The nurse has completed a comprehensive assessment of a 16-year-old client who has been admitted for treatment for presumptive pelvic inflammatory disease. The client reported that she has been living on the streets with a 27-year-old male

Question

She is curled up in the fetal position in bed, and when asked about her pain level, she cries out that she is in severe pain, that is "way over the top" of a 1-to-10 pain scale. She pulls away and flinches when any part of her body is touched. She is febrile and tachycardic. She has been examined and had all necessary labs sent off from the emergency department, and IV antibiotics were started. Since the client has already begun definitive medical treatment for her presumed infection, the nurse identifies the nursing diagnosis of acute pain related to possible pelvic inflammatory disease, and decides that this is the highest priority to address at this time. The appropriate outcome for this nursing diagnosis is: 1. The client's comfort will be achieved and maintained.
2. The client will be discharged to a safe living environment.
3. The client's infection will be eradicated.
4. The client will be reunited with her parents.

Answer 1

The client's comfort will be achieved and maintained.

Rationale: Achieving and maintaining comfort addresses the nursing diagnosis of acute pain related to possible pelvic inflammatory disease identified by the nurse. The other outcomes do not address this nursing diagnosis but may well be considered as a desired outcome for another nursing diagnosis for this client.