Feeling the sharp, stabbing pain of an acute injury or illness is a sensation that no one wants to experience. As nurses, it’s our job to help ease the suffering of our patients and provide the best possible care for those in pain. Creating a comprehensive care plan for acute pain nursing diagnosis can help relieve our patients’ discomfort and get them on the road to recovery. Whether it’s administering medication, providing emotional support, or teaching patients about pain management techniques, this care plan guide will help you utilize those tools on how to manage acute pain
Let’s take a closer look at how we can effectively care for patients experiencing acute pain. Use this guide to formulate your nursing care plans and nursing interventions for patients experiencing acute pain.
Table of Contents
- What is Acute Pain?
- Causes of Pain
- Signs and Symptoms
- Nursing Diagnosis
- Goals and Outcomes
- Related Care Plans
- Nursing Assessment and Rationales
- Nursing Interventions for Acute Pain
- Recommended Resources
- See also
- References
What is Acute Pain?
Pain is a complex and subjective experience influenced by various factors. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” This definition underscores that pain is not merely a physical sensation but also encompasses emotional and psychological dimensions.
Another great and influential definition of pain is from Margo McCaffery, a nurse expert on pain, who defined it as “pain is whatever the person says it is and exists whenever the person says it does.” The unpleasant feeling of pain is highly subjective in nature that may be experienced by the patient.
“Pain is whatever the person says it is and exists whenever the person says it does.”
Margo McCaffery – Pain Management Nurse Pioneer
Acute pain is pain, as defined above, that has a duration of less than 3 months and relief can be anticipated or predicted. In contrast, chronic pain is has a duration of more than 3 months without an anticipated or predictable end. The physiological signs of acute pain emerge from the body’s response to pain as a stressor. Acute pain provides a protective purpose to make the person informed and knowledgeable about the presence of an injury or illness. The unexpected onset of acute pain reminds the patient to seek support, assistance, and relief.
Other factors such as the patient’s cultural background, emotions, and psychological or spiritual discomfort may contribute to acute pain. In older patients, assessment of pain can be challenging due to cognitive impairment and sensory-perceptual deficits. Assessment and management of the nursing diagnosis of acute pain are the main focus of this care plan.
Causes of Pain
Here are the common causes and related factors for patients with Acute Pain:
- Tissue Damage. Surgical incisions, injuries, fractures, burns.
- Inflammation. Conditions like appendicitis or pancreatitis causing swelling and pain.
- Nerve Damage. Neuropathic pain from conditions like sciatica or shingles.
- Psychological Conditions. Stress-induced headaches or muscle tension.
- Procedural Pain. Pain resulting from medical procedures or interventions.
Signs and Symptoms
The following are the common manifestations that defines the characteristics of acute pain. Use these subjective and objective data to help guide you through the nursing assessment. Alternatively, you can check out the assessment guide for acute pain in the subsequent sections.
Subjective data
The most common characteristic of acute pain is when the patient reports or complaints about it. It is also the most common chief complaint that brings patients to their health care providers.
- Reports of pain using scales (e.g., numeric, Wong-Baker FACES)
- Descriptions of pain (e.g., aching, burning, stabbing)
- Patient complaints of pain
- Family or caregiver reports of pain or behavior changes
Objective data
- Guarding behavior or protecting the painful area
- Facial mask of pain (e.g., grimacing, wincing)
- Expression of pain (e.g., restlessness, crying, groaning)
- Autonomic responses to pain, such as:
- Sweating
- Changes in BP, HR, and RR
- Dilated pupils
Nursing Diagnosis
After thorough assessment, nursing diagnoses are formulated to address the challenges of acute pain, guided by the nurse’s clinical judgment and understanding of the patient’s unique condition. While nursing diagnoses help organize care, their use may vary across clinical settings. Ultimately, the nurse’s expertise and judgment shape the care plan to prioritize each patient’s needs. Here are examples of nursing diagnoses that may be useful for common concerns associated with acute pain:
- Acute Pain related to tissue injury from surgical incision AEB patient reporting a pain level of 8 on a 1-10 scale, facial grimacing, and guarding the surgical site.
- Acute Pain related to inflammation and swelling secondary to sprained ankle AEB patient’s verbal report of pain, observed limping, and inability to bear weight on the affected leg.
