Comfort and Pain Management Case Studies PDF

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NURA 303 Fundamentals of Nursing Care Comfort and Pain Management Case Study

Corry Trocheck Objective: To apply the principles of the pain experience and pain management following steps of the nursing process through assessment and planning of care for a client with chronic pain.

Case Study A: You are a nurse on a medical–surgical unit in a hospital caring for one of your patients who is admitted several times per year due to her uncontrolled back and shoulder pain. She is 70 y/o and, by assessing her expression, it is hard to believe she is in pain at all. She can be a challenging patient because she is quite vocal about her pain level and needing more pain medication. 1. Describe factors that could possibly affect a patient’s pain experience and the perception of this experience. Pain is the perception of the individual experiencing it. This perception is influenced by many factors and varies widely from person to person. Culture will influence the way someone perceives and reacts to pain, as well as acceptable expressions of pain (Taylor, Lynn, & Bartlett, 2019). For example, some might view expressing any feelings of pain as weakness and frown upon those who do not control their outward reactions toward pain. The way a family reacts to pain (both their pain and pain felt by others) is also an influence on the perception and experience of pain (Taylor et al., 2019). Gender (and the underlying gender roles we enforce as a society) plays a huge role in how we display pain we experience (Taylor et al., 2019). Boys are typically told to “be tough” when they get injured, whereas girls are allowed to express and feel their pain more openly. Age may be a factor in the perception of pain as well (Taylor et al., 2019).

NURA 303 Fundamentals of Nursing Care Comfort and Pain Management Case Study

Older adults may not report pain due to the reduced perception and constant experience of pain they have. The pain has become a norm and they have adapted to experience it in a different way than another might. Religious beliefs can influence the experience and perception of the experience of pain as well (Taylor et al., 2019). Some patients may view pain as an indicator of the need for spiritual growth, while others think of it as a punishment from God (Taylor et al., 2019). One’s environment can impact the experience of pain in a negative or positive manner. If a patient uses an object (like a blanket) to help them cope and they do not have that in the hospital, they might experience a higher intensity of pain. Support from friends and family will also influence the experience of pain (Taylor et al., 2019). When we are surrounded by those we love and care about us, we can be distracted and feel less anxious about the pain we may have. The fear of pain and our anxiety surrounding that will influence our perception and experience of pain. The child who cries for minutes after receiving an inoculation is not actually in pain from the shot, but they may be experiencing pain from reliving the moment of pain and the anxiety they had about the shot. Fatigue will also have a great impact on how we see and feel pain (Taylor et al., 2019). When we are exhausted, everything seems a bit worse than it actually may be. This is a common problem in the hospital setting because patients cannot get restful sleep while there. As with anything, past experiences will influence how we perceive and experience the situation. Our experience and perception of current pain will be influenced by our past experiences (Taylor et al., 2019). As outlined, many factors dictate how a patient will experience pain and then perceive that experience.

NURA 303 Fundamentals of Nursing Care Comfort and Pain Management Case Study

2. How would you accurately measure the patient’s pain level? Using a pain scale would be the most accurate tool for me to measure their level of pain. Since pain is defined as what the patient is experiencing it as, observation and physical assessment are essential to my assessment and diagnosis, but measuring the pain level must be taken from the patient’s perspective. 3. What characteristics of the patient’s pain should be assessed? Using COLDSPA, I would assess the character, onset, location, duration, severity, pattern and associated factors of the patient’s pain. 4. What non-verbal behavior, if exhibited, might indicate the patient is experiencing pain? Some nonverbal behaviors that a patient may display are moaning or crying, grimacing/wincing, holding affected area, restlessness or rubbing area (Taylor et al., 2019). The patient could also seem distracted or “giving the cold shoulder”.

5. Which situational circumstances can affect an older person’s pain perception? Older adults’ perception of pain may be affected by the aging process or a chronic disease they have and the effects those both have on dulling pain felt and processed (Taylor et al., 2019). Older patients may also be on multiple drugs so their perception of pain may be altered (Taylor et al., 2019, p. 1248). Other circumstances that can affect their pain perception are being bored, lonely or depressed (Taylor et al., 2019, p. 1248).

NURA 303 Fundamentals of Nursing Care Comfort and Pain Management Case Study

6. What nonpharmacological measures might you implement to decrease the patient’s pain or pain perception? There are many nonpharmacological measures that I would want to implement such as trying to distract the patient from the pain, making the patient laugh in the appropriate time and setting, helping my patient relax through deep breathing or listening to music (Taylor et al., 2019). I could also possibly use massage to help stimulate the alpha-beta fibers to send more signals into the dorsal horn, therefore diffusing the amount of pain impulses going to the brain (Taylor et al., 2019). 7. Outline the potential consequences of implementing pain interventions before completing an accurate pain assessment. One consequence of not accurately assessing pain before implementing pain interventions is the inability to make sure the interventions are working. The patient’s pain could have gone down after medication was given, but if we do not have an accurate baseline and level of severity, we could end up giving more medication for pain that has been made better. Another consequence might be that we implement the wrong intervention because we do not have an accurate assessment. If the nurse gives an analgesic for neurological pain the patient has been experiencing for months, that would be an ineffective intervention

References Taylor, C., Lynn, P., & Bartlett, J.L. (2019). Fundamentals of nursing: the art and science of person-centered nursing care. Philadelphia, PA: Wolters Kluwer...