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Thursday, April 12, 2012

Acute Pain related to Headache

Nursing Diagnosis for Headache. Nursing Interventions for Acute Pain related to Headaches.

Acute pain related to stess and tension, irritation / nerve pressure, vasospasm, increased intracranial pressures.

Nursing Interventions for Acute Pain related to Headache:
  1. Make sure the duration / episode problems, who have been consulted, and drug and / or what therapy was used.
  2. Thorough complaints of pain, record the intensity (with a scale of 0-10), characteristics (eg, heavy, throbbing, constant) location, duration, factors that aggravate or relieve.
  3. Note the possible pathophysiological characteristic, such as brain / meningeal / sinus infection, cervical trauma, hypertension, or trauma.
  4. Observe for nonverbal signs of pain, are like: facial expression, posture, restlessness, crying / grimacing, withdrawal, diaphoresis, changes in heart rate / breathing, blood pressure.
  5. Assess the relationship of physical factors / emotional state of a person.
  6. Evaluation of pain behavior
  7. Note the influence of pain such as: loss of interest in life, decreased activity, weight loss.
  8. Assess the degree of making a false step in person from the patient, such as isolating themselves.
  9. Determine the issue of a second party to the patient / significant others, such as insurance, spouse / family
  10. Discuss the physiological dynamics of tension / anxiety with patients / people nearby.
  11. Instruct patient to report pain immediately if the pain arises.
  12. Place on a rather dark room according to the indication.
  13. Suggest to rest in a quiet room.
  14. Give cold compress on the head.
  15. Give the hot moist compress / dry on the head, neck, arms as needed.
  16. Massage the head / neck / arm if the patient can tolerate the touch.
  17. Use the techniques of therapeutic touch, visualization, biofeedback, hypnosis itself, and stress reduction and relaxation techniques to another.
  18. Instruct the patient to use a positive statement "I am cured, I'm relaxing, I love this life". Instruct the patient to be aware of the external-internal dialogue and say "stop" or "delay" if it comes up negative thoughts.
  19. Observe for nausea / vomiting. Give the ice, drinks containing carbonate as indicated.

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