Question

1. You are a nurse in a pediatric unit caring for a 10-year-old who has returned from radiology after having his fractured femur radiographed. He is trying to be brave but is in significant pain. His initial dose of pain medication, while somewhat effective, does not make his pain tolerable.
   1. Which observations would signal the presence of severe pain in your patient?
   2. In developing your nursing diagnoses for his care plan, what pain factors should be identified?
   3. Outline other nursing diagnoses that can result from a patient’s pain and its treatment.
   4. What nonpharmacologic measures can effectively decrease pain?
   5. How could relaxation positively affect his pain?

Answer 1

a. Though the 10 year old is a child but he is trying to be brave. He has fractured femur so we should observe closely for  pain.

• First of all, the pediatric nurse should be very friendly to the child.
• Speak politely and ask if he expereinces extreme pain.
• Tell him that if he is having pain, we'll give you medicine which will cure your pain and you'll be fine.
• Develop a good nurse patient relationship.
• Proper checking off vital signs should be done, if he is having tachycardia then it means he is having extreme pain.

b. Age- In this scenario there is a 10 year old small child. He is not mature to bear the excessive pain. As we grow up we try to cope up to the painful stimuli, we becomemore stronger than before.

• Gender- Girls often cry in pain easily , mostly young girls. boys and girls react different to painful stimuli. Big boys wont cry infront of every one, they try to be seem themselves brave.
• Previous pain experience- If the previous experence is bad then they will worry that this time also the same will happen.
• Level of understanding- In some cases even small children show like they are very grown up. Their level of understanding will be very high.
• Culture- Cultural differences can vary the reactions to situations.

c. Nursing diagnosis

1.Acute pain related to fracture of the femur.

Nursing interventions:

• Assess the level of pain score, non verbal and verbal signs, behavioural signs, emotions of the patient.
• Keep the affected area elevated to releive the pain.
• Provide analgesic as advised by the doctor.
• Divert the mind of the patient.

2. Risk for infection due to environmental exposure.

Nursing interventions:

• Observe the wound for Formation of fruity smelly drainage.
• Instruct the patient not to touch the wound.
• Monitor the vital signs for fever, malasise.

3. Risk for trauma/ fall due to weakness of the body and unable to get up without assistance.

Nursing interventions:

• Advise to take bed rest
• Support the fracture with a pillow, splints or footboard.

4. Risk for inadequate nutritional status

Nursing intervention

• Give the patient a calcium rich diet for a better recovery of the broken bones.
• Advise to drink plenty of fluids.
• Advise to take a well balanced diet.

d. Non pharmacological methods

• Relaxation techniques
• Massage
• Acupuncture
• Fur therapy
• Gel packs

e. Relaxation would actually relieve his pain. It rewlieves the body tension, muscle cramps, mental stress also. It develops a feeling of calmness in the body. It helps to decrease the bloodpressue, pulse rate , breathing pattern etc. The patient feels less pain.