Nursing Care Plan for Pain (acute / chronic) r/t Herniated Nucleus Pulposus

Herniated Nucleus Pulposus

Pain (acute / chronic) related to agent of physical injury, nerve compression, muscle spasm.

Purpose :
Pain (acute / chronic) lost / reduced.

Expected outcomes :
  • Clients seem relaxed and reported pain gone / reduced.
  • Disclose a method that provides removal.
  • Demonstrate the use of therapeutic interventions (eg, relaxation skills behavioral modification) for the relief of pain.
Nursing Interventions :
  • Assess for pain, note the location, time attack, precipitating factors / which aggravate. Ask the patient to establish on a scale of 0-10.
  • Retain bed rest during the acute phase. Place the patient in semi-Fowler's position with spinal bones, bowl and knee in flexion ; supine position with or without elevating the head of 10º - 30º or in the lateral position.
  • Use logroll ( board ) during a change of position.
  • Help mounting brace / corset.
  • Limit activity during the acute phase as needed.
  • Put all the necessities , including a call bell within easy reach by the patient.
  • Instruct the patient to do relaxation techniques / visualization.
  • Instructed to perform the mechanics of the body / right movement.
  • Give a chance to talk / listen to the patient's problems.
Collaboration :
  • Give bed orthopedic / place the board under the mattress.
  • Give medication as needed.
  • Post a physical advocates like ; lumbar back braces, cervical collar.
  • Maintain traction if necessary.
  • Consult a physical therapist.
  • Give specific instructions on the procedure after Myelography if necessary such as : keep not to flow too fast, flat or elevated sleeping position 30º as indicated for several hours.
  • Refer to a pain clinic.

How to Overcome Chronic Pain Without Analgesic

Chronic pain is defined as pain that has lasted longer than three to six months, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed duration, is "pain that extends beyond the expected period of healing".

Real food is so important. Removing the processed foods, and baking goodies will help you get to the optimal 7-10 fruits and vegetables every day. So important for cleaning out your colon. Even if you feel you need a lot of protein, you can fine tune your protein, and slowly add new fruits and vegetables to aid with health and digestion. Marilu Henner, in her book, "Total Health Makeover" decided not to combine any fruits and vegetables together in a meal. This may help the severely constipated person, and I found it very helpful.

Inflammatory foods. First is wheat, next are tomatoes. Tomatoes are on the avoid list for 3 of the 4 genetic types. They are a night shade for example, and sometimes these may cause inflammation and pain. Looking for lycopene? Watermelon is the alternate choice. Finding why sulforphanes and quercetins are needed to fight inflammation, and infection. Find out which foods have the nutrients your body needs, and why broccoli and onions are so helpful to fight inflammation. If you don't like onions find out where other quercetins are found.

Wheat over produced, over processed, and more bountifully grown for greater yield to supply the masses. Even GMO. Not the healthy old wheat we used to depend on. Spelt and kamut are older more nutrient dense, older wheats. Maybe you are on the gluten spectrum, and can find healthy alternatives.

Wheat over produced, over processed, and more bountifully grown for greater yield to supply the masses. Even GMO. Not the healthy old wheat we used to depend on. Spelt and kamut are older more nutrient dense, older wheats. Maybe you are on the gluten spectrum, and can find healthy alternatives.

Know your body, you may be always hungry, or not so much. Knowing how much protein you need. Too little can leave you hungry in a painful sort of way.

Knowing if you have a genetic deficiency that you can supplement to prevent hunger, and remove another reason for chronic pain.

