Acute pain is one of the most common nursing diagnoses, and one of the most frequently tested in nursing exams. Here’s how to write it correctly and build a complete care plan around it.
What is acute pain?
NANDA-I describes acute pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, with sudden or slow onset and an anticipated end, typically lasting less than three months. It’s different from chronic pain, which persists longer.
Writing the diagnosis (PES format)
- Problem: Acute pain
- Etiology (related to): the cause, such as surgical incision, tissue injury, inflammation or ischaemia
- Signs and symptoms (as evidenced by): pain score, guarding, facial grimacing, raised heart rate, restlessness, the patient’s own description
Examples
- Acute pain related to surgical incision, as evidenced by a pain score of 8/10, guarding of the abdomen and reluctance to move.
- Acute pain related to tissue ischaemia secondary to sickle cell crisis, as evidenced by a pain score of 9/10 in both legs, crying and tachycardia.
- Acute pain related to uterine contractions, as evidenced by the woman’s verbal report and restlessness during contractions (labour pain is a separate NANDA-I label in newer editions).
- Acute pain related to inflammation, as evidenced by right lower quadrant tenderness and a pain score of 7/10.
Pain assessment
Use a validated tool appropriate to the patient:
- Numerical rating scale (0–10) for adults who can communicate
- Wong-Baker FACES scale for children and some adults
- FLACC scale for infants and young children who can’t self-report
- Abbey Pain Scale or PAINAD for people with dementia
Use a structured approach such as SOCRATES: Site, Onset, Character, Radiation, Associated symptoms, Time course, Exacerbating and relieving factors, Severity.
Sample care plan: post-operative acute pain
Assessment data
Mrs B, 45, day 1 after open abdominal surgery. Pain 8/10, guarding, HR 104, BP 138/86, refusing to cough or move.
Nursing diagnosis
Acute pain related to surgical incision, as evidenced by a pain score of 8/10, guarding, tachycardia and reluctance to move.
Goals (SMART)
- Short term: Mrs B will report a pain score of 3/10 or less within 1 hour of analgesia.
- Long term: Mrs B will be able to deep breathe, cough and walk to the bathroom with a pain score of 4/10 or less by day 2.
Interventions and rationales
| Intervention | Rationale |
|---|---|
| Assess pain using a 0–10 scale at least every 4 hours and before and after analgesia | Provides a baseline and measures effectiveness |
| Give prescribed analgesia on time (for example, regular paracetamol, plus opioids as prescribed) | Regular, multimodal analgesia controls pain better than waiting for severe pain |
| Monitor for side effects: sedation, respiratory rate, nausea, constipation | Opioids can cause respiratory depression and other adverse effects |
| Position for comfort with pillow support | Reduces tension on the incision |
| Teach splinting the wound with a pillow when coughing | Reduces pain and supports deep breathing to prevent chest infection |
| Use non-drug methods: distraction, breathing exercises, warmth or cold as appropriate | Complements medication and helps the patient feel in control |
| Explain the pain plan and encourage the patient to report pain early | Reduces anxiety, which can increase pain |
| Escalate uncontrolled pain to the medical or pain team | The analgesia plan may need adjusting |
Evaluation
One hour after analgesia, Mrs B reported a pain score of 3/10 and was able to cough with a pillow splint. Short-term goal met. Continue plan and reassess.
Common mistakes in pain care plans
- Writing “related to pain” (circular reasoning).
- Not using a pain score as evidence.
- Forgetting to reassess after giving analgesia.
- Ignoring non-drug interventions.
- Not considering cultural differences in how people express pain.