Acute pain is defined as an unpleasant emotional and sensory experience. It is most often associated with damage to the body’s tissues. The onset of acute pain can be slow or sudden. The main difference between acute and chronic pain is that acute pain has an anticipated resolution lasting less than three months.
Causes (Related to)
The most common cause of acute pain is damage to the body tissues. It can be related to three types of injury agents; physical, biological, or chemical. Acute pain can also be related to psychological causes or exacerbations of existing medical conditions.
- Biological injury agents include bacteria, viruses, and fungi that harm the body and cause pain.
- Chemical injury agents are typically caustic and can cause harm in various ways.
- Physical injury causes pain normally thought of when someone is hurt, such as a broken bone, laceration, or following a surgical procedure.
Signs and Symptoms (As evidenced by)
The following are the common signs and symptoms of acute pain. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.
Subjective (Patient complaints)
- Verbal reports from the patient
- Expressions of pain, such as crying
- Unpleasant feeling (such as a prick, burn, or ache)
Objective (Nurse Observes)
- Significant changes in vital signs
- Changes in appetite or eating patterns
- Changes in sleep patterns
- Guarding or protective behaviors
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for acute pain:
- Patient will report relief of pain.
- Patient will rate the pain scale lower than the initial rate at a level that is acceptable to them or 0/10.
- Patient will manifest vital signs within normal limits.
- Patient will verbalize regaining appetite and sleep.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to acute pain.
1. Assess pain characteristics.
Check for pain quality, severity, location, onset, duration, precipitating, and relieving factors. Accurately assessing the patient’s pain is the first step to planning effective pain management. Nurses can assist patients more correctly reporting their pain by utilizing these particular PQRST evaluation questions:
- P = Provocation/Palliation
- When the discomfort first began, what was the patient doing? What led to it? What makes it better or worse? What appears to set it off? Stress? Position? Specific actions?
- What relieves it? Medication, massage, heat or cold, position change, physical activity, and rest?
- What makes it worse? Moving, bending, lying down, walking, standing?
- Q = Quality
- What sensations do patients have? Use adjectives like “sharp,” “dull,” “stabbing,” “burning,” “crushing,” “throbbing,” “nauseating,” “shooting,” “twisting,” or “stretched” to express the discomfort.
- R = Region or radiation
- Where does the pain come from? Does the discomfort spread? Where? Does it appear to be moving or traveling? Did it begin somewhere else and have a localized origin now?
- S = Scale or Severity
- On a pain scale of 0 to 10, with 0 being no pain and 10 being the highest and worst pain, how bad is the pain? Does it obstruct activities? What is the worst-case scenario? Does it make the patient sit, lie, or move more slowly? How long is a single episode?
- T = Timing
- When exactly did the suffering begin? How much time did it take? Does it happen hourly, and how frequently? Daily? Weekly? Monthly? Is it abrupt or sluggish? When did the patient first encounter it? Did the patient typically experience it during the day? Night? Early in the day? Do patients ever get roused by it? Does it have any other consequences? Does it also exhibit additional symptoms and signs?
2. Ask the patient to rate the pain.
Pain scales can help better understand the patient’s pain. It also evaluates how well the treatment reduces the pain. The most commonly used pain scales go from 0 to 10. The pain scale ranges from 0 (no pain) to 10 (worst pain experienced). The pain scales can be quantitative, qualitative, or combined measurements. Quantitative scales ask, “How bad is the pain?” While qualitative pain scales characterize the nature of the pain. Some other examples of pain scales that are available are:
- Numerical rating scales (NRS) use numbers to rate the pain.
- Visual analog scales (VAS) allow patients to choose the image that most accurately describes their pain level.
- Categorical scales utilize a combination of words and numbers, colors, or places on the body.
3. Look for the underlying cause.
Pain results from an injury, trauma, surgery, or a triggering condition (such as herniated disk, migraine headache, or pancreatitis). Target the cause to alleviate the pain. Shortly after it starts, acute pain becomes prominent. It frequently follows an injury, disease, or medical procedure that is well-known and tends to happen suddenly.
If the underlying cause can be found, treating it is the most efficient way to relieve pain. In other circumstances, the injury or disease causing the discomfort may improve or resolve independently. The cause may require treatment with drugs, surgery, or other therapies. While the patient is awaiting treatment, pain management should be offered. If the source of the pain cannot be immediately found, pain management should still be offered as long as there are no contraindications.
