Chronic Pain Case Study
NURSING CARE PLAN: Teaching
Pt history: Pt is a 76 year old female with a history of two CVA’s (most current CVA in the L middle cerebral artery), Atrial fibrillation with mitral valve replacement, total knee replacement, hip replacement, cholecystectomy, hysterectomy, appendectomy, hemorrhoids, arthritis, gout
NURSING DIAGNOSIS: Ineffective Self Health management r/t lack of knowledge of chronic pain management aeb. patient relates consistent pain at a 5-9 on a scale of 0-10 ten being worst, statement of having “a lot of pain most of the time”, inability to relate pain management alternatives to medications that work “part of the time”, states that pain “gets in the way” of daily functioning two to three times a week on a regular basis
CLIENT …show more content…
GOAL: Patient will have adequate knowledge and ability of one to implement new pain management techniques to improve daily functioning by end of last shift before discharge.
OUTCOME CRITERIA
Client will
1. Demonstrates motivation, readiness, and appropriate cognitive awareness to learn within two shifts of implementation of plan.
2. Discuss and identify two methods with nurse methods by which they will attain the highest understanding of the information provided during first four hours of wakefulness of first shift of implementation.
3. Demonstrate and explain back to nurse cold therapy implementation technique by end of third shift of plan being in place.
Implementation:
0630 1-23-15
INTERVENTIONS/
ACTIONS
Nurse will
1. Determine a plane of care with both the client and husband.
2. Determine patient 's learning style, especially if patient has learned and retained new information in the past.
3. Question patient regarding previous experience and health teaching and discuss any misconceptions that are in place.
4. Asses current cognitive level of functioning determining if any barriers are currently in place, (sedation due to medication, memory and shorter attention span issues related to history of stroke), that may hinder learning so as to accommodate or adjust to remove barrier.
5. Provide information using the determined best learned method with the various mediums (e.g., explanations, demonstrations, pictures, written instructions, short pamphlets and videotapes) that were agreed effective.
6. Provide teaching for non pharmacological measures such as use of cold therapy to increase pain management as per the patients request for alternatives to medications for pain relief.
7. Teach client correct way to implement ice therapy by placing a bag of ice or icepack on the affected area for 15-30 min prior to and after therapy to reduce swelling and provide comfort.
8.
Assess effectiveness and side effects of pain medication adjusting within doctor’s orders as needed for optimum effectiveness. Administer 1/2 dose of narcotic pain medication at least one hour prior to therapy. (Half dose indicated to prior assessment of increased drowsiness and per pt. request.)
RATIONALE
1. Many elderly or terminal patients may view themselves as dependent on their caregiver, and therefore not want to be part of the educational process.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
2. Some persons may prefer written over visual materials, or they may prefer group versus individual instruction. Matching the learner 's preferred style with the educational method will facilitate success in mastery of knowledge.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.117) St. Louis: Elsevier/Mosby.
3. Adults bring many life experiences to each learning session. Adults learn best when teaching builds on previous knowledge or experience. Addressing misconceptions from previous learning gives a starting point for current information …show more content…
offered.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
4.
Cognitive impairments need to be identified so an appropriate teaching plan can be designed. For example, the Mini-Mental Status Test can be used to identify memory problems that would interfere with learning. Physical limitations such as impaired hearing or vision, or poor hand coordination can likewise compromise learning and must be considered when designing the educational approach. Patients with decreased lens accommodation may require bolder, larger fonts or magnifying mirrors for written material.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
5. Different people take in information in different ways. Match the learning style with the educational approach.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
6. Some patients will feel uncomfortable exploring alternative methods of pain relief. However, patients need to be informed that there are multiple ways to manage pain, and few persons need to suffer unnecessarily.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis:
Elsevier/Mosby.
7. The use of noninvasive pain relief measures can increase the release of endorphins and enhance the therapeutic effects of pain relief medications.
Grodner, M., Long Roth, S., & Walkingshaw, B. (2012). Nutritional Foundations and Clinical Applications of Nutrition (5th ed.). (p. 1243) St. Louis: Mosby.
8. The analgesic dose may not be adequate to raise the clients pain threshold or may be causing intolerable or dangerous side effects or both. Ongoing assessment will assist in making necessary adjustments for effective pain management.
Grodner, M., Long Roth, S., & Walkingshaw, B. (2012). Nutritional Foundations and Clinical Applications of Nutrition (5th ed.). (p. 1243) St. Louis: Mosby.
EVALUATION/
REASSESSMENT
Goal not met. Patient discussed with nursing student ways in which she currently dealt with her everyday pain. Using ice with 15 min on and 15 minutes off were discussed. Due to daily schedule, pain and subsequent narcotic pain administration with cognitive side effects patient was not able to finish discussion.
Reassessed
1445 1-23-15
Changes to plan should include: adjusting time to before patient experiences negative effects of medication or reduction to narcotic medication to limit cognitive impairment. Discussion should be broken up into short intervals to reinforce material and alternatives provided.
Rachel Sharp SN
1-23-15
References
Grodner, M., Long Roth, S., & Walkingshaw, B. (2012). Nutritional Foundations and Clinical Applications of Nutrition (5th ed.). St. Louis: Mosby.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. St. Louis: Elsevier/Mosby.
