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Nursing Interventions for Acute Pain - BPH Benign Prostatic Hyperplasia
Nursing Interventions for Acute Pain - BPH Benign Prostatic Hyperplasia
Nursing Diagnosis: Acute Pain - BPH Benign Prostatic Hyperplasia
Acute Pain Definition: Sensory and unpleasant emotional experience arising from actual or potential tissue damage, appear suddenly or slowly with mild to severe intensity with which the end can be anticipated or expected and lasted less than 6 months.
Related factors: Agents injury (biological, chemical, physical, psychological)
Acute pain - Limitation of Characteristics:
- Reports of verbal or non verbal pain
- The fact of the observation
- The position to avoid pain
- The movement to protect
- Cautious behavior
- Face masks
- Sleep disturbance (glazed eyes, looking tired, it is difficult or chaotic motion, grinning)
- Focused on self-
- The focus narrows (decreasing the perception of time, damage to the thought process, decreased interaction with people and the environment)
- Distraction behavior, eg roads, meet other people and / or activities, repetitive activities)
- Autonomic responses (such as diaphoresis, changes in blood pressure, changes in breathing, pulse and dilated pupils)
- Changes in muscle tone, autonomic (probably in the range from weak to stiff)
- Expressive behavior (eg, restlessness, moaning, crying, alert, iritabel, breath / sigh)
- Changes in appetite and drinking.
Goal :
1. Control Pain
Definition: a person's actions to control pain
Indicators:
- Know the factors that cause
- Know the onset / timing of pain
- Non-analgesic relief measures
- Using the analgesic
- Reported the symptoms to the health care team (doctors, nurses)
- Pain can be controlled
1 = not done
2 = rarely done
3 = sometimes done
4 = often done
5 = always done
2. Shows the level of pain
Definition: the severity of pain reported or indicated
Indicators:
- Reported pain
- Frequency of pain
- The duration of pain episodes
- The expression of pain: facial
- The position of protecting the body
- Anxiety
- Changes in respiration rate
- Changes in Heart Rate
- Changes in blood pressure
- Changes in pupil size
- Perspiration
- Loss of appetite
1: weight
2: a little heavy
3: medium
4: a little
5: no
Nursing Interventions for Acute Pain - BPH Benign Prostatic Hyperplasia
1. Pain Management
Definitions: change or reduction of pain to an acceptable level of patient comfort.
Intervention:
- Assess thoroughly about pain, including: location, characteristics, time of occurrence, duration, frequency, quality, intensity / severity of pain, and trigger factors.
- Observation of non-verbal cues of discomfort, especially in the inability to communicate effectively.
- Give analgesics in accordance with the recommendation.
- Use a personal communication that the client can express therapeutic pain.
- Assess the client's cultural background.
- Determine the impact of the expression of pain on quality of life: sleep patterns, appetite, activities, mood, relationships, work, responsibility roles.
- Assess the individual's experience of pain, a family with chronic pain.
- Evaluation of the effectiveness of the actions that have been used to control pain.
- Provide support to clients and families.
- Provide information about pain, such as: the causes, how long the case, and precautions.
- Control of environmental factors that may affect the client's response to discomfort (eg, room temperature, irradiation, etc.).
- Encourage clients to monitor their own pain.
- Teach the use of non-pharmacological techniques. (Ex: relaxation, guided imagery, music therapy, distraction, application of heat and cold, massase).
- Evaluate the effectiveness of measures to control the pain.
- Modification of pain control measures based on client responses.
- Increase the sleep / rest.
- Encourage clients to discuss precisely the experience of pain.
- Tell your doctor if action is not successful or event of a complaint.
- Inform other healthcare team / family members when action nonfarmakologi done, to a preventive approach.
- Monitor the comfort of the client to pain management.
Definition: the use of pharmacological agents to reduce or eliminate pain.
Intervention:
- Determine the location of pain, characteristics, quality, and severity before treatment.
- Give the drug to the principle of "5 right".
- Check the history of drug allergy.
- Involve the client in the electoral analgesics to be used.
- Select the appropriate analgesic / analgesic combination of more than one if it has been prescribed.
- Monitor vital signs before and after administration of analgesics.
- Monitor adverse drug reactions and medication.
- Document the response of the effects of analgesic and unwanted.
- Perform actions to reduce analgesic effects (constipation / stomach irritation).
Definition: manipulate the environment for therapeutic benefit.
Intervention:
- Choose a room with the right environment.
- Limit visitors.
- Determine the things that cause discomfort such as damp clothing.
- Provide a comfortable bed and clean.
- Determine the most comfortable room temperature.
- Provide a quiet environment.
- Pay attention to hygiene to maintain patient comfort.
- Adjust the position of the patient made comfortable.
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