NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING
Client Experiences Labor Pain Acute pain related to labor Goal:
associated with the After nursing intervention,
Objective: contraction of the muscles of the client will:
Observed Pain uterus and by pressure on
Diaphoresis cervix Be able to express relief and
Restlessness comfort with pain being
Facial Grimace controlled
Uncomfortable
Irritability Be able to determine the
V/S Taken as follows: pain’s location,
BP: 130/80 characteristics, onset,
PR: 85/min duration, frequency, quality,
RR: 22/min and severity of pain
T: 36.5℃
O2Sat: 98% Be able to show an appealing
facial expression in relation
to methods that will be
utilized in alleviation/control
of pain
Be able to take adequate rest
periods in relation to prevent
possible fatigue that can
affect with pain
Be able to utilize relaxation
techniques in relation to
reduce tension that may
affect pain
Be able to gain knowledge on
collaborative approaches for
pain management
INTERVENTION EXPECTED OUTCOME
Check the vital signs. monitor Client reports pain is relieved
and document any changes or controlled
or findings that can be
indication to pain severity Demonstrate use of
relaxation skill in means of
To evaluate client’s/SO’s coping with pain
assessment of pain by
including the location, Verbalize sense of control of
characteristics, onset, response to acute situation
duration, frequency, quality, and positive outlook for the
and severity of pain future
Assist client to explore Verbalize pharmacological
methods for regimens or
alleviation/control of pain by nonpharmacological methods
providing comfort measures that provides relief
with repositioning and the
use of heat of cold packs Patient has regained an
ample amount of rest and
Promote wellness by strength
Encouraging the client
adequate rest periods
Instruct and Encourage client
use of relaxation techniques
such as to take Deep and
Slow Breathes
Assess current knowledge on
Collaborative approach for
pain management based on
client’s understanding about
and acceptance of available
treatment options
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