Nursing Management of Pain

Here are the opinion of some experts about the sense of pain:

1. Mc. Coffery (1979), defines pain as a condition that affects a person whose existence is known only if the person ever experienced.
2. Feurst Weifsel Wolf (1974), pain is a feeling of physical and mental suffering or feeling that could lead to tension.
3. Arthur C. Curton (1983), pain is a mechanism for the production of the body, arises when the network is broken, and causes the individual to react to relieve pain stimuli.
4. Scrumum, defines pain as an unpleasant situation due to physical stimulation of nerve fibers in the brain to the body and followed by physical reactions, physiological, and emotional.

Classification of Pain

1. Based on the source

• Cutaneous / Superficial: That pain on the skin / subcutaneous tissue. Usually burning. Example: exposed tip of a knife or scissors.
• Deep somatic: pain arising from the ligaments, blood vessels, tendons and nerves, pain spreads and longer than cutaneous. Example: joint sprain.
• Visceral (the internal organs): stimulation of pain receptors in the abdominal cavity, the cranium and thoracic. It usually occurs due to muscle spasm, ischemia, tissue strain.

2. Based on the causes

• Physical: It could happen because of a physical stimulus. Example: fracture of the femur.
• Psycogenic. Occur for reasons unclear / hard identified, sourced from emotional / psychological and usually unconscious. Example: people who get angry, suddenly felt pain in his chest.

3. Based on the long / duration.

• Acute pain. Is pain that arises suddenly and quickly disappeared, which does not exceed 6 months and is characterized by an increase in muscle tension.
• Chronic pain. Is pain arising slowly, usually takes place in a long time, which is more than 6 months. Are included in the category of chronic pain is pain terminal, chronic pain syndrome, and psychosomatic pain.

Nursing Management for Pain

1. Pharmacological Actions.

• Recommend instructions for treatment, WHO combines the use of analgesic drugs, and drugs effective adjuvant for pain control on the client.

2. Non-Invasive action.
Non-invasive pain control measures used to support the pharmacological therapy that has been given. Type of non-invasive measures, among others:
Building a therapeutic nurse-client relationship.

• Anticipatory guidance.
• Relaxation.
• Guided imagery.
• Distraction.
• Acupuncture.
• Biofeedback.
• Cutaneous stimulation.
• Acupressure.
• Psychotherapy.

3. Measures Invasive / Surgery.
Is the complement of the other measures in an effort to relieve pain, such as measures of cognitive-behavioral, physical and pharmacological therapy. This action is performed when the non-invasive measures can not relieve the pain. Clients need to be given knowledge about the implications after surgery for pain control. Some cases of surgery include:

• Cordotomy.
• Neurectomy.
• Sympatectomy.
• Rhizotomy.

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Nursing Management of Dengue Hemorrhagic Fever

Dengue Hemorrhagic Fever

Dengue hemorrhagic fever is an acute febrile disease caused by four serotypes of dengue virus and is characterized by four main clinical symptoms are high fever, hemorrhagic manifestations, hepatomegaly, and signs of circulatory failure and the onset of shock (dengue shock syndrome) as a result of leakage of plasma which can lead to death. (Rohim et al, 2002; 45).

Signs and Symptoms

1. Fever.
Fever occurs suddenly lasts for 2-7 days, then go down to the normal temperature or lower. Along with ongoing fever, clinical symptoms are not specific example anorexia. Back pain, bone pain and supplies, headache and weakness may accompany it.

2. Bleeding.
Bleeding usually occurs on days 2 and 3 of fever and usually occur on the skin and can be torniguet test positive, easy bleeding at the site of venous function, petechiae and purpura. Mild to moderate bleeding can be seen in the upper gastrointestinal tract, causing haematemesis (Nelson, 1993; 296).
Gastrointestinal bleeding is usually preceded by severe abdominal pain. (Ngastiyah, 1995; 349).

3. Hepatomegaly.
At the onset of fever is usually the liver was palpable, although the liver of malnourished children also. If there is an increase of hepatomegaly and liver palpable springy to note the possibility to take place seizures in patients.

4. Shock.
The onset of shock usually occurs on day 3 since the pain sufferer, starting with signs of circulatory failure, namely the skin moist, cool the tip of the nose, fingers, toes and cyanosis around the mouth. When shock occurs during the fever usually indicate a poor prognosis.


Management of Patients with DHF are as follows:

1. Bed rest.
2. Diet soft meal.
3. Drink plenty of (2-2.5 liters / 24 hours) can be: milk, sweet tea, syrup and give people a bit of ORS, fluid administration is the most important for patients with DHF.
4. Intravenous fluids.
5. Monitor vital signs every 3 hours (temperature, pulse, blood pressure, respiration) if the patient's condition worsens, the strict observation of each hour.
6. Check hemoglobin, hematocrit and platelets every day.
7. Antipyretic drug delivery.
8. Monitor signs of further bleeding.
9. Giving antibiotics if there is a concern of secondary infection.
10. Monitor signs and shock covers; general condition, changes in vital signs, laboratory results deteriorate.

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