Interventions for chronic pain

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    Ok, so my NDX is: Chronic pain r/t osteoarthritis AEB client stating she was often in pain. My instructor ok'd this dx, thankfully, lol.

    My interventions are: (sorry, Im at work and I dont have the paper w/ me so Im not going to list the rationales b/c I can't remember them off the top of my head, however I do have them, so that's not a problem)

    My client is a 84yo female who is confined to a WC, she has oasteoarthritis, dementia, spinal scondylosis, osteoporosis, and CHF. She also has told me that she does not ask for her prn pain meds b/c she doesn't want to be bothersome. I already have 2 other dx's with the careplans made up that my CI said were good, but on this one she said my interventions need to be more specific and I just have no clue how to do that, Im not making the connection or something. Any suggestions?

    1. Administer prescribed analgesics.
    2. Administer an ongoing pain assessment to determine the effectiveness of prescribed medications.
    3. Teach client to ask for prn medication befor pain gets severe.

    I know I had one more, but I cant think of it without my paper in front of me...I just don't know why I'm having so much trouble coming up with specific interventions here, and it's frustrating the heck outta me!
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    I don't know what "stage" her dementia is, but I would suggest maybe something to do with alternative treatments for pain. Like, massage therapy, music therapy, Reiki, visual imagery something of that nature. I have a lady on Hospice who has a disrupted sleep pattern r/t end-stage CHF, and when I put her gospel music on, she actually falls asleep and starts snoring. Why the others haven't decided to do this, I don't know. Anywho, I would try some alternative things, CAM, to assist this patient with her pain management.

    GOOD LUCK
  5. 0
    I also agree with the massage therapy, watching TV, etc. to take the patients mind off of it. You could also do ROM exercises q2h to alleviate some of the pain. Also teach client minimal impact exercises like swimming to strengthen joints without hurting them.
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    1. Administer prescribed analgesics when client states pain at 2 or higher on a 0-5 scale.
    2. Assess pain q2h, prn, and one hour after administering analgesics.
    3. Teach client to ask for prn medication when pain reaches a 2 or higher.


    try that for specific?
  7. 0
    No offense, but I don't think you are going to teach her much at all if she has dementia unless it is extremely mild at this point.
  8. 1
    all right, here's the problem i would have as you're instructor and it goes all the way back to your assessment of the patient. you have to be more specific about this lady's pain. part of doing a care plan is also looking up information about the medical disease that is involved. the pain of osteoarthritis is not a generalized, all over the body, pain. it is usually confined to the joints and involves inflammatory processes. the reason for the pain would be known from a more thorough assessment of the patient and her pain.
    • where is the pain located?
    • how long does it last?
    • how often does it occur?
    • what words does the patient use to describe the pain?
    • what triggers the pain?
    • what relieves the pain?
    • what makes the pain worse?
    • what is the level of pain on a scale of 0 to 10
    • what is the patient's behavior to the pain: changes in body position, moaning, sighing, facial grimacing, withdrawal, crying, restlessness, muscle twitching, irritability, immobility
    pain is a symptom. does the pain only occur with movement or weight bearing? does it go away when the patient is off her feet? is the pain only in specific joints? any stiffness? how is this pain restricting activities? does stiffness occur in the morning after a long period of rest, such as sleep? do the joints involved have any redness, swelling or deformity? knowing all that is going to affect what you are going to do for pain relief. medications aren't the only treatment. and, anyway, medications are a collaborative intervention. dazzle your ci by coming up with independent nursing interventions can you do for pain without a doctor's order. there's a bunch of them for the pain of osteoarthritis.

    also there is a problem with your nursing diagnostic statement if the instructor didn't already point it out: chronic pain r/t osteoarthritis aeb client stating she was often in pain. you can't use a medical diagnosis as a related factor (etiology) of the problem (nursing diagnosis). a possible suitable replacement would be "movement" or "inflammatory process in joints". your supporting evidence (client stating she was often in pain) just isn't specific enough. this again comes from data you collect from your assessment of the patient. it doesn't indicate a very thorough investigation of this patient's pain symptoms. and that is why i think your instructor is saying your interventions need to be more specific. interventions are based on the data you collect. if your data isn't specific enough, how can your interventions be specific?

    you can find information on osteoarthritis at the weblinks listed on this thread if you can't find it in your textbooks:
    donsterRN likes this.
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    Get Down Daytonite!!!!! You Are The Bomb!!! I Dont Know If You Teach But You Are A Wealth Of Information And If The Student Inquiring About This Listens To Your Advice She Will Get An A. Wish You Were Around When I Was In Lpn School But I Will Be In Rn Program Before Long. Would Like To Give Some Advice On This But Daytonite Said All I Was Gonna Say And More. Kudos Daytonite!!!!
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    don't forget that chronic pain can be treated with more than analgesics. Other meds include anti-inflammatories, muscle relaxers, tranquilizers---all depending on the clinical situation and the MD orders. Also consider heat, positioning, distraction, anxiety (very good studies recently on pain perception related to memory and anxiety. If we can lower the pts. anxiety we may lower pain perception).
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    I know I'm kind of late on this but what your instructor may be asking for by "more specific" interventions is possibly listing the specific pain medication orders which would then lead into monitoring for their side effects (and whatever they may be). Then for your ongoing pain assessment maybe you should say what scale you are going to use since she is cognitively impaired along with how you will document the pt's description of the pain (triggering factors, onset, relieving factors, duration, etc.) Hope this helps!


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