Pain

 

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 less than six months

1. Your initials (required): 

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis  reports pain  expressive behavior (restless, moaning, crying, irritability) 
guarding or protective behavior  self focus  inability to sleep  changes in appetite  increased BP  increased pulse 
increased respiratory rate  diaphoresis

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

pathophysiologic disorders  treatment related (surgery, diagnostic tests, medications, other treatments)  trauma 


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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