- Acute Pain related to musculoskeletal injury (e.g., fracture, sprain) as evidenced by patient describing pain as sharp or throbbing, limited range of motion, and swelling at the injury site.
- Acute Pain related to inflammation (e.g., appendicitis, pancreatitis) as evidenced by patient reporting localized abdominal pain, pain intensity increasing with movement, and presence of nausea or vomiting.
- Acute Pain related to mucosal irritation and inflammation in the urinary tract (e.g., urinary tract infection) as evidenced by patient reporting burning sensation during urination, frequent need to urinate, and abdominal discomfort.
- Acute Pain related to cervical dilation and uterine contractions during labor as evidenced by patient reporting contraction pains, expressing distress during contractions, and utilizing pain relief techniques.
- Acute Pain related to thermal injury (frostbite) as evidenced by numbness progressing to severe pain upon rewarming, skin discoloration, and patient expressing distress.
- Acute Pain related to chemical injury agents (burns) as evidenced by reports of burning sensation, redness, blistering, and facial grimacing.
Goals and Outcomes
The following are the common nursing care planning goals and expected outcomes for Acute Pain:
- Patient demonstrates the use of appropriate diversional activities and relaxation skills.
- Patient describes satisfactory pain control at a level (for example, less than 3 to 4 on a rating scale of 0 to 10)
- Patient displays improved well-being such as baseline levels for pulse, BP, respirations, and relaxed muscle tone or body posture.
- Patient uses pharmacological and nonpharmacological pain-relief strategies.
- Patient displays improvement in mood, coping.
Related Care Plans
Diseases, medical conditions, and related nursing care plans for Acute Pain nursing diagnosis:
- Surgery (Perioperative Client)
- Brain Tumor
- Fracture
- Hypertension
- Tonsillitis
- Click here for more sample nursing care plans for the acute pain nursing diagnosis.
Nursing Assessment and Rationales
Proper nursing assessment of acute pain is imperative for the development of an effective pain management plan. Nurses play a crucial role in the assessment of pain, use these techniques on how to comprehensively assess acute pain:
Perform pain assessment
1. Perform a comprehensive assessment of pain. Determine the location, characteristics, onset, duration, frequency, quality, and severity of pain via assessment.
The patient experiencing pain is the most reliable source of information about their pain. Their self-report on pain is the gold standard in pain assessment as they can describe the location, intensity, and duration. Thus, assessment of pain by conducting an interview helps the nurse in planning optimal pain management strategies.
Alternatively, you can use the nursing mnemonic “PQRST” to guide you during pain assessment:
- Provoking Factors: “What makes your pain better or worse?”
- Quality (characteristic): “Tell me what it’s exactly like. Is it a sharp pain, throbbing pain, dull pain, stabbing, etc?”
- Region (location): “Show me where your pain is.”
- Severity: Ask your pain to rate pain by using different pain rating methods (e.g., Pain scale of 1-10, Wong-Baker Faces Scale).
- Temporal (onset, duration, frequency): “Does it occur all the time or does it come and go?”
The Numeric Rating Scales (NRS) is a pain assessment tool suitable for adults and children over seven who can understand and use numbers to rate their pain intensity.
How to Use:
- Explain the Scale:
- Say to the patient: “Please rate your pain on a scale from 0 to 10, where 0 means ‘no pain’ and 10 means ‘the worst pain you can imagine.'”
- Assessment:
- Ask: “What number between 0 and 10 best describes your pain right now?”
- Document the Response:
- Record the number provided by the patient.
Interpretation:
- 0: No pain.
- 1–3: Mild pain.
- 4–6: Moderate pain.
- 7–10: Severe pain.
The Wong-Baker FACES Pain Rating Scale is another pain assessment tool designed for children over three years old and adults who have difficulty expressing their pain verbally, this scale helps patients communicate the intensity of their pain using facial expressions.

How to Use:
- Present the Scale:
- Show the patient the Wong-Baker FACES chart, which displays six faces ranging from a happy face at 0 (“No Hurt”) to a crying face at 10 (“Hurts Worst”).
- Ensure the patient can see all the faces clearly.
- Explain the Scale:
- Say to the patient: “These faces show how much something can hurt. The face on the left means no pain, and the faces show more and more pain up to the face on the right, which shows the worst pain possible.”
