will report pain is relieved or controlled.
  - Patient will adhere to prescribed pharmacological regimen.
- Interventions:
  - Encourage verbalization of feelings about pain.
  - Administer analgesics as indicated, up to maximum dosage.
  - Provide or promote non-pharmacological pain management methods.
  - Collaborate in the treatment of underlying diabetes and proactive pain management.
  - Evaluate pain characteristics and intensity using appropriate pain scales.
  - Assess patient’s management of diabetic neuropathy.
  - Assess patient’s feet for complications.
  - Monitor vital signs and skin color.

Care Plan #6: Labor Pain

Diagnostic Statement: Acute pain related to the labor process as evidenced by diaphoresis, facial grimacing, and irritability.
- Expected Outcomes:
  - Patient will engage in non-pharmacologic measures to reduce discomfort/pain.
  - Patient will report pain at a manageable level.
- Interventions:
  - Provide/encourage comfort measures (massage, repositioning, etc.).
  - Administer pain medication as ordered.
  - Encourage frequent voiding.
  - Offer encouragement, information, and positive reinforcement.
  - Provide a quiet, ventilated, and dimly lit environment.
  - Evaluate degree of discomfort through verbal and nonverbal cues.
  - Assess stage of labor by recording contractions.
  - Perform vaginal examination.

Conclusion: Enhancing Patient Care Through Effective Pain Management

Acute pain management is a critical component of nursing care. By understanding the causes, symptoms, and assessment techniques for acute pain, nurses can develop and implement effective care plans tailored to individual patient needs. Utilizing a combination of pharmacological and non-pharmacological interventions, along with continuous assessment and patient education, ensures optimal pain relief, promotes recovery, and enhances the overall patient experience. Prioritizing patient comfort and well-being through comprehensive pain management remains a fundamental aspect of quality nursing practice.

References

Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. Elsevier Health Sciences.
Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b000000928
HSS. (2020, August 18). Managing pain after orthopedic surgery. https://www.hss.edu/playbook/managing-pain-after-orthopedic-surgery/
Johns Hopkins Medicine. (2021, August 8). Acute bronchitis. Johns Hopkins Medicine, based in Baltimore, Maryland. https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-bronchitis
MedlinePlus. (n.d.). Pain. MedlinePlus – Health Information from the National Library of Medicine. Retrieved February 2023, from https://medlineplus.gov/pain.html
Occupational Safety and Health Administration. (n.d.). Biological agents – Overview | Occupational safety and health administration. https://www.osha.gov/biological-agents
Physiology, pain – StatPearls – NCBI bookshelf. (2021, July 26). National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK539789/
PubMed Central (PMC). (n.d.). A systematic review of non-pharmacological interventions used for pain relief after orthopedic surgical procedures. Retrieved February 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480131/
SpringerLink. (n.d.). World Health Organization analgesic ladder. Retrieved February 2023, from https://link.springer.com/chapter/10.1007/978-3-030-87266-3_67
Union Health. (n.d.). Pain management after orthopedic surgery terre haute, Indiana (IN), union health. Retrieved February 2023, from https://www.myunionhealth.org/blogs/pain-management-after-orthopedic-surgery
WebMD. (2007, January 1). Chemical burns. Retrieved February 2023, from https://www.webmd.com/first-aid/chemical-burns#091e9c5e80010a27-3-10