Chapter 34: Comfort and Pain Management

A patient is in the terminal stage of an illness and has become increasingly delirious and agitated over the past 48 hours. The patient's son has come to visit and sharply criticized the nurse for failing to "keep her comfortable and calm in her last days." How should the nurse best respond?

"I know it must be very difficult to see your mother suffering. From your experience caring for her, is there anything more we could be doing to relieve her anxiety?" The nurse should acknowledge the son's feelings and then extend a genuine offer for input or suggestions based on the son's knowledge of his mother. The nurse should not focus solely on the son's anxiety or stress without addressing his complaint. It would be inappropriate for the nurse to elicit help from the son and characterizing the patient's experience as "normal" is not helpful or therapeutic.

A nurse is evaluating the effectiveness of the preoperative education regarding pain control. Which statement by the client would indicate a need for further education?

"I will have my wife push the PCA button when I'm asleep." The client should be the only one to administer medication via the PCA pump. Using the pump prior to getting out of bed and/or ambulating will help decrease the pain. Distraction is an effective nonpharmacologic means of dealing with pain. Constipation is a common side effect from many pain medications. Increasing fluid intake is one way of attempting to prevent it.

After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client?

3 The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 1 = awake and alert; no action necessary 2 = occasionally drowsy but easy to arouse; requires no action 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

The nurse is conducting an admission assessment, and asks the client what medication is taken for pain. The client responds, "I take a little white pill to control my pain, but I don't know the name of it," and presents the nurse with a plastic baggie full of white pills. What is the priority nursing intervention?

Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy. The priority nursing intervention is to ask the client for the original bottle that the drug was dispensed into from the pharmacy. This will provide the most accurate identification of the medication. Other interventions can subsequently be implemented.

The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action?

Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. Research has shown that treatment bias may delay pain-relieving measures. The nurse manager should privately and professionally educate the nurse, and then subsequently educate the nurse aide. Addressing the concern quickly is important so the client can receive appropriate care and pain management. Entering the conversation is not the best action to educate the nurse and disciplinary action doesn't help to immediately address the current situation.

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? (Select all that apply.)

Assess for pain control 30 minutes after administering an analgesic. Consider cultural implications of the perception of pain. Provide pain medication before activity that may increase pain. Pain assessment should never be delegated to a UAP. Pain medication should be given in advance of an activity that may increase pain. The nurse should consider cultural implications associated with pain, and assess for pain control after medication is given. Assumptions should not be made about pain.

A patient has been receiving large doses of opioids during recovery from traumatic wounds. When assessing the patient in order to identify the potential cause of the patient's recent nausea, the nurse should prioritize which of the following assessments?

Assessment of the patient's recent pattern of bowel movements Constipation is a common cause of nausea. As a result, a careful assessment of the patient's recent bowel pattern is warranted. Alterations in respiratory status, fluid balance, and peripheral nervous function are not common causes of nausea and vomiting. TAKE A PRACTICE QUIZ

A client in pain believes that their pain is a punishment from God, and feels angry and resentful. Which of the following is the most appropriate action by the nurse?

Encourage client to confer with a spiritual advisor. The most appropriate action by the nurse would be to encourage the client to confer with a spritual advisor to work through feelings of anger and resentment as it relates to God and their pain experience. Consulting a psychiatric nurse practitioner may help the client work through feelings of anger and resentment, but may not address the underlying feelings/beliefs related to God and the client's experience of pain. Encouraging the client to pray or to have visitors pray for the client may not help the client work through feelings of anger and resentment related to God and their experience of pain.

While assessing an infant, the nurse notes that the infant displays an occasional grimace and is withdrawn; legs are kicking, body is arched, and the infant is moaning during sleep. When awakened, the infant is inconsolable. What scale should the nurse use while assessing pain in this infant?

FLACC SCALE The FLACC Scale (face, legs, activity, cry, and consolability) is used to measure pain for children between the ages of 2 months and 7 years. The Braden scale is used to predict pressure sore risk. The FACES Scale is used to assess pain in older children using a series of faces, ranging from a happy face to a crying face. APGAR score is done at birth to assess how well the baby tolerated the birthing process.

The nurse is assessing a patient for the chronology of the pain she is experiencing. Which is an example of an appropriate interview question to obtain this data?