- Confirm understanding by asking if they have any questions.
- Assessment:
- Ask the patient: “Point to the face that shows how much you hurt right now.”
- If the patient cannot point, they can state the number or describe the face.
- Document the Response:
- Record the number corresponding to the face the patient selected (0, 2, 4, 6, 8, or 10).
Interpretation:
- 0: No pain.
- 2: Hurts a little bit.
- 4: Hurts a little more.
- 6: Hurts even more.
- 8: Hurts a whole lot.
- 10: Hurts worst.
FLACC Scale is an observational tool used to assess pain in infants and children aged 2 months to 7 years, or in individuals who cannot communicate their pain verbally.
How to Use:
- Observation:
- Observe the patient unobtrusively for 1–5 minutes.
- Note behaviors in each of the five categories: Face, Legs, Activity, Cry, Consolability.
- Scoring:
- Assign a score of 0, 1, or 2 for each category based on your observations.
- Add the scores from all five categories for a total between 0 and 10.
Criteria | 0 POINTS | 1 POINT | 2 POINTS |
---|---|---|---|
Face | No particular expression or smile. | Occasional grimace or frown; withdrawn; disinterested. | Frequent to constant frown, clenched jaw, quivering chin. |
Legs | Normal position or relaxed. | Uneasy, restless, tense. | Kicking or legs drawn up. |
Activity | Lying quietly, normal position, moves easily. | Squirming, shifting back and forth, tense. | Arched, rigid, or jerking. |
Cry | No cry (awake or asleep). | Moans or whimpers; occasional complaint. | Crying steadily, screams or sobs; frequent complaints. |
Consolability | Content, relaxed | Reassured by occasional touching, hugging, or being talked to; distractible. | Difficult to console or comfort. |
Interpretation:
- 0: Relaxed and comfortable.
- 1–3: Mild discomfort.
- 4–6: Moderate pain.
- 7–10: Severe discomfort/pain.
PAINAD Scale is designed to assess pain in patients with advanced dementia who cannot verbally communicate their pain.
How to Use:
- Observation:
- Observe the patient during rest and activity.
- Scoring:
- Score each of the five categories from 0 to 2.
Categories and Scoring:
Criteria | 0 | 1 | 2 |
---|---|---|---|
Breathing (Independent of Vocalization) | Normal breathing. | Occasional labored breathing; short periods of hyperventilation. | Noisy labored breathing; long periods of hyperventilation; Cheyne-Stokes respirations |
Negative Vocalization | None. | Occasional moan or groan; low-level speech with a negative or disapproving quality. | Repeated troubled calling out; loud moaning or groaning; crying. |
Facial Expression | Smiling or inexpressive. | Sad, frightened, frowning. | Facial grimacing. |
Body Language | Relaxed. | Tense, distressed pacing, fidgeting. | Rigid, fists clenched, knees pulled up, pulling or pushing away. |
Consolability | No need to console. | Distracted or reassured by voice or touch. | Unable to console, distract, or reassure. |
Interpretation:
- Higher scores indicate more severe pain.
2. Assess the location of the pain by asking to point to the site that is discomforting.
Using charts or drawings of the body can help the patient, and the nurse determines specific pain locations. For clients with a limited vocabulary, asking to pinpoint the location helps in clarifying your pain assessment – this is especially important when assessing pain in children.
See also: Pain Perplex: 5 Things Nurses Need to Understand About Pain Management
3. Perform history assessment of pain
Additionally, the nurse should ask the following questions during pain assessment to determine its history: (1) effectiveness of previous pain treatment or management; (2) what medications were taken and when; (3) other medications being taken; (4) allergies or known side effects to medications.
4. Determine the client’s perception of pain.
In taking a pain history, provide an opportunity for the client to express in their own words how they view the pain and the situation to gain an understanding of what the pain means to the client. You can ask, “What does having this pain mean to you?”, “Can you describe specifically how this pain is affecting you?”.
5. Pain should be screened every time vital signs are evaluated.
Many health facilities set pain assessment as the “fifth vital sign” and should be added to routine vital signs assessment.
6. Pain assessments must be initiated by the nurse.
Pain responses are unique for each person, and some clients may be reluctant to report or voice out their pain unless asked about it.