Social, Biological and Cultural Factors in Conversion Disorder

One piece of evidence that social and cultural factors play a role in conversion disorder is shown from the decreasing of this disorder in the last few centuries. Several hypotheses that explain that this disorder begin to decrease is such therapists who are experts in the field of psychoanalysis to mention that in the second half of the 19th century, when the rate of occurrence of conversion disorder is high in France and Austria, seyual behavior in repress may contribute to the increased prevalence of this disorder. The reduced interference may be caused by the increasing versatility of seyual norms and the development of the science of psychology and medicine in the 20th century, which is more tolerant of anxiety due to dysfunction not related to physiological terms than before. In addition, the role of social and cultural factors also indicate that conversion disorder is more often experienced by those who live in rural areas or at the level of low socioeconomic (Binzer et al., 1996; Folks, Ford & Regan, 1984 in Davidson, Neale, Kring, 2004 ). They experience this due to lack of knowledge about the medical and psychological concepts. Meanwhile, the diagnosis of hysteria reduced in industrialized societies, such as the UK, and is more common in underdeveloped countries, such as Libya (Pu et al., In Davidson, Neale, Kring, 2004).

Although genetic factors expected to be an important factor in the development of conversion disorder, research does not support this. Meanwhile, in several studies, conversion symptoms more often appears on the left side of the body than the right side (Binzer et al., In Davidson, Neale, Kring, 2004). This is an exciting discovery because the function of the left side of the body is controlled by the right hemisphere of the brain. The right hemisphere of the brain is also expected to play a bigger role than the left hemisphere is associated with negative emotions. However, based on a larger research note that there is no observable difference of the frequency of symptoms on the right versus the left side of the brain (Roelofs et al., In Davidson, Neale, Kring, 2004).

Psychoanalysis Theory and Behavioral Theory of Conversion Disorder

Psychoanalysis Theory of Conversion Disorder

Studies in Hysteria (1895/1982), Breuer and Freud states that conversion disorder is caused when a person experiences events that lead to a large increase in emotion, but affect can not be expressed, and the memory of the event is removed from consciousness. Specific symptoms mentioned conversion can be causally associated with the traumatic event that gave rise to these symptoms.

Freud also hypothesize that conversion disorder in women occurs early in life, caused by unresolved Electra complex. Based on psychodynamic view of Sackheim and colleagues, verbal reports and behavior can be separated from each other unconsciously. Hysterically blind person can say that he can not see and can simultaneously influenced by the visual stimulus. The way they show that they can see depends on the extent of blindness.

Behavioral Theory of Conversion Disorder

The views behavioral, proposed by Ullman and Krasner (in Davidson, Neale, Kring, 2004), states that conversion disorder similar to malingering, where individuals adopt a symptom to achieve a goal. In their view, individuals with conversion disorder is trying to behave according to their views on how a person with a disease affecting motor or sensory abilities, will react. This raises two questions: (1) Whether a person is able to do so? (2) Under what conditions such behavior often appear?

Based on existing evidence, the answer to question (1) is yes. A person can adopt behavior patterns that correspond to the classic symptoms of conversion. For example paralysis, analgesias, and blindness, as we know, can also appear in people who are in hypnosis. As for the question (2) Ullman and Krasner specifies two conditions that can increase the tendency of motor and sensory inability inimitable. First, the individual must have experience with the role to be adopted. Such individuals may have physical problems that are similar or the symptoms observed in others. Secondly, the game of the role must be given rewards. Individuals will show an inability only if the behavior was expected to reduce stress or to obtain other positive consequences. However, this behavioral view is not fully supported by the evidence of the literature.

Modern Theories that Discuss Somatoform Disorders

Modern theories that discuss somatoform disorders, such as dissociative disorders, psychodynamic theory and learning theory.

1. Psychodynamic Theory

Freud developed a theory of mind that threaten or unconscious. Freud believed that the ego functions to control seyual impulses and aggressive threatening or unacceptable that arise from id through such self-defense mechanism of repression. Control as it inhibits the onset of anxiety that would occur if the person becomes aware of the impulses it.

According to psychodynamic theory, hysterical symptoms has a function that gives the person primary and secondary advantages, namely:

Primary, namely the loss of fundamental anxiety derived from the development of neurotic symptoms.
Secondary, the fringe benefits associated with neurotic disorders or other, such as expressions of sympathy, attention increased, and free from responsibility.

