EXPLANATION

ASSESSMENT
OF THE
PROBLEM
Gouty arthritis is
S> Naut-ut
a disorder of
latta met jay
purine
sakak lal lalo nu
metabolism
magna ak, as
characterized by
verbalized by
elevated uric
the patient.
acid levelswith
> Rated pain as
deposition of
8/10 in severity, urate crystals in
localized at the
joints and other
left foot,
tissues. In the
characterized
case of the
as throbbing,
patient, it
continuous by
deposited on
timing, non
the tissues of
radiating and
the left foot
aggravated by
producing pain
movement and
and swelling.
alleviated by
Pain is an
rest.
unpleasant
O
sensory
> facial
experience
grimace upon
arising from
palpation
potential tissue
> guarding
damage. It is a
behavior
subjective state
> limited,
in which a
slowed
person
movement
demonstrates
noted on the
discomfort. Pain

GOALS AND
OBJECTIVES

NURSING
INTERVENTION

LTO
>After 3 days of
nursing
intervention, the
patient will be
able to maintain
pain free
condition.

Dx
> Assess pain
characteristics: quality,
severity, location,
onset and duration of
pain, severity, location,
onset and duration of
pain.

STO
> After 30 mins.
of nursing
interventions,
the patient will
be able to
experience relief
of pain from
8/10 to 2/10 as
manifested by:
a. absence of
facial grimace
upon palpation
b. no guarding
on the left foot
c. vital signs
within normal
range
d. can
demonstrate

> Observe non verbal

cues and pain
behaviors.

Tx
> Provide comfort
measures such as use
of incentive spirometry
or blow bottles
> Provide
psychological support
or motivation.

> Administer
medications analgesics

RATIONALE

> To rule out worsening of

underlying condition or
development of complications.
(Doenges, et. Al., Nurses Pocket
Guide, 9th Ed. p.500)

> Observations may or may not be

congruent with verbal reports
or may be only indicator present
when client is unable to verbalize.
(Doenges, et. Al., Nurses Pocket
Guide, 9th Ed. p.500)

> To provide non pharmacological

pain management. (Doenges, et.
Al., Nurses Pocket Guide, 9th Ed.
p.368)

> If the client is ill, ascertain the

motivation for returning to an
optimal level of wellness. (MedicalSurgical Nursing, 7th Ed. By Black
and Hawk p. 75)
> Necessary for treatment of the

EVALUATION
FULLY MET IF:
LTO: After 3 days of
nursing intervention,
the patient was able to
maintain pain free
condition.
STO; After 30 mins. of
nursing interventions,
the patient was able to
experience relief of
pain from 8/10 to 2/10
as manifested by:
a. absence of facial
grimace
b. no abdominal
guarding
c. vital signs within
normal range
d. can demonstrate
non pharmacological
ways to relief pain
e. verbalization of
relief from pain.
PARTIALLY MET IF:
LTO: After 3 days of
nursing intervention,
the patient was NOT
able to maintain pain

affected side
> purplish
discoloration
and swelling
noted around
the left foot
> with limited
answers to
questions
>sweating
noted on the
forehead and
the back

interferes with a
persons ability
to rest,
concentrate and
perform normal
activities.

non
pharmacological
ways to relief
pain
e. verbalization
of relief from
pain.

like ketorolac and

mefenamic acid as
prescribed.

A> Acute pain

related to
inflammatory
process
secondary to
gouty arthritis
> Assist with
laboratory or
diagnostic studies as
indicated.

> Assist with ROM

exercises.

underlying cause. (Nurses Pocket

Guide, 9th Ed. By Doenges, et. Al.,
p.542) Ketorolac decreases
prostaglandin synthesis by nonselective competitive inhibition of
cyclo-oxygenase (COX-1 and COX2), producing peripherally-mediated
analgesia.
(http://www.medscape.com
/viewarticle/750116_2)
Mefenamic acid binds the
prostaglandin synthetase receptors
COX-1 and COX-2, inhibiting the
action of prostaglandin synthetase.
As these receptors have a role as a
major mediator of inflammation
and/or a role for prostanoid
signaling in activity-dependent
plasticity, the symptoms of pain are
temporarily reduced.
(http://www.drugbank.ca/
drugs/DB00784) To maintain
acceptable level of pain. (Doenges,
et. Al., Nurses Pocket Guide, 9th Ed.
p.368)
> To determine changes indicative
of healing or infection or
complications. To identify causative
or precipitating factors. (Doenges,
et. Al., Nurses Pocket Guide, 9th Ed.
p.70)

free condition.
But
STO; After 30 mins. of
nursing interventions,
the patient was able to
experience relief of
pain from 8/10 to 4/10
as manifested by:
a. absence of facial
grimace
b. no abdominal
guarding
c. vital signs within
normal range
d. can demonstrate
non pharmacological
ways to relief pain
e. verbalization of
relief from pain.
NOT MET IF:
There was no
improvement at all.
(Still with 9/10 pain)

Edx
> Encouraged to
> Instruct the client to
report any
improvement or
exacerbation in pain
experience.

> To promote circulation and

prevent excessive tissue pressure.
(Fundamentals of Nursing 7th Ed by
Kozier p. 535)

> Encourage
verbalization of
feelings about the
pain.

> Unrelieved pain can create other

problems such as anxiety,
immobility, respiratory problems
and delay in healing. (MedicalSurgical Nursing, 7th Ed. By Black
and Hawk p. 443)

> Encourage and

assist client to do deep
breathing exercises

> Only the client can judge the

level and distress of pain; pain
management should be a team
approach that includes the client.
Very few people lie about pain.
(Medical-Surgical Nursing, 7th Ed.
By Black and Hawk p. 443)

> Encourage relatives

to perform touch
therapy.

> Deep breathing for relaxation is

easy to learn and contributes to
pain relief and / or reduction by
reducing muscle tension and
anxiety. (Medical-Surgical Nursing,
7th Ed. By Black and Hawk p. 479)

> Encourage

> The human body is believed to

have energy fields that express
aberrant patterns when body
systems are insulted. Therapeutic

mobilization.

touch is thought to realign aberrant

fields. (Medical-Surgical Nursing, 7th
Ed. By Black and Hawk p. 480)

> Encourage adequate

rest periods including
uninterrupted periods
of sufficient duration,
meeting comfort
needs, limiting /
avoiding use of
caffeine or alcohol and
medications affecting
REM sleep.

> To promote circulation and

prevent excessive tissue pressure.
(Fundamentals of Nursing 7th Ed by
Kozier p. 535)

> Discuss with the

relatives the
importance of early
detection and
reporting of changes in
condition or any
unusual physical
discomforts or
changes.
> Teach the client and
significant others
about the non
pharmacologic ways to
lessen pain.

> To prevent fatigue. (Doenges, et.

Al., Nurses Pocket Guide, 9th Ed.
p.368)

> Promotes early detection of

developing complications. (Kozier,
Fundamentals of Nursing 7th Ed, p.
536)

> It may be possible to teach

clients a combination of these
techniques to maximize their
opportunities for self control over
manifestations of pain. (Black and
Hawk, Medical-Surgical Nursing, 7th

Ed., p. 476)