Pt history: Pt is a 76 year old female with a history of two CVA’s (most current CVA in the L middle cerebral artery), Atrial fibrillation with mitral valve replacement, total knee replacement, hip replacement, cholecystectomy, hysterectomy, appendectomy, hemorrhoids, arthritis, gout
NURSING DIAGNOSIS: Ineffective Self Health management r/t lack of knowledge of chronic pain management aeb. patient relates consistent pain at a 5-9 on a scale of 0-10 ten being worst, statement of having “a lot of pain most of the time”, inability to relate pain management alternatives to medications that work “part of the time”, states that pain “gets in the way” of daily functioning two to three times a week on a regular basis
CLIENT …show more content…
GOAL: Patient will have adequate knowledge and ability of one to implement new pain management techniques to improve daily functioning by end of last shift before discharge.
OUTCOME CRITERIA
Client will
1. Demonstrates motivation, readiness, and appropriate cognitive awareness to learn within two shifts of implementation of plan.
2. Discuss and identify two methods with nurse methods by which they will attain the highest understanding of the information provided during first four hours of wakefulness of first shift of implementation.
3. Demonstrate and explain back to nurse cold therapy implementation technique by end of third shift of plan being in place.
Implementation:
0630 1-23-15
INTERVENTIONS/
ACTIONS
Nurse will
1. Determine a plane of care with both the client and husband.
2. Determine patient 's learning style, especially if patient has learned and retained new information in the past.
3. Question patient regarding previous experience and health teaching and discuss any misconceptions that are in place.
4. Asses current cognitive level of functioning determining if any barriers are currently in place, (sedation due to medication, memory and shorter attention span issues related to history of stroke), that may hinder learning so as to accommodate or adjust to remove barrier.
5. Provide information using the determined best learned method with the various mediums (e.g., explanations, demonstrations, pictures, written instructions, short pamphlets and videotapes) that were agreed effective.
6. Provide teaching for non pharmacological measures such as use of cold therapy to increase pain management as per the patients request for alternatives to medications for pain relief.
7. Teach client correct way to implement ice therapy by placing a bag of ice or icepack on the affected area for 15-30 min prior to and after therapy to reduce swelling and provide comfort.
8.
Assess effectiveness and side effects of pain medication adjusting within doctor’s orders as needed for optimum effectiveness. Administer 1/2 dose of narcotic pain medication at least one hour prior to therapy. (Half dose indicated to prior assessment of increased drowsiness and per pt. request.)
RATIONALE
1. Many elderly or terminal patients may view themselves as dependent on their caregiver, and therefore not want to be part of the educational process.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
2. Some persons may prefer written over visual materials, or they may prefer group versus individual instruction. Matching the learner 's preferred style with the educational method will facilitate success in mastery of knowledge.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.117) St. Louis: Elsevier/Mosby.
3. Adults bring many life experiences to each learning session. Adults learn best when teaching builds on previous knowledge or experience. Addressing misconceptions from previous learning gives a starting point for current information …show more content…
offered.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
4.
Cognitive impairments need to be identified so an appropriate teaching plan can be designed. For example, the Mini-Mental Status Test can be used to identify memory problems that would interfere with learning. Physical limitations such as impaired hearing or vision, or poor hand coordination can likewise compromise learning and must be considered when designing the educational approach. Patients with decreased lens accommodation may require bolder, larger fonts or magnifying mirrors for written material.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
5. Different people take in information in different ways. Match the learning style with the educational approach.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis: Elsevier/Mosby.
6. Some patients will feel uncomfortable exploring alternative methods of pain relief. However, patients need to be informed that there are multiple ways to manage pain, and few persons need to suffer unnecessarily.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. (p.116) St. Louis:
Elsevier/Mosby.
7. The use of noninvasive pain relief measures can increase the release of endorphins and enhance the therapeutic effects of pain relief medications.
Grodner, M., Long Roth, S., & Walkingshaw, B. (2012). Nutritional Foundations and Clinical Applications of Nutrition (5th ed.). (p. 1243) St. Louis: Mosby.
8. The analgesic dose may not be adequate to raise the clients pain threshold or may be causing intolerable or dangerous side effects or both. Ongoing assessment will assist in making necessary adjustments for effective pain management.
Grodner, M., Long Roth, S., & Walkingshaw, B. (2012). Nutritional Foundations and Clinical Applications of Nutrition (5th ed.). (p. 1243) St. Louis: Mosby.
EVALUATION/
REASSESSMENT
Goal not met. Patient discussed with nursing student ways in which she currently dealt with her everyday pain. Using ice with 15 min on and 15 minutes off were discussed. Due to daily schedule, pain and subsequent narcotic pain administration with cognitive side effects patient was not able to finish discussion.
Reassessed
1445 1-23-15
Changes to plan should include: adjusting time to before patient experiences negative effects of medication or reduction to narcotic medication to limit cognitive impairment. Discussion should be broken up into short intervals to reinforce material and alternatives provided.
Rachel Sharp SN
1-23-15
References
Grodner, M., Long Roth, S., & Walkingshaw, B. (2012). Nutritional Foundations and Clinical Applications of Nutrition (5th ed.). St. Louis: Mosby.
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. St. Louis: Elsevier/Mosby.