Acute Pain NCP for Appendicitis

Appendicitis is a condition characterized by inflammation of the appendix. The appendix is a small pouch attached to the beginning of your large intestine. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy.

The main symptom of appendicitis is abdominal pain. Symptoms of appendicitis may take 4-48 hours to develop. Other symptoms include:

• loss of appetite,
• nausea,
• vomiting,
• lack of appetite, and
• fever.

Diagnosis is based on patient history (symptoms) and physical examination backed by an elevation of neutrophilic white blood cells. Histories fall into two categories, typical and atypical. Typical appendicitis usually includes abdominal pain beginning in the region of the umbilicus for several hours, associated with anorexia, nausea or vomiting. The pain then "settles" into the right lower quadrant (or the left lower quadrant in patients with situs inversus totalis), where tenderness develops. The combination of pain, anorexia, leukocytosis, and fever is classic. Atypical histories lack this typical progression and may include pain in the right lower quadrant as an initial symptom. Atypical histories often require imaging with ultrasound and/or CT scanning.

Nursing Diagnosis for Appendicitis: Acute Pain related to distention of the intestinal tissue.

Goal: Pain will be solved
Expected outcomes: normal breathing. normal circulation.

Intervention:

1) Assess the level of pain, location and characteristics of pain.
Rationale: To determine the extent of pain and is an indicator of early to be able to give further action.

2) Encourage deep breathing.
Rationale: deep breathing, can breathe oxygen adequately, so that the muscles into relaxation so as to reduce pain.

3) Perform gate control.
Rationale: The gate control large diameter nerve stimulating small-diameter nerve so that pain stimuli are not forwarded to the hypothalamus.

4) Give analgesics.
Rationale: As a prophylactic in order to relieve pain (if already know the symptoms for sure).

Acute Pain and Anxiety related to Pyelonephritis

Pyelonephritis is a type of urinary tract infection (UTI) that affects one or both kidneys.

Pyelonephritis is caused by a bacterium or virus infecting the kidneys. Though many bacteria and viruses can cause pyelonephritis, the bacterium Escherichia coli is often the cause. Bacteria and viruses can move to the kidneys from the bladder or can be carried through the bloodstream from other parts of the body. A UTI in the bladder that does not move to the kidneys is called cystitis.

Symptoms of pyelonephritis can vary depending on a person’s age and may include the following:

• fever
• vomiting
• back, side, and groin pain
• chills
• nausea
• frequent, painful urination

Nursing Diagnosis : Acute Pain related to infection of the kidneys

Goal: pain in the kidneys is reduced

Expected outcomes: No pain on urination, no pain on percussion pelvis.

Interventions and Rationale

1. Assess the intensity, location, and factors that aggravate or relieve pain.
R /: Pain is a great sign of infection.

2. Give adequate rest and activity levels that can be tolerant.
R /: Clients can rest and muscles can relax.

3. Encourage drinking plenty of 2-3 liters if no contraindications
R /: To assist clients in urination.

4. Give analgesics according to the treatment program.
R /: Analgesic block the path of pain.

5. Monitor urine output to changes in color, odor and voiding patterns, input and output every 8 hours and monitor the results of urinalysis repeated.
R: To identify indications of progress or deviations from expected results.

6. Record the location, the length of the intensity scale (1-10) spread pain.
R /: To help evaluate the place of obstruction and cause pain.

7. Provide comfortable action, bleak back rub, the rest.
R /: Improve relaxation, reduce muscle tension.

8. Assist or encourage the use of focused relaxation breathing.
R /: Helps redirect the attention and for muscle relaxation.

9. Give perineal care.
R /: To prevent contamination of the urethra.


Nursing Diagnosis: Anxiety related to lack of information about the disease process, prevention methods, and home care instructions.

Goal: Anxiety is reduced

Expeected Outcome : Clients say taste anxiety diminished

Interventions and Rationale:

1. Assess the level of anxiety.
R /: To determine the severity of the client's anxiety.

2. Give the client the opportunity to express feelings.
R /: In order for the client to have passion and want empathy to care and treatment.

3. Give support to the client.

4. Give spiritual encouragement.

5. Give an explanation of the illness.
R /: In order to fully understand the client's illness experiences.

Acute Pain related to Myocardial Infarction

Nursing Diagnosis : Acute Pain related to Myocardial Infarction 

Goals and Expected outcomes :

• Expected loss or uncontrolled chest pain

The expected outcomes:

• Patients are able to demonstrate the use of relaxation techniques.
• Patients showed reduced stress, relaxed and easy to move.

