Help with nursing dx chronic pain r/t....

[wesmom]

I am doing a care plan for a 73 yof who has scoliosis, arthritis, back pain and osteoporosis. Her primary dx is chronic pain but I am having a hard time figuring out what to put for r/t without using her medical dx. Any help would be greatly appreciated!!!

[Daytonite, BSN, RN]

the challenge and fun of writing a nursing diagnostic statement is using words to turn a medical diagnosis into what nanda calls nursing language which is just a fancy way of reducing the medical diagnoses to acceptable generic medical terminology without a hint of medical diagnosis. chronic pain, the nanda taxonomy tells is, is caused by actual or potential tissue damage. this patient has scoliosis, arthritis, and osteoporosis which are the sources of her pain. i usually tell students that the first thing they need to do as part of their assessment activity is to look up information about the pathophysiology of these diseases in order to discover the cause of the patient's pain for the "related to" part of the diagnostic statement. i love using the online merck manual for this kind of information:

• http://www.merck.com/mmpe/sec19/ch284/ch284i.html
  
• http://www.merck.com/mmpe/sec04/ch034/ch034e.html
  
• http://www.merck.com/mmpe/sec04/ch036/ch036a.html

the answer to your question is chronic pain r/t chronic disability, joint deterioration and muscle spasm aeb [back pain which is a pretty vague description + any other symptoms of pain]. these related factors are due to the underlying pathophysiologies of scoliosis (deformity causes the pain), arthritis (loss of cushioning material at joint ends results in bone grinding against bone), and osteoporosis (microfractures occur causing shortening of bones and resulting in muscle spasms of supporting muscles trying to keep the bones in alignment) that are the source of pain for these conditions. make sure you describe the pain more specifically and include pain evidence that includes all three medical conditions if that is possible (for instance, does she have pain in any of her large/small joints or legs from the arthritis and osteoporosis?).

pain assessment resources: https://allnurses.com/forums/1536937-post3.html

[wesmom]

Thank you so much!! The resources you gave me were great!! I am trying to include acute pain as well as chronic pain. I am writing a paper on elderly in the community. I have a great article I want to refernce to about pain management but it's about acute pain and not chronic pain. I'm going to use the article anyway because it has some good pain management ideas in it that will work for both diagnoses (chronic and acute). Thanks again for all of your help and ideas!!

Would it be appropriate to add for a dx: pain, acute r/t actual tissue damage? I am trying to add the acute pain as a diagnosis.

[Daytonite, BSN, RN]

look at the definitions of these two diagnoses. the major difference between them is the amount of time the pain has been present.

• acute pain
  
• chronic pain

if one type of pain is a newer onset then, yes, it is appropriate to diagnose it as acute pain since it has yet to be controlled. pain, whether acute or chronic, is due to tissue injury that has, or is, going on.

[wesmom]

After looking at the time period for both of them, I won't be able to use acute pain. Her pain has been present for a lot longer than 6 months. I will try and use the article as pain management in general, not specifically towards acute pain. Again, thanks a lot!!! You are a wealth of information!!!