Question

A 60-year-old African American woman with metastatic ovarian cancer is experiencing chronic pain. Her pain ratings have been between 3 and 7 on the 0-10 numeric rating scale. Her vital signs remain within normal ranges. She is fully able to participate in her daily care. She describes herself as the matriarch of her family, and looks forward to daily visits from her family even when her pain rating is high. Her church pastor calls and visits her several times per week. She anticipates discharge in a few days.

Initial Discussion Post:

Address the following:

Identify and state a priority nursing diagnosis label for your assigned client related to pain.

Develop and state three (3) nursing interventions for this nursing diagnosis label or patient problem. When planning individualized nursing interventions, consider the patient’s type of pain and cultural perspective.

Provide your rationale or reasoning for each intervention chosen.

Identify another interdisciplinary team member and an action they could take to help resolve the chosen client problem or nursing diagnosis.

Answer 1

The priority nursing diagnosis is " Acute pain related to disease process as evidenced by reports of pain".

Nursing interventions with rationale:

• Determine the pain history like location, duration and the pain relief ,measures used. This will help the health personnel to identify accurate intervention needed according to the type of pain and to evaluate the effectiveness of the given interventions.
• Determine the timing or precipitants of 'breakthrough' pain when using round the clock medications. Pain may occur near the end of dose interval indicating the need of higher dose of medications. Pain may also be precipitated by identifiable triggers which may require short supplemental doses.
• Evaluate and be aware of the painful effects of particular therapies. Educate the patient about what to expect. Pain is associated with invasive procedures used in the treatment of cancer. Wide range of discomforts are common depending on the procedure or agents being used.
• Provide nonpharmacological comfort measures like massaging, repositioning, back rub and diversional activities like music, television. This promotes relaxation and helps to refocus attention.
• Provide cutaneous stimulation like heat or cold massage. It will reduce inflammation, muscle spasm, and associated pain.
• Encourage use of stress management skills like relaxation techniques, biofeedback, aromatherapy,laughter and therapeutic touch. These techniques enhances patient's active participation in treatment and increases sense of control.

In the above scenario, the patient is experiencing moderate pain as the numerical pain scale score is between 3-7. The patient who considers herself to be the matriarch of the family is deeply influenced by her family and cultural practices. That is why she expects her family to visit daily even at a high intensity of pain. Cultural and religious belief of being visited by her church pastor boost her morale. This creates a hope to gain better health and encourages her to cope with stress developed to due pain.

The other interdisciplinary team member is the Oncologist who would prescribe her medications to relieve her pain. A health counsellor can also help her to resolve the problem by helping her understand what SO to expect and how to buildup a strong coping mechanism to reduce stress related to pain.