7. Use the Wong-Baker FACES Rating Scale to determine pain intensity.
Some clients (e.g., children, language constraints) may not relate to numerical pain scales and may need to use the Wong-Baker Faces Rating Scale. Pain assessment tools help translate the patient’s subjective experience of pain into objective numbers or descriptors.
Determine factors that causes acute pain
8. Investigate signs and symptoms related to pain.
An accurate assessment of pain is crucial in providing an individualized plan of care. Bringing attention to associated signs and symptoms may help the nurse in evaluating the pain. In some instances, the existence of pain is disregarded by the patient.
9. Determine the patient’s anticipation for pain relief.
Some patients may be satisfied when pain is no longer intense; others will demand complete elimination of pain. This influences the perceptions of the effectiveness of the treatment modality and their eagerness to engage in further treatments.
10. Assess the patient’s willingness or ability to explore a range of techniques to control pain.
Some patients may be hesitant to try the effectiveness of nonpharmacological methods and may be willing to try traditional pharmacological methods (i.e., the use of analgesics). A combination of both therapies may be more effective, and the nurse has the duty to inform the patient of the different methods to manage pain.
11. Determine factors that alleviate pain.
Ask clients to describe anything they have done to alleviate the pain. These may include, for example, meditation, deep breathing exercises, praying, etc. Information on these alleviating activities can be integrated into planning for optimal pain management.
Determine patient’s response to pain
12. Evaluate the patient’s response to pain and management strategies.
It is essential to assist patients to express as factually as possible (i.e., without the effect of mood, emotion, or anxiety) the effect of pain relief measures. Inconsistencies between behavior or appearance and what the patient says about pain relief (or lack of it) may reflect other methods the patient is using to cope with the pain rather than pain relief itself.
13. Provide ample time and effort regarding the patient’s report of their pain experience.
Patients may be reluctant to report their pain as they may perceive staff to be very busy and have competing demands on their time from other nurses, doctors, and patients (Manias et al., 2002). Interruptions during pain management can prevent nurses from assessing and managing the patient’s pain experience.
14. Evaluate what the pain suggests to the patient.
The meaning of pain will directly determine the patient’s response. Some patients, especially the dying, may consider that the “act of suffering” meets a spiritual need.
15. Regularly reassess and document the patient’s pain level following the initiation of the pain management plan, including each new report of pain and before and after the administration of analgesic agents.
Consistent reassessment ensures the effectiveness of pain management strategies and allows timely adjustments to the treatment plan. The frequency of reassessment should align with the patient’s pain stability and institutional policies, ranging from every 10 minutes during acute phases to every 4 to 8 hours for stable pain conditions.
Nursing Interventions for Acute Pain
Nurses are not to judge whether the acute pain is real or not. As a nurse, we should spend more time treating patients. The following are the therapeutic nursing interventions for your acute pain nursing diagnosis:
Provide measures to relieve pain before it becomes severe.
It is preferable to provide an analgesic before the onset of pain or before it becomes severe when a larger dose may be required. An example would be preemptive analgesia, which is administering analgesics before surgery to decrease or relieve pain after surgery. The preemptive approach is also useful before painful procedures like wound dressing changes, physical therapy, postural drainage, etc.
Acknowledge and accept the client’s pain.
Nurses have the duty to ask their clients about their pain and believe their reports of pain. Challenging or undermining their pain reports results in an unhealthy therapeutic relationship that may hinder pain management and deteriorate rapport.
Initiating nonpharmacologic pain management
Incorporate nonpharmacologic methods, such as guided relaxation, deep breathing exercises, and music therapy, into the patient’s pain management plan.
Nonpharmacologic methods in pain management may include physical, cognitive-behavioral strategies, and lifestyle pain management. See methods below:
Provide cognitive-behavioral therapy (CBT) for pain management.
These methods are used to provide comfort by altering psychological responses to pain. Cognitive-behavioral interventions include:
- Distraction. This technique involves heightening one’s concentration upon non-painful stimuli to decrease one’s awareness and experience of pain. Drawing the person away from the pain lessens the perception of pain. Examples include reading, watching TV, playing video games, and guided imagery.
