Assessment Objective: Pain score of 3/10 when on rest and 5/10 when moving.

Subjective: With slight facial grimacing Irritability Guarding Behavior Self-focused BP:140/90 PR:110 RR:23 T: 37 C

Nursing Diagnosis Acute pain r/t injuring biological and chemical agents caused by progression of osteosarcoma

Rationale Pain is defined as an unpleasant sensory either physical or emotional experience associated with actual or potential tissue damage. In medical point of view, pain has been always referred to as the 5th vital sign. The pathophysiology of pain is usually divided into 4 distinct stages: (1) transduction, (2) transmission, (3) pain modulation, and (4) perception. The brain can inhibit or facilitate the intensity and propagation of pain stimuli via specific neural pathways. This modulation function of the brain accounts for the variations in pain perception of different individuals who sustains identical injury and in response to drug therapy. Transduction occurs at the sensory level, when a stimulus is converted into a nerve signal.

Planning After 30 mins. of nursing interventions,the patient will be able to: 1. Have a pain score of 2/10 during rest. 2. Have a pain score of 4/10 during movement.

Intervention Rationale 1. Perform a 1. Pain is a comprehensive subjective assessment of experience and pain to include must be location, described by the characteristics, client in order to onset, duration, plan effective frequency, treatment quality, intensity or severity, and precipitating factors of pain. 2. Reduce or 2. Personal factors After 1 hour of eliminate can influence nursing factors that pain and pain interventions, the precipitate or tolerance. patient will be able increase of Factors to: patients that may be 1. Verbalize pain experience precipitating or and (e.g., fear, augmenting demonstrat fatigue, pain should be e (nonverbal monotony, and reduced cues) relief lack of or eliminated to and/ or knowledge). enhance the control of overall pain discomfort management 2. Have a pain program score of 3/10 during 3. Teach the use of 3. The use of movement. nonpharmacolo noninvasive

Evaluation After 30 mins. of nursing interventions, the patient was able to:

1. Have a pain score of 2/10 during rest. 2. Have a pain score of 4/10 during movement. After 1 hour of nursing interventions, the patient was able to: 1. Verbalize and demonstra te (nonverbal cues) relief and/ or control of discomfort 2. Have a pain score of 3/10

Transmission is the primary function of nerves by acting as a conduit transferring pain information from the peripheral nerves to the central nervous system. Pain modulation refers to the function of neural cells to inhibit, reduce, or dampen the intrinsic modulatory activity of the central nervous system, thus reducing the painful stimuli. Perception is the conscious awareness, usually localized in certain areas of the body. Levels of pain perception depend on factors such as personal experiences, immediate environment, and socio-cultural influences. One of the earliest signs of Osteosarcoma is bone pain. The cause of bone pain is two-fold: activation of osteoclasts by tumor cells and activation of nocioceptors due to prostaglandin and

3. Recognize the importance of nonpharmacolo gical methods to relieve pain. 4. Demonstrat e properly pain managemen t techniques.

gic techniques (e.g., relaxation, guided imagery, music therapy, distraction, and massage) before, after, and if possible during painful activities; before pain occurs or increases; and along with other pain relief measures. 4. Provide patient with optimal pain relief with prescribed analgesics

pain relief measures can increase the release of endorphins and enhance the therapeutic effects of pain relief medications

during movement. 3. Recognize the importance of nonpharmacol ogical methods to relieve pain. 3. Demonstrate properly pain management techniques.

4. Each client has a right to expect maximum pain relief. Optimal pain relief using analgesics includes determining the preferred route, drug, dosage, and frequency for each individual. Medications ordered on a

cytokine production. The dysregulated osteoclastic activity leads to bone resorption and malignant osteolysis. Uncontrolled osteolysis can lead to hypercalcemia, pathologic fractures and moderate to severe pain.

5.

Assist client in repositioning and turning.

6. Encourage rightbrain stimulation with activities such as love, laughter and music 7. Elicit behaviors that are conditioned to produce relaxation, such as deep breathing, yawning, abdominal breathing, or peaceful imaging. 8. Create a quiet, nondisruptive

prn basis should be offered to the client at the interval when the next dose is available. 5. To reduce pain when moving around and to ensure safety 6. To release endorphins, enhancing sense of well-being

7. Relaxation techniques help reduce skeletal muscle tension, which will reduce the intensity of the pain

8. Comfort and a quiet

environment with dim lights and comfortable temperature when possible.

atmosphere promote a relaxed feeling and permit the client to focus on the relaxation technique rather than external distraction 9. Each person may find different images or approaches to relaxation more helpful than others. The nurse should have a variety of relaxation scripts or audiovisual aids to help clients find the best one for them 10. Return demonstrations by the participant

9. Individualize the content of the relaxation intervention (e.g., by asking for suggestions about what patient enjoys or finds relaxing)

10. Demonstrate and practice the relaxation technique with

patient.

11. Evaluate the effectiveness of the pain control measures used through ongoing assessment of patients pain experience

provide an opportunity for the nurse to evaluate the effectiveness of teaching sessions 11. Research shows that the most common reason for unrelieved pain is failure to routinely assess pain and pain relief. Many clients silently tolerate pain if not specifically asked about it 12. Conveys to the health care team effective strategies in reducing or eliminating pain.

12. Evaluate and document patients response to relaxation therapy