Upload
natalieshirley
View
218
Download
0
Embed Size (px)
Citation preview
8/15/2019 M Zarate Nursing Interventions Ortho Pain
1/30
Nursing Interventions toRelieve Orthopedic PainMaricela Zarate, RN
January 22,2014
1
8/15/2019 M Zarate Nursing Interventions Ortho Pain
2/30
Objective
Cite effective non-pharmacological nursing interventionsfor orthopaedic pain
2
8/15/2019 M Zarate Nursing Interventions Ortho Pain
3/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
4/30
Assessment of the Orthopedic Pain
Pain Assessment Tools
• Pain scale, WONG-Baker FACES scale,Verbal rating scale, etc.
•
Description of the pain• Duration of pain
• What makes it worse or better
Patients with advance dementia
require behavioral observation todetermine the presence of pain.(Wells, Passaro, and McCaffery, 2008)
4
8/15/2019 M Zarate Nursing Interventions Ortho Pain
5/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
6/30
Complementary and AlternativeMedicine((Wells, Passaro, and McCaffery, 2008)
Opioids, nonopioid, and NSAID’s
Alternative Interventions
Effective Communication
Gittell and Colleagues study suggested that communication, goal
setting, and patient education contributed to better pain outcome.
6
8/15/2019 M Zarate Nursing Interventions Ortho Pain
7/30
Patient Education(Wells, Passaro, and McCaffery, 2008)
Done in the Pre-op phase
Ensures the patient is familiar with the scale
Alternatives to pain management
Assess for Coping Techniques
7
8/15/2019 M Zarate Nursing Interventions Ortho Pain
8/30
Coping Techniques(Wells, Passaro, and McCaffery, 2008)
Natural
“Before suggesting or Instructing patients in the use ofnondrug techniques, nurses need to be aware of themethods used effectively and preferred by the patient.”
8
8/15/2019 M Zarate Nursing Interventions Ortho Pain
9/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
10/30
Cognitive Techniques
10
8/15/2019 M Zarate Nursing Interventions Ortho Pain
11/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
12/30
Distraction
Imagery
Slow gentle breathing
Music
One study found that 19% to28% of patientsspontaneously adopt a
distraction technique whilerecovering from total hip ortotal knee arthoplasty
(Pellino, Gordon, Engelke, et al.,2005.)
12
8/15/2019 M Zarate Nursing Interventions Ortho Pain
13/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
14/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
15/30
Relaxation techniques benefit thefollowing conditions (NIH, 2013)
Anxiety
Asthma
Depression
Fibromyalgia
Headache
Heart disease and heartsymptoms
High Blood Pressure
Insomnia
Irritable bowel syndrome
Nausea
Nightmares
Overactive Bladder
Pain
Tinnitus
Smoking cessation Temperomandibular condition
(TMJ)
15
8/15/2019 M Zarate Nursing Interventions Ortho Pain
16/30
MUSIC(Ware,2013)
• Can reduce stress and create a calmingenvironment
• Contributes to distraction
• Refocusing attention
16
8/15/2019 M Zarate Nursing Interventions Ortho Pain
17/30
Choosing MusicSedating or soothing music is
Instrumental Synthesizer
Harp
Piano
Orchestra Slow jazz
The intervention is delivered via audiotapeand headphones. The duration is typically
20-30 minutes and may involve a single ormultiple exposures.(Wells, Pasero, and McCaffery,2008)
17
8/15/2019 M Zarate Nursing Interventions Ortho Pain
18/30
Physical Techniques
18
8/15/2019 M Zarate Nursing Interventions Ortho Pain
19/30
Hand and Foot Massage( Wells, Pasero, and McCaffery, 2008)
• Massage. Recently investigators haveexamined hand and foot massage asan alternative to back or bodymassage.
•
Reviews of the massage literatureconclude it has a beneficial effect on
Anxiety
Tension
Depression Stress hormones
Pain
19
8/15/2019 M Zarate Nursing Interventions Ortho Pain
20/30
Cold for Pain Control
Application of cold for painrelief and reduction ofswelling is recommended by
the American Academy ofOrthopedic Surgeons (2011).
“Ice Compression minimizeswelling and pain”.
(Roberts,2007)
20
8/15/2019 M Zarate Nursing Interventions Ortho Pain
21/30
Research on Cold Therapy
• Cold Therapy has been investigated inpatients undergoing orthopedic surgeries(primarily total knee arthoplasty) and hasbeen found to improve pain, range ofmotion, and function.
• However, a study by Smith and othersfound that pain similar with the cryo padand the compression bandage applied bythe surgeon at the end of surgery; inaddition, the cold therapy increased thecost of care and took more nursing time.
• Thus, using cold therapy via the cryo padprovides no benefit over compressionbandages after knee replacement and isless cost effective.
21
8/15/2019 M Zarate Nursing Interventions Ortho Pain
22/30
Repositioning
“all that may be requiredis to realign the body or
reposition the affectedlimb. Proper bodyalignment is a key factorin patient comfort.”
( Nursing Care Related to theMusculoskeletal System, KindleEdition, ISBN 978-1-78258-128-4)
22
8/15/2019 M Zarate Nursing Interventions Ortho Pain
23/30
Positioning for Better Respiratory andGI function(O’Plasty, 2008)
Assess the patient’s current position in the bed. Note the position of the hips relative to the bed
If the hips are moved to just above the place where the bedbends [___x/, the patient will be able to have better lungand abdominal excursion, thus contributing to enhanced
comfort levels.
23
8/15/2019 M Zarate Nursing Interventions Ortho Pain
24/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
25/30
Safe Repositioning
Never pull the patient by the arm to help her/him rollonto her side
Always use the pad or the flat part of your hand againstthe largest firm patient structure- the hip, upper thigh,mid back between the scapula– to roll a patient to theside.
Source: O’Plasty, A . (2008). Positioning for pain control. Retrievedfrom
http://allnurses.com/geriatric-nusrses-ltc/positioning-pain-control-350770.html
25
8/15/2019 M Zarate Nursing Interventions Ortho Pain
26/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
27/30
8/15/2019 M Zarate Nursing Interventions Ortho Pain
28/30
Conclusion
Pain control is better attained when is managed by properlyassessing the patient’s previous experiences and how theyhave managed it at home. Better outcomes are alsoobtained when pain is managed using complementary andalternative medicine.
28
8/15/2019 M Zarate Nursing Interventions Ortho Pain
29/30
Questions???
29
8/15/2019 M Zarate Nursing Interventions Ortho Pain
30/30