N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide • Chronic pain with a goal that the individual’s pain will be controlled at a tolerable level • Risk for injury with a goal that the individual will be free of injury • Sleep disturbance with a goal that the individual will have at least six hours of uninterrupted sleep each night • Acute pain with a goal that the individual’s pain will be decreased • Knowledge deficit about pain relief interventions with a goal that the individual will be able to decrease reliance on pain medication as other measures are implemented These diagnoses should be related to specific issues that the individual is experiencing and should be prioritized with the individual and healthcare teammembers. Planning As stated previously, patient-centered goals are created during this phase of the nursing process. The diagnoses stated above are paired with appropriate goals. It is important to use established nursing standards and protocols, taking into consideration evidence-based practice, ethical and legal implications, and standards of care when determining expected outcomes and appropriate interventions. Interventions that might be included to enhance comfort and achieve goals include: • Verify the level of discomfort with the patient. Note changes in the medical record and inform other health professionals working with the patient. • Perform a comprehensive assessment of pain to include location, characteristics, onset/duration, frequency, quality, intensity or severity of pain, and precipitating factors. • Ensure that the patient receives attentive analgesic care. • Use therapeutic communication strategies to acknowledge the pain experience and convey acceptance of the patient’s response to pain. • Explore the patient’s knowledge and beliefs about pain. • Consider cultural influences on pain response. • Determine the impact of the pain experience on quality of life (e.g. sleep, appetite, activity, cognition, mood, relationships, performance of job, and role responsibilities). • Explore with the patient factors that relieve or worsen pain. • Evaluate past experiences with pain to include individual or a family history of chronic pain or resulting disability, as appropriate. • Evaluate, with the patient and the healthcare team, the effectiveness of past pain control measures that have been used. • Utilize a developmentally appropriate assessment method that allows for monitoring the change in pain. The method should assist in identifying actual and potential precipitating factors (flow sheet or daily diary). • Provide information about the pain, such as causes of the pain, how long it will last, and anticipated discomforts from procedures. • Reduce or eliminate factors that precipitate or increase the pain experience (fear, fatigue, monotony, and lack of knowledge). • Consider the patient’s willingness to participate, ability to participate, preference, support of significant others for method, and contraindications when selecting a pain relief strategy.

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