NURSING CARE PLAN (PAIN MANAGEMENT)

SCENARIO: 73-year-old woman fell at home and could not move and was in excruciating pain. She was brought into the emergency
department with a suspected broken hip by paramedics. She is accompanied by her husband and has a history of osteoporosis.

PATHOPHYSIOLOGY: Fractures occur when pressure exerted on the bone is stronger than the bone itself. Fracture can occur in
diseased bone (osteoporosis) with no or only minimal trauma and is referred to as a pathological fracture. The inflammation that
occurs with any tissue damage causes pain by compressing nerves in the area of injury.

STUDENT NURSE: Jan Marc A. Gorero BSN-1

RATIONALE FOR
ASSESSMENT DIAGNOSIS PLANNING/OUTCOMES INTERVENTIONS EVALUATION
INTERVENTIONS
SUBJECTIVE: Acute pain Patient will state pain 1. The nurse will 1. Toradol is an NSAID MET/UNMET
After falling in the related to level is decreased to an Administer that relieves pain by – continue
bathroom, movement of acceptable level of 2/10 prescribed reducing inflammation at plan of care
Patient rates pain bone fragments, within 6 hours of Morphine sulfate the site of injury and
10/10. Her edema, and receiving two doses of every 3-4 hours. thereby decreasing pain.
husband said injury to the soft morphine sulfate. and Toradol every 6 Morphine treats severe
that the pain was tissue as hours. pain by functioning in the
so intense that evidenced by Moaning and crying will brain to reduce pain
he couldn't move patient stating, subside within 15 2. The nurse will sensation. Ketorolac
her. “pain is at minutes. assess and record (Toradol) has been
10/10”, patient’s level of shown in studies to be
OBJECTIVE: increased heart Patient will verbalize two pain every 2 hours helpful in the treatment
Patient refusing rate and blood techniques of non- until stable using of bone pain, with a
to move, pressure, pharmacological pain Wong-Baker longer duration of action
moaning, and moaning and relief by discharge. FACES and FLACC and fewer side effects
crying. crying by patient (face, legs, activity, than opioids.
and swelling crying and
Vital Signs: noted in left hip. consolability 2. The effectiveness of
98.6F, 112, 24 scales.) therapies is determined
and 170/90. by pain assessment. The
Edema and 3. The nurse will perception of pain can
redness to left maintain the injured be influenced by a
hip. Left hip is joint immobilized. variety of circumstances,
abducted and including anxiety levels.
externally rotated 4. Alternative
with left leg comfort measures, 3. Immobilization helps
measuring such as massage, pain while also
shorter than right. posture preventing bone
Limited range of modifications, displacement and soft
motion noted. and/or back rubs, tissue injury.
will be provided by
the nurse. 4. Improves overall
circulation and
5. The nurse will minimizes muscle
educate the patient weariness by reducing
on non- areas of localized
pharmacological pressure.
pain management
techniques. 5. Progressive
relaxation, deep
breathing methods,
visualization, or guided
imagery refocuses
attention, provides a
sense of control, and
may improve coping
capacities in dealing with
the stress of traumatic
injury and pain that is
expected to last a long
time.