- Eliciting the Relaxation Response. Stress correlates to an increase in pain perception by increasing muscle tension and activating the SNS. Eliciting a relaxation response decreases the effects of stress on pain. Examples include directed meditation, music therapy, and deep breathing.
- Guided imagery. Involves the use of mental pictures or guiding the patient to imagine an event to distract from the pain.
- Repatterning Unhelpful Thinking. Involves patients with strong self-doubts or unrealistic expectations that may exacerbate pain and result in failure in pain management.
- Other CBT techniques include Reiki, spiritually directed approaches, emotional counseling, hypnosis, biofeedback, meditation, and relaxation techniques.

Provide cutaneous stimulation or physical interventions
Cutaneous stimulation provides effective pain relief, albeit temporary. The way it works is by distracting the client away from painful sensations through tactile stimuli. Cutaneous stimulation techniques include:
- Massage. When appropriate, massaging the affected area interrupts the pain transmission, increases endorphin levels, and decreases tissue edema. Massage aids in relaxation and decreases muscle tension by increasing superficial circulation to the area. Massage should not be done in areas of skin breakdown, suspected clots, or infections.
- Heat and cold applications. Cold works by reducing pain, inflammation, and muscle spasticity by decreasing the release of pain-inducing chemicals and slowing the conduction of pain impulses. Cold is best when applied within the first 24 hours of injury while heat is used to treat the chronic phase of an injury by improving blood flow to the area and through reduction of pain reflexes.
- Acupressure. An ancient Chinese healing system of acupuncture wherein the therapist applies finger pressure points that correspond to many of the points used in acupuncture.
- Contralateral stimulation. Involves stimulating the skin in an area opposite to the painful area. This technique is used when the painful area cannot be touched.
- Transcutaneous Electrical Nerve Stimulation (TENS). Is the application of low-voltage electrical stimulation directly over the identified pain areas or along with the areas that innervate pain.
- Immobilization. Restriction of movement of a painful body part is another nonpharmacologic pain management. To do this, you need splints or supportive devices to hold joints in the position optimal for function. Note that prolonged immobilization can result in muscle atrophy, joint contracture, and cardiovascular problems. Check with the agency protocol.
- Other cutaneous stimulation interventions include therapeutic exercises (tai-chi, yoga, low-intensity exercises, ROM exercises), and acupuncture.
Assess the patient’s response to nonpharmacologic interventions.
Regular assessment helps determine the effectiveness of nonpharmacologic methods and guides necessary adjustments to optimize pain management and care plan.
Integrate patient-preferred nonpharmacologic methods into daily care, such as warm compresses or positioning for comfort.
Simple, patient-centered comfort measures are often easy to implement and can provide additional relief alongside pharmacologic treatments.
Provide pharmacologic pain management
Provide pharmacologic pain management as ordered.
Pain management using pharmacologic methods involves using opioids (narcotics), nonopioids (NSAIDs), and co analgesic drugs.
The World Health Organization (WHO) published guidelines on the logical usage of analgesics to treat cancer using a three-step ladder approach – also known as the analgesic ladder. The analgesic ladder focuses on aligning the proper analgesics with the intensity of pain.
- Step 1: For mild pain (1 to 3 pain rating), the WHO analgesic ladder suggests the use of nonopioid analgesics with or without coanalgesics. If pain persists or increases despite providing full doses, then proceed to the next step.
- Step 2: For moderate pain (4 to 6 pain rating), opioid, or a combination of opioid and nonopioid is administered with or without conanalgesics.
- Step 3: For severe pain (7 to 10), the opioid is administered and titrated in ATC scheduled doses until the pain is relieved.
Administer nonopioids including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, as ordered.
NSAIDs work in peripheral tissues. Some block the synthesis of prostaglandins, which stimulate nociceptors. They are effective in managing mild to moderate pain. All NSAIDs have anti-inflammatory (except for acetaminophen), analgesic, and antipyretic effects. They work by inhibiting the enzyme cyclooxygenase (COX), a chemical activated during tissue damage, resulting in decreased synthesis of prostaglandins. NSAIDs also have a ceiling effect. Once the maximum analgesic benefit is achieved, additional amounts of the same drug will not produce more analgesia and may risk the patient for toxicity.