How does the pain develop and progress? When assessing the chronology of the client's pain, the nurse could ask the client how does the pain develop and progress. To assess the quality of the client's pain, the nurse could ask for the client to describe the pain. To assess the quantity of the pain, the client could be asked to rate the pain on a scale of one to ten. To assess the alleviating factor of the pain, the nurse could ask what the client does to alleviate the pain and how well does it work.

A nurse is assessing a client's pain. The nurse notes which database finding that is indicative of acute pain?

Increased blood pressure The increase in blood pressure that may accompany acute pain is believed to be due to overactivity of the sympathetic nervous system.

A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid?

Naloxone Naloxone is an opioid antagonist that reverses the respiratory-depressant effect of an opioid.

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit?

Narcan

Which guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers?

Pain can be a source of fear and threat to the toddler's security. During the toddler and preschool years, children are achieving a sense of autonomy. Because pain can be a source of fear and threat to security, children respond with crying, anger, physical resistance, or withdrawal.

A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain?

Phantom pain The nurse should document the pain as phantom pain, a type of neuropathic pain that is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. The client perceives that the amputated limb still exists and feels burning, itching, and deep pain in tissues that have been surgically removed. The client is not experiencing referred pain, visceral pain, or cutaneous pain. Visceral pain is associated with disease or injury. Referred pain is not experienced in the exact site where an organ is located. Cutaneous pain originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma.

A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention?

Stool softeners and increased fluid intake The most common side effect of opioid use is constipation. Consequently, stool softeners and increased fluid intake may be indicated. Opioids may cause respiratory depression, but this fact in and of itself does not create a need for oxygen supplementation or chest physiotherapy. The use of opioids does not create a need for calorie restriction, supplements, frequent turns, or the use of skin emollients.

A nurse is caring for a client who is receiving morphine via a patient controlled analgesia (PCA) pump. When assessing the client, she notes that his respiratory rate is 4. What should the nurse do first?

Stop the PCA pump. A side effect of morphine is respiratory depression. In this situation, the nurse should first stop the PCA pump and then notify the physician. Naloxone is used to reverse the sedative effects of opioids, but this is not the first step.

A female client with a long and complex history of chronic pain has begun a program of biofeedback with an advanced practice nurse. Together, the nurse and the client would identify what goal of this program?

The client will learn to alter her physiological responses to her pain. With biofeedback, a client learns to control or alter a physiologic phenomenon (eg, pain, blood pressure, headache, heart rate and rhythm, seizures) as an adjunct to traditional pain management. Biofeedback does not involve massage or specific coping techniques.

A student nurse is assessing a patient who reports pain that he rates at 6 on a 10-point scale. The patient is lying in bed and using his mobile device. The nurse observes that he is not grimacing or guarding. When analyzing this data, the nurse should prioritize what assessment finding?

The fact that the patient describes his pain as 6 out of 10 The overarching principle of pain management in nursing is that the nurse should accept the patient's self-report of pain as being accurate and authentic, even if it does not appear consistent with the patient's visual presentation.

The nurse is providing education to a client about the role of endogenous opioids in the transmission of pain. Which information about the release of endogenous opioids is most accurate?

They bind to opioid receptor sites throughout the CNS. When endogenous opioids are released, they are believed to produce their analgesic effects by binding to specific opioid receptor sites throughout the central nervous system (CNS), blocking the release or production of pain-transmitting substances.

A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure?

cutaneous stimulation Acupressure, a modern-day Western descendant of acupuncture, involves the use of the fingertips to create gentle but firm pressure to usual acupuncture sites. This technique of holding and releasing various pressure points has a calming effect, most likely related to the body's release of endorphins and enkephalins. Acupressure is easily taught to patients and families. Because patients can perform acupressure on themselves, it gives them a feeling of control in their care.

A nurse is caring for a client with cancer who is experiencing pain. What would be the most appropriate assessment of the client's pain?

the client's pain based on a pain rating The client's assessment of pain, based on a pain rating, is the most appropriate assessment data. The pain is rated on a 0 to 10 scale and nursing actions are then implemented to reduce the pain. The nurse's impression of pain and nonverbal clues are subjective data which should be considered, but which are not more important than the pain rating. Pain relief after nursing intervention is appropriate, but is a part of evaluation.