2. Learning Theory

Psychodynamic theory and learning theory that the symptoms in conversion disorder can be overcome anxiety. Psychodynamic theorist looking for the cause of anxiety in conflicts that are not realized. Learning to focus on things that directly strengthen the symptoms and secondary role in helping individuals avoid or escape from an uncomfortable situation or arouse anxiety. The difference in the learning experience can be explained that the "why historically, conversion disorder is more often reported by women than men".

3. Cognitive Theory

Explanation other cognitive functioning in the role of a distorted mind.

Symptoms of Conversion Disorder

Conversion Disorder

In conversion disorder, sensory and motor symptoms, such as loss of vision or sudden paralysis, cause diseases associated with damage to the nervous system, whereas the organs and the nervous system of the individual fine. Psychological aspects of the symptoms of this conversion is shown by the fact that this disorder usually appear suddenly in an unpleasant situation. Usually this allows individuals to avoid some of the activities or responsibilities or individuals are eager to get attention. The term conversion, basically derived from Freud, which stated that the energy of instinct in repress transferred to the sensory-motor aspects and disrupt normal function. To that end, anxiety and psychological conflict is believed to be transferred to the physical symptoms.

Conversion symptoms usually develop in adolescence or early adulthood, which usually appear after the unpleasant incident in life. The prevalence of conversion disorder is less than 1%, and usually experienced by women (Faravelli et al., 1997; Singh & Lee, 1997 in Davidson, Neale, Kring, 2004). Conversion disorder is usually associated with a diagnosis of Axis I such as depression and abuse of illegal substances, and with a personality disorder, which is borderline and histrionic personality disorder (Binzer, Anderson & Kullgren, 1996; Rechlin, Loew & Jorashky, 1997 in Davidson, Neale, Kring, 2004) .

Pain Disorder and Hypochondriasis - Symptoms

Pain Disorder

In pain disorder, the patient experienced pain resulting in an inability to significantly; psychological factors thought to play an important role in the emergence, survival and perceived pain levels. The patient may not be able to work and become dependent on painkillers. The pain can be associated with conflict or stress, or it can occur so that individuals can avoid unpleasant activities and to get attention and sympathy that was not previously obtained.

Accurate diagnosis of pain disorder is somewhat difficult because of the subjective experience of pain is always a psychological phenomenon influenced, wherein the pain itself is not a simple sensory experiences, such as sight and hearing. To that end, decide whether the pain is felt a pain disorder that is classified as somatoform disorder, it is very difficult. However, in some cases can be distinguished clearly how the pain experienced by individuals with somatoform disorders with the pain of individuals who experience pain due to physical problems. Individuals who feel the pain caused by a physical disorder, showing the location of the pain that is experienced with more specific, more detailed in providing sensory description of the pain they experienced, and describes situations where pain is felt sicker or more reduced (Adler et al., in Davidson, Neale, Kring, 2004).


Hypochondriasis is a somatoform disorder in which individuals overwhelmed with fear of having a serious disease which is quite repetitive though of medical certainty to the contrary, that he was fine. The disorder usually begins in early adolescence and tend to continue. Individuals who experience this is usually the consumers who frequently use health services; sometimes they assume their doctors are incompetent and do not care (Pershing et al., in Davidson, Neale, Kring, 2004). In theory stated that they were overreacting to the physical sensations are common and minor disturbances, such as an irregular heartbeat, sweating, coughing that sometimes occurs, pain, abdominal pain, as evidence of their belief. Hypochondriasis often coincided with anxiety and mood disorders.

Ischaemic Heart Disease - 3 Nursing Diagnosis and Interventions

Ischemic Heart Disease (IHD) also known as Coronary artery disease (CAD), atherosclerotic heart disease, atherosclerotic cardiovascular disease, coronary heart disease is the most common type of heart disease and cause of heart attacks. The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.

Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. The risk of artery narrowing increases with age, smoking, high blood cholesterol, diabetes, high blood pressure, and is more common in men and those who have close relatives with CAD. Other causes include coronary vasospasm, a spasm of the blood vessels of the heart, it is usually called Prinzmetal's angina.

Diagnosis of IHD is with an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention (angioplasty) or coronary artery bypass surgery (CABG).

Nursing Diagnosis and Interventions for Ischaemic Heart Disease

Nursing Diagnosis : Decreased cardiac output related to electrical factors (dysrhythmias), Decrease in myocardial contraction, structural abnormalities (papillary muscular dysfunction and ventricular septal rupture)

Outcome: The patient will demonstrate a stable cardiac condition or better.

  • Maintain bed rest with head elevation of 30 degrees during the first 24-48 hours.
  • Assess and monitor vital signs and hemodynamic per 1-2 hours.
  • Monitor and record ECG continue to assess the rate, rhythm, and order to each change per 2 or 4 hours.
  • Review and report signs of CO reduction.

Nursing Diagnosis : Acute pain related to an imbalance of oxygen supply to myocardial demands.

Outcome: The patient will express pain decreased

  • Assess pain location, duration, radiation, occurrence, a new phenomenon.
  • Review of previous activities that cause chest pain.
  • Create a 12 lead ECG during anginal pain episodes.
  • Assess signs of hypoxemia, give oxygen therapy if necessary.
  • Give analgesics as directed.
  • Maintain a rest for 24-30 hours during episodes of illness
  • Check vital signs, during periods of illness.

Nursing Diagnosis : Anxiety related to the needs of the body is Threatened.

Objectives: The patient will demonstrate reduced anxiety after nursing actions.
  • Assess signs and verbal expressions of anxiety
  • Take action to reduce anxiety by creating a calm environment
  • Accompany patient during periods of high anxiety
  • Provide an explanation of procedures and treatments
  • Encourage patients to express feelings
  • Refer to the spiritual adviser if necessary

Nursing Interventions for Depression

Depression is a condition that is more of a sad situation, when the depressed person's condition to cause the disruption of their daily social activities then it is called as a depression disorder. Some symptoms of depression disorders are feelings of sadness, excessive fatigue after usual routine activity, lost interest and enthusiasm, lazy bunch, and disruption of sleep patterns. Depression is one of the major causes of suicide.

Nursing Interventions for Depression

Goal :
There was no violence for Self-Directed or Other-Directed

1. Clients can build a trusting relationship.

Interventions :
  • Introduce yourself to the patient
  • Do interactions with patients as often as possible with empathy
  • Listen to the notice of the patient with empathy and patient attitude more use non-verbal language. For example: a touch, a nod.
  • Note the patient talks and give a response in accordance with her wishes
  • Speak with a low tone of voice, clear, concise, simple and easy to understand
  • Accept the patient is without comparing with others.

2. Clients can use adaptive coping

Interventions :

  • Give encouragement to express feelings and say that nurses understand what patients perceived.
  • Ask the patient the usual way to overcome feeling sad / painful
  • Discuss with patients the benefits of commonly used coping
  • Together with patients looking for alternatives, coping.
  • Give encouragement to the patient to choose the most appropriate coping and acceptable
  • Give encouragement to patients to try coping that have been selected
  • Instruct the patient to try other alternatives in solving problems.

3. Clients are protected from violent behavior to self and others.

Interventions :

  • Monitor carefully the risk of suicide / violence themselves.
  • Keep and store the tools that can be used by patients for violent behavior, self / others, in a safe place and locked.
  • Keep materials that endanger the patient's appliance.
  • Supervise and place the patient in the room that easily monitored by nurse.

4. Clients can improve self-esteem

Interventions :
  • Help to understand that the client can overcome despair.
  • Assess and mobilize internal resources of individuals.
  • Help identify sources of hope (eg, peer relationships, beliefs, things to be resolved).