Nursing Interventions - Acute Pain related to Myocardial Infarction

Independent
1. Monitor or record the characteristics of the pain, noted the report verbal, nonverbal cues, and the haemodynamic response (grimacing, crying, anxiety, sweating, clutching his chest, rapid breathing, blood pressure / heart frequency change).

Rational: Variations in the appearance and behavior of the patient as pain occurs as the assessment findings. Most patients with Acute Myocardial Infarction looks sick, distraction, and focus on the pain. History of verbal and deeper investigation of the precipitating factors should be delayed until the pain is gone. Breathing may be increased as a result of pain and is associated with anxiety, stress cause temporary loss of catecholamines would increase heart rate and blood pressure.

2. Take a complete picture of the pain of the patient, including the location, intensity (0-10), duration, quality (shallow / spread), and distribution.

Rational:
Pain is a subjective experience and should be described by the patient. Help patients to assess pain by comparing the experience of others.

3. Observations over the previous history of angina, pain resembling angina, or pain in Myocardial Infarction. Discuss family history.

Rational:
Can compare the pain is there from the previous pattern, according to the identification of complications such as widespread infarction, pulmonary embolism, or pericarditis.

4. Instruct patient to report pain immediately.

Rational:
Delays in the reporting of pain, inhibit pain relief and require increased doses of the drug. In addition, severe pain can cause shock by stimulating the sympathetic nervous system, resulting in further damage and interfere with diagnostic and pain relief.

5. Provide a quiet, slow activity, and comfortable action (eg, bed linen dry / not crossed, rubbing his back). Patient approach calmly and with confidence.

Rational:
Lowering external stimuli in which anxiety and heart strain and limited coping abilities and judgment of the current situation.

6. Assist patients in relaxation techniques, eg, deep breathing / slow, behavioral distraction, visualization, imagination guidance.

Rational:
Assist in the reduction in the perception / response to pain. Giving control of the situation, increase positive behavior.

7. Check vital signs before and after drug pemnerian.

Rational:
Hypotension / respiratory depression can occur as a result of the provision. This problem can increase the myocardial damage in the presence of ventricular failure.


Collaboration:

8. Give supplemental oxygen by nasal cannula or mask as indicated.

rational:
Increasing the amount of oxygen available for myocardial usage and also reduce discomfort in relation to tissue ischemia.

Acute Pain related to Nasopharyngeal Carcinoma

Nursing Diagnosis and Nursing Interventions for Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a malignancy of the nasopharynx from nasopharyngeal mucosal epithelium or glands found in the nasopharynx. Nasopharyngeal carcinoma is the most carcinomas in the ENT. Most of the clients come to the ENT in a state of advanced or late.

Nursing Diagnosis: Acute Pain related to agency physical injury (surgery)

Objectives: After nursing intervention, client comfort level increases,

evidenced by the level of pain: the client may report pain in workers, frequency of pain, facial expressions, and states of physical and psychological comfort, blood pressure 120/80 mmHg, pulse: 60-100 x / min, respiration: 16-20x/mnt
Control of pain evidenced by client to report symptoms of pain and pain control.

Nursing Interventions:

Pain management:

1. Perform a comprehensive pain assessment, including the location, characteristics, duration, frequency, quality factor and precipitation.
2. Observation nonverbal reactions of discomfort.
3. Use therapeutic communication techniques to determine the client's experience of pain before.
4. Control of environmental factors that affect pain such as room temperature, lighting, noise.
5. Reduce pain precipitation factor.
6. Choose and pain management (pharmacological / non-pharmacological) ..
7. Teach non-pharmacological techniques (relaxation, distraction, etc.) to overcome the pain.
8. Give analgesics to reduce pain.
9. Evaluation of pain reducers / pain control.
10. Collaboration with the doctor if there are complaints about the administration of analgesics to no avail.
11. Monitor client's acceptance of pain management.

Analgesic administration:.

1. Check program providing analgesic; types, dosage, and frequency.
2. Check history of allergy.
3. Determine the analgesic of choice, route of administration and optimal dosage.
4. Monitor vital signs before and after the administration of analgesics.
5. Give analgesics on time especially when pain appears.
6. Evaluation of analgesic efficacy, side effects signs and symptoms.