A nurse observes that a client who underwent knee surgery 2 weeks ago needs progressively larger doses of analgesics to get relief from pain. The nurse interprets this as:

tolerance The client is manifesting tolerance, which is characterized by the need for larger doses of analgesics to produce the original effect. The client is not manifesting addiction, dependence, or sedation. Addiction is a psychological condition characterized by a drive to obtain and take substances for other than the prescribed value. Dependence is a physiologic response wherein a person who is dependent on opioids responds to abrupt discontinuation with characteristic withdrawal symptoms. Sedation is an adverse effect of administration of opioid analgesics.

The nurse is caring for a client who reports having "kidney pain from a urinary tract infection" for 3 days. How will the nurse describe this pain when reporting off via SBAR? (Select all that apply.)

visceral acute Visceral pain (discomfort arising from internal organs) is associated with disease or injury. It is sometimes referred or poorly localized. Acute pain (discomfort that has a short duration) lasts for a few seconds to less than 6 months. Other answers are incorrect.

A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as

"Acute pain tends to increase during the day and is called a routine pain response" Acute pain occurs abruptly after an injury or disease and persists until healing occurs. Acute pain also may be associated with anxiety and fear. Acute pain consistently increases at night and during wound care, ambulation, coughing, and deep breathing.

After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what?

"I could use the TENS unit if I feel pain somewhere else on my body." The client needs further instruction when she says she can use the TENS unit on other areas of the body. Such a statement would indicate that the client does not understand that the unit should be used as prescribed by the physician in the location defined by the physician.

While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain?

"Sometimes it seems like I can never get a moment to myself." Caregiver role strain may be exhibited by statements of exhaustion, frustration, or seeming overwhelmed. If the client states that time to themselves is rare, he or she may be feeling consumed with care for the client with chronic pain. Feeling badly regarding a loved one's pain, discussing insurance coverage, and helping the loved one by doing household tasks do not indicate caregiver role strain.

Two hours after receiving a pain medication, the client states he still is suffering from pain. Which question is appropriate to ask the client first?

"Tell me more about your pain." Pain intensity indicates the magnitude or amount of pain perceived. Terms used to describe pain intensity include none, mild, slight, moderate, severe, and excruciating. Pain intensity also may be described on a numeric scale. The most appropriate assessment question is one which allows for all information and is a broad question.

The nurse is caring for four clients. Which client does the nurse identify as the most likely to have undertreated pain? (Select all that apply.)

29-year old who has a speech impediment 34-year old with schizophrenia 41-year old who is from a different country a) 60-year old with early onset dementia Clients who are most likely to have underassessed and undertreated pain include infants; children younger than 7; culturally diverse clients; clients with mental challenges, dementia, hearing, or speech impairment; or those who experience psychological disturbances. The client with a broken ulna and the client with recurrent pancreatitis are not as likely to have undertreated pain.

A postsurgical patient has been ordered a patient-controlled analgesia (PCA) pump that administers a specified dose of morphine when the patient pushes a button. The nurse determines that the patient is experiencing severe pain, and assessment reveals that the patient has been reluctant to use the PCA because of her fear of addiction. What information should the nurse's patient education include?

Addiction resulting from opioid use during illness is exceedingly rare. Addiction is very rare in persons suffering from terminal conditions, and concerns about it should not preclude the consideration of opioids for people in intractable pain. Addictions are not necessarily self-limiting conditions and the patient would benefit from education, not a consultation with addictions services. Tolerance is different from addiction and is an expected phenomenon.

A patient has been achieving pain control after foot surgery by using hydromorphone (Dilaudid), an opioid analgesic. When planning to address the potential adverse effects of this treatment, the nurse should prioritize which of the following interventions?

Administering stool softeners and increasing fluid intake to prevent constipation Opioids nearly always cause constipation; the nurse must take a proactive approach in managing this adverse effect. The patient is much less likely to experience falls or confusion, although there is a possibility of these adverse effects. Opioids cause respiratory depression, but this does not normally create a need for supplementary oxygen. A soft diet and low-residue foods will not normally prevent nausea.

A patient has been experiencing increasingly severe pain after suffering burns in a workplace accident. What pain management strategy is most likely to address the patient's pain?

Around-the-clock, scheduled dosing of analgesics supplemented by additional doses when needed Constant pain requires around-the-clock administration of analgesics to maintain therapeutic levels of analgesia. Access to additional analgesia for breakthrough pain is critical and must be built into the treatment plan. Pain medications should not be withheld overnight in patients with severe pain. Pain control, not minimizing of dosing, is the goal of pain management. Patients must not be encouraged to endure their pain until it becomes unbearable.