5. Clients can use the social support

Interventions :
  • Review and make use of individual external sources (the people closest to, the health care team, support groups, religion).
  • Assess support system beliefs (values, past experiences, religious activities, religious beliefs).
  • Make referrals as indicated (eg, counseling, religious leaders).

6. Clients can use the drug correctly and precisely

Interventions :
  • Discuss about the drug (name, dosage, frequency, effect and side effects of taking medication).
  • Help using the drug with the principle of 5 correct (right patient, medication, dose, manner, time).
  • Encourage talking about effects and side effects are felt.
  • Give positive reinforcement when using the drug properly.

Source :

Endocarditis - Nursing Diagnosis Activity Intolerance and Acute Pain

Activity intolerance related to inflammation and degeneration of muscle cells myocarditis, cardiac filling restriction (cardiac output).

Characterized by:

  • Complaints of weakness / fatigue / tightness during activity.
  • Changes in vital signs while the activity.
  • Signs of CHF.

  • Increased activity capabilities.
  • Reduction of physiological signs that do not fit.
  • Reveals the importance of limited activity.

Interventions and Rationale :
1. Assess the patient's response activities. Note the presence / emergence and change of complaints like weakness, fatigue and shortness of breath during activity.
R/ : Myocarditis causing inflammation and allow disruption in muscle cells that can lead to CHF.
Decreased cardiac filling / cardiac output will cause the liquid to collect in the pericardial cavity (if any pericarditis), which in turn can cause endocarditis and valvular dysfunction trend decline in cardiac output.

2.Monitor rate or rhythm of the heart / pulse, blood pressure and respiration amount, before / after and during activities as needed.
R/ : Help illustrate the level of the heart and pulmonary decompensation. Decreased blood pressure, tachycardia, and tachypnea are indicative of heart activity disorders.

3. Maintain bedrest during periods of fever and as indicated.
R/ : Control changes infection, during the acute phase of pericarditis / endocarditis.
Note: Fever increases oxygen demand, thereby increasing the ability of the heart and reduces the activity.

4. Plan of care by setting the rest / sleep period.
R /: Maintaining balance the needs of cardiac activity, enhancing the healing process and emotional coping skills.

5. Evaluation of emotional response to the situation / administration support.
R/ : R /: Anxiety will arise due to infection and cardiac responses (psychological). The level of anxiety and emotional needs of the patient will be a good coping posed by the possibility of life-threatening illness. Support is needed to face the possibility of frustration due to long hospitalization / healing period.

6. Collaboration: Provide oxygen therapy as indicated.
R /: Improved oxygenation ability to myocarditis, offset the increase in oxygen consumption. Can be seen in the activity.

Acute pain related to inflammation of the myocardium and pericardium, systemic effects of the infection, and ischemic tissue (myocardium).

Characterized by:

  • Chest pain radiating to the neck or back.
  • Joint pain.
  • Increased pain on deep inspiration, activity, and change the position.
  • Fever or chills.
  • Clients can identify ways to prevent pain.
  • Clients can control and report pain arising.
  • Clients can demonstrate relaxation techniques and a variety of activities that are indicated for individual circumstances.

Interventions and Rationale :
1. Observe for chest pain, record the time, factors complicate / originator, record the non-verbal signs of discomfort such as weakness, muscle tension and tears.
R /: Location of pain of pericarditis in the substernal radiating to the neck and back. But in contrast to myocardial ischemic pain / infarction. The pain will increase as the inspiration, position changes, and reduced the time to sit / lean forward.
Note: Chest pain is the presence or absence of endocarditis / myocarditis depends on the presence of ischemia.

2. Maintain or create a peaceful environment and a fun action such as changes in position, put a cold compress or warm, mental support, and so on.
R /: These measures can reduce the patient's physical and emotional discomfort.

3. Give the medication as indicated.
R /: To prevent the onset of pain or reduce the inflammatory response.

Source :

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