Nursing

Nursing Diagnosis

Problem with

With Rationale

Objectives

Nursing Interventions

Rationale for

Evaluation

Interventions

cues
Problem Pain

Acute Pain related to

After 1 hour of

inflammatory process

nursing

Subjective

and destruction of

intervention,

cues: I feel

the joint.

client will be

may joints are

very painful
every time I
wake up in the
morning, as
verbalized by
the client.
Pain Scale:
8/10
Objective
cues: guarding
or protective
behavior, facial
grimacing

Rationale: Joint pain

is due to
prostaglandin
release, edema, and
synovial
inflammation and
destruction.

able to verbalize
pain is relieved
from 8/10 to

Assessment:
a. Investigate reports of pain, location,
intensity. Note precipitating factors and
nonverbal cues.
(Pain scale: 8/10,
Characteristic: Aching

teaching client
will be able to:
Identify 5 pain
management

Onset: Every mornings

met. After an

pain management needs

hour of nursing

and effectiveness of the

intervention,

program.

client

b. Duration of the pain

disease.
a2. Rests painful joints
and maintains neutral
position. Use of splints

Location: joints on both sides of the body

can decrease pain and

may reduce damage to

techniques such
as biofeedback,

Goal partially

important in determining

reflects the severity of the

2/10.After 2
hours of health

a. Pain assessment is

b. Duration: 2-3 hours

the joint.

guided-imagery,
controlled
breathing,

visualization.
Perform through

Exacerbation: movements, or stress on

joints
Relief: Warm compresses on joints
Radiation: non-radiating

return
Associated s/s: tenderness, swelling,

the 5 pain

warmth, stiffening

management
lifetime use.

b2. Promotes relaxation

with pain scale

of 5/10.
After 3 hours
of health
teaching, client
was able to
identify 5 out
of 5 pain

tension.

to perform 3
out of 5 pain

relaxation and mobility,

management

decreases pain, and

techniques.

d2. Prevents fatigue and

joint, decreasing joint
movement and associated

a2. Place pillows, sandbags, trochanter rolls,

Client was able

c2. Heat promotes muscle

joint stiffness. Stabilizes

Independent:

techniques.

and reduces muscle

relieves morning stiffness.

demonstration

techniques for

was controlled

management

progressive
relaxation, and

verbalized pain

pain.

and splints.

e2. Promotes relaxation,

reduces muscle tension,

b2. Provide gentle massage.

c2. Apply warm, moist compresses to
affected joints several times a day.
d2. Encourage frequent changes of position.
Assist client to move in bed, supporting
affected joints above and below.

facilitating participation in
therapy.
1. This medication inhibits
the enzyme COX-2. This
enzyme is required for the
synthesis of
prostaglandins, but is less
harmful to the stomach
and the kidneys. May take

e2. Medicate before planned activities.

celecoxib with or without

food intake.

Collaborative:
2. This medication is
Administer medications as indicated.
Example medications:

classified under Disease

Modifying Antirheumatic
Drug (DMARD). DMARD
blocks the destructive
effects of interleukin-1 on

1. celecoxib (Celebrex) 100 mg/cap, 1 cap

cartilage and bone

BID, PO

resorption by inhibiting its

binding at specific tissue

2. anakinra (Kineret) 100 mg/ml, 100 mg

at the receptor sites.

OD via Sub
a3. Soft or sagging

Health Teaching:
a3. Recommend firm mattress or bed board.
Elevate linens with bed cradle as needed.
b3. Recommend client to take warm bath or
shower on arising or at bedtime.

mattress prevents
maintenance of proper
body alignment, placing
stress to affected joints.
b3. Heat promotes muscle
relaxation and mobility,
decreases pain, and

c3. Teach client the different kinds

relieves morning stiffness.

diversional activities or pain management

techniques and how to perform them.

c3. Refocuses attention,

provides stimulation, and

d3. (Biofeedback, guided-imagery,

enhances self-esteem and

controlled breathing, progressive relaxation,

feelings of general well-

and visualization)

being.

Instruct client to follow pharmacologic

d3. Teaching and

regimen as prescribed. Instruct them the

involving them with their

uses, dosage, time of use, contraindications,

medical regimen increases

interactions, and other medication related

their understanding

concerns.

regarding the prescribed

medications, thus
increasing their
pharmacological regimen
compliance.