A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation?

Ask the boy to draw a cartoon about the color or shape of his pain. Asking the boy to draw a cartoon about the color or shape of his pain is an excellent intervention by the nurse. The child could be in pain and not complaining, so ignoring the boy's pain is not correct. Distracting the boy so he does not notice his pain would not be appropriate. Medicating the boy with analgesics to reduce the anxiety of experiencing the pain is not correct. Addressing the anxiety does not address the pain.

A client reports a dull, aching pain to his right flank where he was struck during a football game one week ago. What is responsible for the transmission of such pain?

C-fibers Stimulation of C-fibers, which are slow conducting fibers, is responsible for the dull and poorly localized pain persistent after the injury. A-delta fibers give rise to bright, sharp, and well-localized pain that is immediately associated with the injury. The frontal lobe of the brain is not directly involved in the physiology of the pain response. The spinal dorsal complex horn is the site where complex processing of messages occurs.

How should the nurse position the head of the bed for a client receiving epidural opioids?

Elevated 30 degrees The nurse should position the head of the bed so that it is eleveated 30 degrees unless contraindicated. Elevation of the client's head minimizes upward migration of the opioid in the spinal cord, thereby decreaseing the risk for respiratory depression.

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort?

Endorphins Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals, which have prolonged analgesic effects and produce euphoria. It is thought that certain measures, such as skin stimulation and relaxation techniques, release endorphins.

Which of the following is considered to be the most potent neuromodulators?

Endorphins Endorphins and enkephalins are opioid neuromodulators. Endorphins are powerful pain blocking chemicals with prolonged analgesic effects. Enkephalins are considered less potent. There are no neuromodulators called efferent or afferent.

When asking an older adult client about abdominal pain, the client reports, "I don't want to be a bother because nothing hurts too much." The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action?

Gently mention that the client appears to be experiencing pain that can be treated. Pain is underdetected and poorly managed among older adults, because they often do not want to be perceived as a complainer, or they feel that pain is part of growing older. The nurse should gently mention that the client appears to be experiencing pain that can be treated, and then continue the conversation by reassuring that the client is not a bother. Documenting without addressing the client's report, confirming age as a reason for pain, and reminding that pain can be tolerated are inappropriate nursing actions.

A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find?

Guarding of the chest area A person's behavioral response to pain can be demonstrated by protecting or guarding the painful area, grimacing, crying, or moaning. Increased blood pressure and respiratory rate are typical physiologic (sympathetic) responses to moderate pain. Decreased heart rate is a typical physiologic (parasympathetic) response to severe pain.

The nurse that ascribes to the gate control theory of pain would be most likely to prescribe which of the following for the relief of pain? (Select all that apply.)

Heat Massage Cold The gate theory supports that the signals at the gate in the spinal cord determine which impulses eventually reach the brain. A limited amount of sensory information can be processed by the nervous system at any given moment. When there is too much information sent through, certain cells in the spinal column interrupt the signal as if closing a gate. The theory appears to explain why mechanical and electrical interventions such as heat, cold, pressure, and massage provide effective pain relief.

The nurse likes to use humor to help clients deal with pain. What guidelines should the nurse follow when using humor to foster pain relief?

Humor should take into account the client's personality and circumstances. Humor should be used only with clients who are responsive to it and wish to use it. Consequently, the nurse must assess the client's personality and circumstances carefully. It should not normally be used in the presence of moderate or severe pain, though it can be used, if appropriate, when caring for older clients or those from other cultures.

The nurse recognizes which of the following statements is true of chronic pain?

It may cause depression in clients. Chronic pain may lead to withdrawal, depression, anger, frustration, and dependency. Clients have difficulty describing chronic pain because it may be poorly localized. Moreover, health care personnel have difficulty assessing it accurately because of the unique responses of individual clients to persistent pain. Chronic pain is commonly characterized by periods of remission and exacerbation.

A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing?

Neuropathic pain The client is experiencing neuropathic pain or functional pain. Neuropathic pain is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. In cutaneous pain, the discomfort originates at the skin level. In visceral pain, the discomfort arises from internal organs caused from a disease or injury. In chronic pain, the discomfort lasts longer than 6 months.

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client?

