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ACUTE PAIN NURSING CARE PLAN

Acute Pain
Nursing Care
Plan
UPDATED ON MAY 8, 2022 BY GIL WAYNE, BSN, R.N.

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Use this guide to formulate your nursing

care plans and nursing interventions for
patients experiencing acute pain.

The unpleasant feeling of pain is highly

subjective in nature that may be
experienced by the patient. The
International Association for the Study of
Pain (IASP) defined pain as “an unpleasant
sensory and emotional experience
associated with actual or potential tissue
damage, or described in terms of such
damage.” 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.”

Acute pain provides a protective purpose to

make the patient 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. It has a
duration of fewer than six months. The
physiological signs of acute pain emerge
from the body’s response to pain as a
stressor.

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.

1. Common Signs and Symptoms of

Acute Pain
2. Patient Goals for Acute Pain
3. Related Nursing Care Plans for Acute
Pain
4. Acute Pain Nursing Assessment
5. Nursing Interventions for Acute Pain
6. Recommended Resources
7. See also
8. References and Sources

Common Signs and

Symptoms of Acute
Pain
The following are the common
manifestations 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.

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.
Self-report of intensity using
standardized pain intensity scales
(e.g., Wong-Baker FACES scale,
visual analog scale, numeric rating
scale)
Self-report of pain characteristics
(e.g., aching, burning, electric
shock, pins, and needles,
shooting, sore/tender, stabbing,
throbbing) using standardized
pain scales (e.g., McGill Pain
Questionnaire, Brief Pain
Inventory)
Other signs of pain include:
Guarding behavior or protecting
the body part
Facial mask of pain (e.g.,
grimaces)
Expression of pain (e.g.,
restlessness, crying, moaning)
Autonomic response to pain:
Profuse sweating
Alteration in BP, HR, RR
Dilation of the pupils
Proxy reporting pain and
behavior/activity changes (e.g., family
members, caregivers)

Patient Goals for

Acute Pain
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 Nursing
Care Plans for
Acute Pain
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.

NOTE: This nursing care plan is

recently updated with new
content and a change in
formatting. Nursing assessment
and nursing interventions are
listed in bold and followed by
their specific rationale in the
following line. Still, when writing
nursing care plans, follow the
format here.

Acute Pain Nursing

Assessment
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 assess
acute pain:

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?”

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.

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.

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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.

 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.

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.

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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.

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 care plan:

1. 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.

2. 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.

3. Provide nonpharmacologic pain

management.
Nonpharmacologic methods in pain
management may include physical,
cognitive-behavioral strategies, and lifestyle
pain management. See methods below: 

3.1. 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.

3.2. 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.

4. Provide pharmacologic pain

management as ordered.
Pain management using pharmacologic
methods involves using opioids (narcotics),
nonopioids (NSAIDs), and coanalgesic
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.