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Nursing Interventions toRelieve Orthopedic PainMaricela Zarate, RN

January 22,2014

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Objective

Cite effective non-pharmacological nursing interventionsfor orthopaedic pain

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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)

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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.

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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

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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.”  

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Cognitive Techniques

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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.)

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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)

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MUSIC(Ware,2013)

• Can reduce stress and create a calmingenvironment

• Contributes to distraction

• Refocusing attention

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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)

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Physical Techniques

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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

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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)

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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.

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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)

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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.

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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

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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.

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Questions???

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