4. Distinguish the type of pain.
Knowing the type of pain, can assist the nurse in determining an appropriate pain management plan. Actual tissue injury or stimuli with the potential to cause tissue damage are caused by nociceptive pain. While neuropathic pain can result from several nerve impulse problems.
5. Identify the aggravating factors.
Determine to what extent cultural, environmental, intrapersonal, and intrapsychic factors may contribute to pain. These influences alter the patient’s expression of the pain experienced by increasing or potentially decreasing the patient’s pain tolerance. For instance, loud and bright environments may exacerbate stress causing increased distress to a patient already experiencing severe pain.
6. Observe signs and symptoms.
Pain results in observable behavioral and physiological changes. It sets off the body’s fight-or-flight reaction. It causes faster breathing and pulse rates. Assess for changes in vital signs and conduct a physical exam.
7. Ask the patient about the use of non-pharmacological methods.
Assess the patient’s comfort level with non-pharmacological methods of pain relief. Some patients are unaware that non-pharmacological methods can be used with or instead of analgesic drugs. A more effective reduction in pain can be achieved using a combination of these therapies.
8. Assess the patient’s expectations for pain relief.
Some patients are satisfied with a reduction of pain, while others desire it to be eliminated. Discussing their expectations can affect their perception of the effectiveness of their pain control and willingness to participate in treatment.
Encourage the patient to decide how comfortable they need to attain their functional goals based on their current state of health. Sometimes, it is not possible to entirely eliminate pain so a reasonable goal should be discussed with the patient. To correctly set a patient’s comfort-function goal, nurses must first outline the crucial steps in the healing process and explain how pain management contributes to successful outcomes.
9. Consider the age and developmental stage.
The client’s age, developmental stage, and present health should be considered. Their developmental stage or other diseases may alter their capacity to report pain parameters or their reaction to pain and management strategies. For instance, very young children are susceptible to pain due to decreased ability to report pain. Therefore age-appropriate pain rating scales and collaboration with caregivers should be used to manage pain.
Nursing Interventions
Nursing interventions and care are essential for the patient’s recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with acute pain.
1. Administer the appropriately prescribed analgesic.
Analgesic drugs like NSAIDS, opioids, and local anaesthetics pharmacologically reduce acute pain quickly and effectively.
- Painkillers available over the counter, such as acetaminophen, aspirin, or ibuprofen
- Prescription pain relievers, such as corticosteroids or specific COX-2 inhibitors
- Opioid drugs, which may be administered for severe pain after an operation or injury
- Specific neuropathic pain or functional pain syndromes may be treated with antidepressant or seizure medicines.
2. Follow the pain ladder.
The pain ladder is crucial for assessing the patient’s pain level and prescribing the appropriate drugs. The pain ladder comprises a three-step transition from non-opioids through mild opioids to potent opioids to provide adequate pain relief. It consists of three steps:
- Mild pain uses non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.
- Moderate pain utilizes weak opioids (such as hydrocodone, codeine, and tramadol) with or without non-opioid pain relievers.
- Severe and persistent pain uses potent opioids with or without non-opioid painkillers. Potent opioids are morphine, methadone, fentanyl, oxycodone, buprenorphine, tapentadol, hydromorphone, and oxymorphone.
3. Assess the appropriateness of a patient-controlled analgesia (PCA) pump.
Assess if the patient is a PCA candidate. PCA is the IV infusion of opioids through a pump controlled by the patient. If the patient meets the criteria, this can be a more effective method of pain management. PCA enables patients to self-administer analgesia and gives the patient some degree of control over the dosage they receive. It is important to assess if the patient is both physically able and willing to hit the PCA button but also mentally competent to understand that doing so will relieve their discomfort.
4. Evaluate pain after interventions.
Reassess pain level after 30 minutes of interventions. It is essential to reassess pain following interventions to determine if those actions were practical and if the patient’s pain control goals have been met. Also take into consideration how long it will take the medication administered to reach its maximal effectiveness. Some medications such as those administered IV will take effect almost immediately, while others may not reach peak efficacy for hours.