Common side effects of NSAIDs include heartburn or indigestion. There is also a possibility of forming a small stomach ulcer due to platelet aggregation. To prevent these side effects, clients should be taught to take NSAIDs with food and a full glass of water.
Common NSAIDs include:
- Aspirin. It can prolong bleeding time and should be stopped a week before a client undergoes any surgical procedure. Should never be given to children below 12 years of age due to the possibility of Reye’s syndrome. May cause excessive anticoagulation if the client is taking warfarin.
- Acetaminophen (Tylenol). May have serious hepatotoxic side effects and possible renal toxicity with high dosages or with long-term use. Limit acetaminophen usage to 3 grams per day.
- Celecoxib (Celebrex). Is a COX-2 inhibitor that has fewer GI side effects than COX-1 NSAIDs.
For the full list, please visit: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Related Agents
Administer opioids as ordered.
Opioids are indicated for severe pain and can be administered orally, IV, PCA systems, or epidurally.
- Opioids for moderate pain. These include codeine, hydrocodone, and tramadol (Ultram) which are combinations of nonopioid and opioid.
- Opioids for severe pain. These include morphine, hydromorphone, oxycodone, methadone, and fentanyl. Most of these are controlled substances due to potential misuse. These drugs are indicated for severe pain, or when other medications fail to control pain.
For the full list, please visit: Narcotics, Narcotic Antagonists, and Antimigraine Agents
Administer coanalgesics (adjuvants), as ordered.
Coanalgesics are medications that are not classified as pain medication but have properties that may reduce pain alone or in combination with other analgesics. They may also relieve other discomforts, increase the effectiveness of pain medications, or reduce the pain medication’s side effects. Commonly used coanalgesics include:
- Antidepressants. Is a common coanalgesic that helps in increasing pain relief, improving mood, and reducing excitability.
- Local Anesthetics. These drugs block the transmission of pain signals and are used for pain in specific areas of nerve distribution.
- Other coanalgesics. Include anxiolytics, sedatives, and antispasmodics to relieve other discomforts. Stimulants, laxatives, and antiemetics are other coanalgesics that reduce the side effects of analgesics.
Manage acute pain using a multimodal approach.
A multimodal approach is based on using two or more distinct methods or drugs to enhance pain relief (rather than resorting to opioid use or other pain management strategies alone). Different combinations of analgesic medications, adjuvants, and procedures can act on different sites and pathways in an additive or synergistic fashion. Combining medications and techniques allows the lowest effective dose of each drug to be administered, resulting in reduced side effects.
Administer analgesia before painful procedures whenever possible.
Doing so will help prevent pain caused by relatively painful procedures (e.g., wound care, venipunctures, chest tube removal, endotracheal suctioning, etc.).
Perform nursing care during the peak effect of analgesics.
Oral analgesics typically peak in 60 minutes, and intravenous analgesics in 20 minutes. Performing nursing tasks during the peak effect of analgesics optimizes client comfort and compliance in care.
Evaluate the effectiveness of analgesics as ordered and observe for any signs and symptoms of side effects.
The patient’s effectiveness of pain medications must be evaluated individually since they are absorbed and metabolized differently.
Using Patient-Controlled Analgesia (PCA)
Educate the patient on the proper use of PCA, ensuring they understand how to self-administer doses and the importance of pressing the button only when needed.
Patient understanding and education is important in effective pain management. It ensures that the patient correctly uses the PCA device to achieve desired pain relief and prevents misuse or overuse.
Monitor the patient’s sedation level and respiratory status closely, especially when a basal rate is included in the PCA regimen.
Continuous monitoring helps detect signs of over-sedation or respiratory depression, which are potential risks when using opioids, particularly for opioid-naïve patients.
Instruct staff, family, and visitors not to press the PCA button for the patient and to inform the nurse if there are any concerns about pain control.
Unauthorized use of the PCA by others (PCA by proxy) can lead to over-sedation or other safety issues. Ensuring that only the patient controls the PCA maintains safe and effective pain management.
Assess the patient’s cognitive and physical ability to use the PCA equipment regularly.
Regular assessment ensures that the patient remains capable of using the device safely and effectively. Any change in the patient’s condition that impacts their ability to use the PCA should prompt a reassessment of their pain management plan.
Educate the patient and authorized family members, if applicable, about Authorized Agent Controlled Analgesia (AACA) when PCA use by the patient is not feasible.
