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NURSING
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Acute pain related to After 8 hours of rendering INDEPENDENT: INDEPENDENT: After 8 hours of
SUBJECTIVE: surgical procedure nursing intervention the 1. Evaluate pain 1. Provide rendering nursing
The patient has (hysterectomy) as patient should be able to: regularly noting information care, the goals was
a pain scale of 8 manifested by the characteristic, about need for met partially as
The patient pain scale of 8 (pain location intensity effectiveness of evidenced by:
expresses scale from – 10), facial (0-10) intervention.
discomfort on grimace, guarding
his incision site behaviour, and verbal 2. Identify specific 2. Prevents undue
report of discomfort Decrease pain scale activity limitations strain on Decreased
on incision site. of 8 to 4 as evidence operative site pain scale to
by being relieved or the level of 5
being relaxed 3. Reposition as 3. May relieve pain
without grimacing indicated and enhance
or reporting the circulation
discomfort on his Reduced
incision site. 4. Encourage of 4. Relieves muscle complaint of
relocation and emotional pain on the
technique like tension incision site
deep breathing
exercise
Manage pain by
following prescribed Patient had
pharmacologic 5. Changes in vital claimed that
OBJECTIVE: regimens and be signs may be the pain is
The patient relieved by nursing 5. Monitor vital signs used for rough already
grimaces during interventions estimate of pain subsiding
movement DEPENDENT:
The patient 1. Administer analgesic DEPENDENT: No more
guards the area medication as 1. To relieve mild facial grimace
by resisting Take a rest and prescribed by the or moderate
movement sleep physician pain.
LAYSON, NICOLE KAYE B.
1N-A