5. Educate the patient about pain management.
Teach regarding effective timing of medication doses prior to activities that exacerbate pain and to avoid periods of intense pain. Patients can help effectively manage their pain with additional knowledge of when to request pain medication to maximize its effectiveness and prevent severe pain episodes.
If the patient is not able to verbally respond to questions, the nurse can request that the patient nod their head, squeeze their hand, move their eyes up and down, or raise their fingers, hand, arm, or leg to indicate the presence of discomfort. If applicable, provide the patient with writing materials, pain intensity charts, or numbers they can reference.
6. Encourage feedback from the patient.
Instruct the patient to assess the interventions’ effectiveness and report the effectiveness of different interventions to the care team. Feedback can assist the care team in modifying and improving pain control strategies. Ask the patient how much pain they were experiencing both before and after taking pain management. What were actions taken if the patient’s pain level was intolerable?
7. Respond immediately to reports of pain.
If the patient is experiencing an altered passage of time due to pain, fear of delayed pain relief can exacerbate the pain experience. Prompt responses to reports of pain reduce anxiety and promote trust.
8. Promote periods of rest for the patient.
Fatigue can contribute to pain. A quiet, darkened room with minimal noise and interruptions can promote rest and reduce pain.
9. Encourage the use of non-pharmacological therapy.
Use relaxation and breathing exercises and music therapy. These techniques help produce a sense of tranquility for the patient. The goal is to reduce pain related to tension or stress. Complementary therapies are:
- Biofeedback teaches the patient to control bodily functions like breathing actively.
- Acupressure or acupuncture stimulates particular pressure spots on the body to relieve pain.
- Massage relieves tension and pain by pressure and rubbing the muscles or other soft tissues.
- Meditation releases tension and stress by concentrating on thoughts in specific ways during meditation.
- Yoga or tai chi combines slow and intentional movements with deep breaths to relax the muscles.
- Natural relaxation practices continuous muscle relaxation where the patient can contract and relax various muscles.
- Guided imagery can picture something comforting for the patient, diverting them from pain.
10. Remove the stimuli.
Divert away the patient’s attention from the painful stimuli using effective distractors that can reduce the pain the patient perceives. Provide appropriate and engaging distractions for the patient to redirect their attention. Diversional therapy involves using the mind to redirect the attention to something else. The patient can put the pain on hold and concentrate instead on things like playing games, counting, practicing breathing exercises, and many other things.
11. Monitor for side effects of medications.
Monitoring for side effects is also essential to maintain the patient’s comfort and safety. Drugs have varying effects based on each person’s metabolism, and efficacy should be evaluated case by case. Sedation, mental fogginess, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression are typical adverse effects of opioid treatment. Watch out for physical dependence that may put the patient at risk for overdosage and poor pain management.
12. Anticipate the need for pain relief.
Pain is most effectively managed by preventing it. Intervening as soon as possible can decrease the total amount of analgesic needed to provide adequate pain control.
13. Refer to needed therapies.
Physical therapy could ease the pain brought on by illnesses like multiple sclerosis or arthritis, as well as injuries. While occupational therapy may teach patients how to modify their routines and environments to minimize pain.
14. Apply a compress device.
To relieve uncomfortable swelling and inflammation brought on by injuries or persistent illnesses like arthritis, apply an ice pack or cold pack wrapped in a towel. While using heating pads or a warm bath relieves cramps, pain, or muscle stiffness.
15. Follow RICE for minor injuries.
For minor injuries that do not require medical attention, follow RICE:
- Rest the affected area.
- Ice the affected area with a towel-wrapped cold pack for 10 to 20 minutes to reduce swelling.
- Compress by wrapping the affected area with an elastic bandage to provide support. It should be applied tightly enough to prevent numbness.
- Elevate the affected area above the heart to encourage venous return.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for acute pain.
Acute pain care plans should always be individualized to the patient. The care planning process should assess contributing factors to the patient’s pain, the appropriateness of the planned interventions, and effective methods for evaluating the patient’s response.
Nursing Diagnosis
1.Activity intolerance related to body weakness evidenced by poor performance of daily activities
2.Risk for deep vein thrombosis related to immobilization evidenced by limited movement in and out of bed
3.Acute pain related to disease process evidenced by facial expression and verbalization
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