Student Nurses Community

NURSING CARE PLAN Impaired Comfort

ASSESSMENT

SUBJECTIVE:
My head hurts,
as verbalized by
the patient.
Pain scale of 6 out
of 10.

OBJECTIVES:
Facial mask of
pain
Facial grimace
Restlessness

Vital signs
T- 36.2
P- 86
R- 22

DIAGNOSIS

Impaired
comfort
related
headache

INFERENCE

PLANNING

INTERVENTIONS

RATIONALE

EVALUATION

traction to or
irritation of the
meninges and blood
vessels

stimulation of
nociceptors

nociceptor sends a
message up the
length of the nerve
fiber to the nerve
cells in the brain

Headache/pain

unpleasant feeling
that is conveyed to
the brain by sensory
neurons

alters comfort/
impairs ability of
person to function

After 4
hours of
nursing
intervention
s, patients
subjective
perception
of altered
comfort/pain
will be
decreased;
patient will
be able to
verbalize
relief of
pain; there
will be
diminished
or absent
nonverbal
indicators.

Note for the

location, scale,
intensity and onset
of pain

To determine
the nursing care
to be given to
the patient.

Maintain a calm and

quite environment.

To minimize
stimulus that
could aggravate
the condition of
the patient

After 4 hours of
nursing
interventions,
goal met.
Patient
verbalized being
relieved of pain
and there is no
nonverbal
indicators of
pain/discomfort
present.

Use relaxation
technique such as:
heat and cold
application an deep
breathing exercise
Provide a dim and
light but providing
good ventilation.

To promote
comfort and
relaxation.
To add comfort
to the patient

Offer back rubs,

massages, slow
rhythmic breathing,
repositioning and
other diversional
activities such as
music, TV, etc.

They serve as
nonpharmacological
methods for
reducing
pain/promoting
comfort

Dependent:

To help relieve

Student Nurses Community

BP 140/60

Administer pain
medications as
ordered

of pain.