Opioid analgesics The nurse would expect to administer opioid analgesics to a client with severe pain following a mastectomy. Nonopioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are usually the drugs of choice for both acute and persistent moderate chronic pain. Corticosteroids would be used to address inflammation and swelling.

Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients?

Pain assessment may require multiple methods in order to ensure accurate pain data. It is often necessary to use more than one technique for pain assessment in children. Though their neurologic system is indeed developing, children feel pain acutely, and it is inappropriate to withhold analgesics until they are a "last resort." It is simplistic to specify a numeric pain scale for all clients above a certain age; the assessment tool should reflect the client's specific circumstances, abilities, and development.

A client has an order for a narcotic analgesic every 3 to 4 hours and he received his last dose 3 hours earlier. Which action is most appropriate for the nurse to take in response to the client's request for pain medication on his first postoperative day?

Provide the client with pain medication. Inadequate or poor pain assessment is a leading factor in poor pain control, because the health care professional may not know a client has pain. The nurse must provide the next dose of pain medication.

A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics?

Sedation Opioids and opiates can cause sedation, nausea, and constipation. They also can cause respiratory depression, which is the main side effect to watch for with narcotics. Opioids and opiates do not lead to anxiety, diarrhea, or insomnia in clients.

The nurse is working with a patient who lives with chronic pain as the result of an autoimmune disease. When planning this patient's care, the nurse should consider what aspect of the patient's suffering?

Suffering is likely to affect every dimension of the patient's life. Suffering has physical, emotional, cognitive, cultural, social, existential, and spiritual aspects and is a profoundly personal and subjective experience. Consequently, it affects each dimension of an individual's life. It is not purely psychological and cannot always be completely relieved. The suffering individual can influence his or her experience of suffering, but so can other people, including nurses. TAKE A PRACTICE QUIZ

Who is the authority on the presence and extent of pain experienced by a client?

The client The only one who can be a real authority on whether, and how, an individual is experiencing pain is that individual.

A nurse implements cutaneous stimulation for a client as part of a strategy for pain relief. Which nursing action exemplifies the use of this technique?

The nurse gives the client a massage before bed. Some forms of cutaneous stimulation include the following: massage, application of heat or cold (or both intermittently), acupressure, transcutaneous electrical nerve stimulation (TENS). All the options listed are examples of complementary and alternative relief measures, but only massage is an example of cutaneous stimulation.

A client asks the nurse which vitamins should be taken daily for feelings of fatigue, anxiety, and depression 1 week before menses. Which of the following is the correct response by the nurse?

Vitamin B6 The nurse should encourage taking Vitamin B6 daily, as it may be effective at relieving symptoms of irritability, fatigue, and depression related to the premenstrual period.

The triage nurse is assessing a 5-year-old client who has come to the emergency department with a caregiver after falling off of a skateboard. Which pain assessment tool will the nurse choose to use?

Wong-Baker FACES® scale Children as young as 3 years of age can use the Wong-Baker FACES® scale. A word, numeric, or visual analog scale are more appropriate for adults.

When the male client on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should:

actively solicit information about the client's pain level. Some cultures see pain tolerance as a virtue; often men are expected to tolerate pain more stoically than women do. Health care providers need to recognize the client's cultural beliefs and not impose their own judgments.

A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as:

biofeedback. Biofeedback is a technique that uses a machine to monitor physiologic responses through electrode sensors on the client's skin. The unit transforms the data into a visual display, and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers. Hypnosis is an alteration in a person's state of consciousness so that pain is not perceived as it normally would be. Therapeutic Touch involves using one's hands to direct an energy exchange consciously from the practitioner to the client in order to facilitate healing or pain relief.

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a p.r.n. drug regimen as an effective method of pain control would be the client:

in the postoperative stage with occasional pain. A p.r.n. (as needed) medication would be most appropriate for a client in the postoperative stage with occasional pain. A client in the early postoperative period would benefit from the dosage of pain medication with around the clock dosing. A client experiencing chronic pain would benefit from the dosage of pain medication with around the clock dosing. A client experiencing acute pain would benefit from the dosage of pain medication with around the clock dosing.

A client describes pain in the lower leg and has been diagnosed with a herniated lumbar disk. The pain in the leg is what type of pain?

referred pain Pain from the abdominal, pelvic, or back region may be referred to areas far distant from the site of tissue damage.

Besides controlling pain of the postabdominal surgery client with narcotics, the nurse suggests to the client that he:

use distraction. Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions.