Monica Heater Nursing Diagnosis: Chronic pain r/t disease process AEB c/o pain all the time.

Long Term Goal: Patient will have adequate control of pain in one week.

Intervention 1. Monitor VS q 4 hours.

Rationale 1. Vital signs can be an indicator of pain. Mild to moderate pain will increase the heart rate, blood pressure, and respiration rate. Severe pain may decrease the heart rate, blood pressure and respirations. Vital signs are an important part of assessing pain. 2. Teach patient that 0 is no pain and 10 is the worst pain possible. Teaching patient to communicate pain using a scale can help determine what pain medication to administer if needed.

Outcome Criteria 1. Patient will have normal vital signs every shift, as her pain is well controlled.

Evaluation 1. Met. Patient verbalizes no pain on say shift.

2. Teach pain scale 0-10 upon admission.

2. Patient will using the adult pain scale when reporting pain.

2. Patient did not report pain, no need to use scale.

Intervention 3. Asses pain q 2 hours.

Rationale 3. Knowing the amount of pain is important is knowing if and what medications a patient may need. This is the first step to helping the patient achieve improved comfort. It is very important to say ahead of the pain. If the pain gets too severe, it will be more difficult to get back under control. (Nursing Diagnosis Handbook) 4. Chronic pain patients had twice the rate of suicide than the people without pain. Patients over 60 who committed suicide had physical illness especially pain, breathlessness, and disability. If depression occurs, treatment is an option. (NDH, Harwood et al 2006)

Outcome Criteria 3. Patient will report pain as soon as possible.

Evaluation 3. Patient did not report pain.

4. Monitor for signs of depression weekly.

4. Nurse and/or family will pick up on signs of depression as soon as it occurs.

4. Patient has not shown any signs of depression up to this point in her care.

Intervention 5. Assist patient OOB BID

Rationale 5. Immobility may cause the patient to experience more pain. Changing positions regularly can avoid this added pain or discomfort. Medication may be needed before transferring. 6. Tylenol is a medication that is used to treat mild to moderate pain. It works by inhibiting the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. Has no significant antiinflammatory properties or GI toxicity, making prolonged use okay. May need to monitor liver function tests. (Daviss Drug Guide)

Outcome Criteria 5. Patient will sit in chair for 2 hours twice each day.

Evaluation 5. Met - Patient was up in chair once during our shift and tolerated it well.

6. Administer Tylenol 975mg PO daily.

6. The patients pain will be well controlled throughout the each day.

6. Met Patient reports no pain during our shift.

7. Apply Lidoderm patch daily.

7. Lidoderm is a patch that contains lidocaine which and an anesthetic used to treat pain. It produces local anesthesia by inhibiting transport of ions across neuronal membranes, thereby preventing initiation and conduction of normal nerve impulses. Health care providers will need to monitor of skin irritation caused from the patch. Sites will need to be rotated with each new patch. (Daviss Drug Guide)

7. Patient will experience well controlled pain each day.

7. Met Patient reports no pain during our shift.