Nursing Care Plan: Acute pain related to diminished arterial circulation and oxygenation of tissues with production/ accumulation of lactic acid in tissues, and inflammatory process.

Scientific Basis:

Buerger’s disease is an inflammatory of small and medium arteries and veins that leads to vascular obstruction. At first, pain in the palm of the hand and arch of the foot is the main symptoms. Pain becomes more severe with disease progressions, and as ischemia affects the nerves, the client may experience numbness, burning pain when at rest, and decreased sensation in the hands and lower extremities.

Pain is highly subjective state in which a variety of unpleasant sensations and a wide range of distressing factors may be experienced by sufferer.

Gulanick, 2007; White, 2002


Intervention and Rationale

I: Assess degree and characteristics of discomfort/pain. Note guarding of extremity. Palpate leg with caution.
R: Degree of pain is directly related to extent of circulatory deficit, inflammatory process, degree of tissue ischemia, and extent of edema associated with thrombus development. Changes in characteristics of pain may indicate progression of problem/development of complications.

I: Assess for referred pain as appropriate.
R: To help determine possibility of underlying condition or organ dysfunction requiring treatment.

I: Maintain bed rest during acute phase
R: Reduces discomfort associated with muscle contraction and movement.

I: Anticipate need for pain relief.
R: One can most effectively deal with pain by preventing it. Early detection and intervention may decrease the total amount of analgesic required.

I: Monitory severity of pain rating scale. Note location, quality and associated manifestation of skin, aggregation factors that increase pain and factors that alleviate the pain.
R: The single most reliable indicator of the existence of pain is the client’s self report.

I: Elevate affected extremity.
R: Encourages venous return to facilitate circulation, reducing stasis/edema formation.

I: Encourage client to change position frequently
R: Decreases/prevents muscle fatigue, helps minimize muscle spasm, maximize circulation to tissues.

I: Monitor vital signs, noting elevated temperature.
R: Elevations in heart rate may indicate increased pain/discomfort or occur in response to fever and inflammatory process. Fever can also increase client’s discomfort.

I: Provide rest periods to facilitate comfort, sleep, and relaxation.
R: The client’s experiences of pain may become exaggerated as the result of fatigue.

I: Help the client use non-pharmacological methods to control pain such as listening to music, watching TV and therapeutic massage.
R: Cognitive and behavioral strategies can restore client’s sense of control, personal efficiency and active participation in care, and by using mental picture distract oneself from painful stimuli, and heightens one’s concentration upon non-painful stimuli to decrease awareness and experience of pain.

I: Plan care activities around periods of greatest comfort whenever possible.
R: Pain diminishes activity or participation.

I: Note non-verbal cues e.g. restlessness, reluctance to move, tachycardia, diaphoresis etc.
R: Non-verbal cues maybe both physiological and psychological and maybe used in conjunction with verbal cues to identify extent of severity of the problem.

Gulanick, 2007; Doenges, et al, 2006; Kruse, et al, 2003