Angelite Nurses: Alteration in Comfort: Pain

Alteration in Comfort: Pain

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
(_) Musculoskeletal disorder (_) Visceral disorder (_) Cancer (_) Information (_) Trauma (_) Diagnostic test	(_) Immobility/improper positioning (_) Pressure points (_) Pregnancy (_) Fear (_) Anxiety/stress (_) Overactivity (_) Other:_____________________________ ____________________________________ ____________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Pt. reports or demonstrates discomfort.
Minor: (May be present)	(_) Autonomic response to acute pain: increased BP, P, R diaphoresis dilated pupils guarding facial mask of pain crying/moaning abdominal heaviness cutaneous irritation

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient will:

(_) Experience relief of pain A.E.B.

(_) Other:

(_) Asses characteristics of pain: location, severity on a scale of 1-10, type, frequency, precipitating factors, relief factors.

(_) Eliminate factors that precipitate pain: eg.:__________________
________________________

(_) Offer analgesics q___ hrs prn (according to physician order).

(_) Teach patient to request analgesics before pain becomes severe.

(_) Explore non-pharmacological methods for reducing pain/promoting comfort:

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

Angelite Nurses