Pain, Chronic

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: an unpleasant sensory and emotional experience arising from actual or potential tissue damage  with a duration of  six months or more 

1. Your initials (required): 


2. Defining Characteristics- check those that apply to your client:
None- high risk diagnosis  reports pain  expressive behavior (restless, irritability)  guarding or protective behavior  self focus  inability to sleep  changes in appetite  depression  reduced interaction with people  fatigue  altered ability to continue previous activities

3. Related Factors- check those that apply to your client:

chronic physical-psychosocial disability (metastatic cancer, neurologic injury, arthritis for example)

4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 

6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 

7A. Interventions 

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7B. Rationale for each intervention
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