In situations where the patient cannot use the PCA independently, an authorized agent can help manage the patient’s pain safely and effectively. Proper education ensures that the designated person understands their role and the safety measures required.
Promptly adjust or discontinue the basal rate if increased sedation or respiratory changes are noted.
Quick action to modify the opioid dosage helps prevent complications such as respiratory depression and supports safe pain management practices.
Document and reassess pain levels frequently, especially before and after PCA administration.
Consistent documentation and reassessment help evaluate the effectiveness of the PCA therapy and guide any necessary adjustments for optimal pain management.
Pediatric Pain Management
Children have unique needs and require tailored approaches to pain management. These interventions may include:
Use age-appropriate pain assessment tools, such as the FLACC scale for infants and the Wong-Baker FACES scale for children over three years old.
Appropriate tools provide accurate assessments, essential for effective pain management in children.
Administer pain medications based on the child’s weight and developmental level, following pediatric dosing guidelines.
Weight-based dosing ensures safe and effective analgesia tailored to the child’s physiology.
Avoid contraindicated medications like aspirin in children under 12 years due to the risk of Reye’s syndrome.
Prevents serious adverse effects associated with certain medications in children.
Provide distraction techniques such as toys, games, or videos during painful procedures.
Distraction reduces the child’s focus on pain and lowers anxiety levels.
Encourage parental presence and involvement during care.
Parental support offers comfort and security, helping the child cope with pain.
Explain procedures using simple, age-appropriate language and visual aids.
Clear communication enhances understanding and reduces fear in pediatric patients.
Geriatric Pain Management
Older adults may have increased sensitivity to medications and may have communication barriers which may impair pain management. Consider the following nursing interventions:
Utilize pain assessment tools suitable for older adults, considering any sensory or cognitive impairments.
Ensures accurate pain evaluation despite potential communication barriers.
Initiate analgesic therapy with lower doses and titrate slowly while monitoring for side effects, as ordered.
Older adults are more sensitive to adjuvant analgesics, including antidepressants and anticonvulsants, which can cause sedation and other CNS effects. Slow titration helps minimize adverse effects and ensures patient safety.
Use acetaminophen as the first-line treatment for mild musculoskeletal pain.
Acetaminophen is recommended for managing mild pain in older adults due to its lower risk profile compared to NSAIDs, especially for conditions like osteoarthritis.
Monitor for signs of NSAID-induced GI toxicity, and assess the need for a COX-2 selective NSAID or a nonselective NSAID with a lower risk of causing ulcers if NSAIDs are required.
Older adults have an increased risk of GI adverse effects from NSAIDs. Choosing NSAIDs carefully and adding a proton pump inhibitor when necessary can reduce the risk of GI complications.
Consider opioid therapy over NSAIDs for older adults who are at high risk for GI complications.
Opioids may be a safer alternative than NSAIDs for pain management in older adults to minimize the risk of GI toxicity. The American Geriatrics Society recommends opioids for this reason, particularly when NSAID use is contraindicated or poses significant risk.
Educate older patients and caregivers on the potential side effects of both NSAIDs and opioids, including signs of GI distress and sedation.
Patient and caregiver education promotes early detection of side effects and ensures timely intervention, contributing to safer pain management.
Review all medications to identify potential interactions due to polypharmacy.
Minimizes the risk of adverse drug reactions and enhances medication safety.
Implement gentle physical therapies like massage or warm compresses, ensuring skin integrity is maintained.
Provides pain relief while considering the fragility of elderly skin and tissues.
Face the patient, speak clearly, and ensure they have any necessary hearing or vision aids.
Overcomes sensory impairments, facilitating effective communication and understanding.
Patients with Cognitive Impairments
Use observational pain assessment tools like the PAINAD scale to evaluate pain levels.
Allows for pain assessment when the patient cannot self-report effectively.
Observe for non-verbal signs of pain, such as facial grimacing, agitation, or changes in usual behavior.
Identifies pain through behavioral cues when verbal communication is limited.
Provide care from consistent caregivers to establish familiarity and reduce anxiety.
Consistency enhances trust and may improve the patient’s cooperation with interventions.
Simplify communication by using short sentences, clear instructions, and visual cues.
Aids understanding despite cognitive limitations, ensuring the patient can participate in care.
Involve family members or caregivers in the pain management plan.
They can offer valuable insights into the patient’s behaviors and preferences, enhancing individualized care.
Placebos
Avoid the use of placebos for pain management in clinical practice.
The use of placebos in a deceitful manner violates ethical principles, breaches trust in the nurse-patient relationship, and deprives patients of appropriate pain assessment and treatment.
Educate the healthcare team about the ethical and legal implications of using placebos deceptively.
Raising awareness helps prevent the misuse of placebos and promotes adherence to evidence-based and ethical pain management practices.
Validate and accept the patient’s report of pain, regardless of the presence of physical stimuli.
Research has shown that pain relief following placebo administration does not invalidate a patient’s pain report. Acknowledging and addressing patient-reported pain supports trust and effective treatment.
Incorporate evidence-based pain management strategies tailored to the individual’s needs instead of relying on placebos.
Personalized pain management promotes optimal patient outcomes, enhances comfort, and supports trust between the patient and healthcare provider.
For more interventions related to pain, please visit Chronic Pain Nursing Care Plan
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
References
Suggested resources to deepen your understanding for this acute pain nursing diagnosis and care plan:
- Hartrick, C. T. (2004). Multimodal postoperative pain management. American Journal of Health-System Pharmacy, 61(suppl_1), S4-S10.
- Herr, K., Titler, M. G., Schilling, M. L., Marsh, J. L., Xie, X., Ardery, G., … & Everett, L. Q. (2004). Evidence-based assessment of acute pain in older adults: current nursing practices and perceived barriers. The Clinical journal of pain, 20(5), 331-340.
- Hsieh, L. L. C., Kuo, C. H., Lee, L. H., Yen, A. M. F., Chien, K. L., & Chen, T. H. H. (2006). Treatment of low back pain by acupressure and physical therapy: randomized controlled trial. Bmj, 332(7543), 696-700.
- Khan, K. A., & Weisman, S. J. (2007). Nonpharmacologic pain management strategies in the pediatric emergency department. Clinical Pediatric Emergency Medicine, 8(4), 240-247.
- Loeser, J. D., & Treede, R. D. (2008). The Kyoto protocol of IASP basic pain terminology☆. Pain, 137(3), 473-477.
- Loggia, M. L., Juneau, M., & Bushnell, M. C. (2011). Autonomic responses to heat pain: Heart rate, skin conductance, and their relation to verbal ratings and stimulus intensity. PAIN®, 152(3), 592-598.
- Manias, E., Botti, M., & Bucknall, T. (2002). Observation of pain assessment and management− the complexities of clinical practice. Journal of clinical nursing, 11(6), 724-733.
- McCaffery, M. (1990). Nursing approaches to nonpharmacological pain control. International Journal of nursing studies, 27(1), 1-5.
- Reid, C., & Davies, A. (2004). The World Health Organization three-step analgesic ladder comes of age.
- Urden, L. D., Stacy, K. M., & Lough, M. E. (2006). Thelan’s critical care nursing: diagnosis and management (pp. 918-966). Maryland Heights, MO: Mosby.
- Treede, R. D. (2018). The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain reports, 3(2).
- Pasero, C., & McCaffery, M. (1999). Pain: clinical manual (Vol. 9). St. Louis: Mosby.
- Urba, S. G. (1996). Nonpharmacologic pain management in terminal care. Clinics in geriatric medicine, 12(2), 301-311.
- Vargas-Schaffer, G. (2010). Is the WHO analgesic ladder still valid?: Twenty-four years of experience. Canadian Family Physician, 56(6), 514-517.
- Voscopoulos, C., & Lema, M. (2010). When does acute pain become chronic?. British journal of anaesthesia, 105(suppl_1), i69-i85.
Thanks so much
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Thank you. This is very helpful guidance for student nurses like myself. Keep up the great work.
I learned a lot and very helpful ☺️. Thank you.
Thanks so much I really appreciate it I learnt a lot
Thanks for sharing this amazing post! Remember that acute pain management should be individualized based on the patient’s unique circumstances. Regular reassessment and communication are key components of effective acute pain management. Always adhere to your healthcare facility’s policies and protocols when implementing pain management interventions.
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