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Nursing Interventions to

Relieve Orthopedic Pain


Maricela Zarate, RN
January 22,2014
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Objective

Cite effective non-pharmacological nursing interventions


for orthopaedic pain

Assessment of Orthopedic Pain


Careful assessment and evaluation to the
patients pain will allow the nursing staff to
determine the appropriate nursing
interventions required .The nursing
management might involve such actions as
repositioning the patient, support or
elevations of the affected limbs, application
of heat or cold, or the administration of
analgesics, sedatives, or muscle relaxants as
ordered by the physician.
(Nursing Care Related to the Musculoskeletal System, Kindle Edition,
ISBN 978-1-78258-128-4.)

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 to
determine the presence of pain.
(Wells, Passaro, and McCaffery, 2008)

Complementary and Alternative


Medicine
Complementary and alternative
medicine can work safely
alongside each other as long as
there is effective communication
between all practitioners as well
as between patients and
practitioners
(Prince of Wales Foundation for Integrated Health, UK, 2003)

Complementary and Alternative


Medicine
((Wells, Passaro, and McCaffery, 2008)

Opioids, nonopioid, and NSAIDs


Alternative Interventions

Effective Communication
Gittell and Colleagues study suggested that communication, goal
setting, and patient education contributed to better pain outcome.

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

Coping Techniques
(Wells, Passaro, and McCaffery, 2008)

Natural
Before suggesting or Instructing patients in the use of
nondrug techniques, nurses need to be aware of the
methods used effectively and preferred by the patient.

Non Pharmacological pain


management Techniques

COGNITIVE

PHYSICAL

1.

Distraction

1.

Massage

2.

Relaxation

2.

Cold Therapy

3.

Music

3.

Repositioning

4.

Elevation, immobilizing
the effected part

Cognitive Techniques

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Distraction

Focusing attention away from the pain

Distraction is Effective

(Wells, Passaro, and McCaffery, 2008)

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Distraction

Imagery
Slow gentle breathing
Music

One study found that 19% to


28% of patients
spontaneously adopt a
distraction technique while
recovering from total hip or
total knee arthoplasty

(Pellino, Gordon, Engelke, et al.,


2005.)

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Relaxation

Its safe

Induce sleep

Reduce pain

Calm emotions

Breathing and focused attention can calm


the mind and body

( NIH National Center for Complementary and Alternative


Medicine, 2013.)

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How Relaxation Techniques May


Work
( National Institutes of Health, 2013)

Contrasts with the fight or flight stress response


Slows the heart rate

Reduces Blood Pressure


Reduces oxygen consumption and levels of stress
hormones
Relaxation techniques may reduce surgery pain, as well
as abdominal pain

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Relaxation techniques benefit the


following conditions (NIH, 2013)
Anxiety

Irritable bowel syndrome

Asthma

Nausea

Depression

Nightmares

Fibromyalgia

Overactive Bladder

Headache

Pain

Heart disease and heart


symptoms

Tinnitus

High Blood Pressure


Insomnia
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Smoking cessation
Temperomandibular condition
(TMJ)

MUSIC

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(Ware,2013)

Can reduce stress and create a calming


environment

Contributes to distraction

Refocusing attention

Choosing Music
Sedating or soothing music is
Instrumental

Synthesizer
Harp
Piano

Orchestra
Slow jazz

The intervention is delivered via audiotape


and headphones. The duration is typically
20-30 minutes and may involve a single or
multiple 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 have


examined hand and foot massage as
an alternative to back or body
massage.

Reviews of the massage literature


conclude it has a beneficial effect on

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Anxiety

Tension

Depression

Stress hormones

Pain

Cold for Pain Control


Application of cold for pain
relief and reduction of
swelling is recommended by
the American Academy of
Orthopedic Surgeons (2011).
Ice Compression minimize
swelling and pain.
(Roberts,2007)

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Research on Cold Therapy

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Cold Therapy has been investigated in


patients undergoing orthopedic surgeries
(primarily total knee arthoplasty) and has
been found to improve pain, range of
motion, and function.

However, a study by Smith and others


found that pain similar with the cryo pad
and the compression bandage applied by
the surgeon at the end of surgery; in
addition, the cold therapy increased the
cost of care and took more nursing time.

Thus, using cold therapy via the cryo pad


provides no benefit over compression
bandages after knee replacement and is
less cost effective.

Repositioning

all that may be required


is to realign the body or
reposition the affected
limb. Proper body
alignment is a key factor
in patient comfort.
( Nursing Care Related to the
Musculoskeletal System, Kindle
Edition, ISBN 978-1-78258-128-4)

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Positioning for Better Respiratory and


GI function
(OPlasty, 2008)

Assess the patients 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 bed
bends [___x/, the patient will be able to have better lung
and abdominal excursion, thus contributing to enhanced
comfort levels.

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Positioning Tips

Are the hips and shoulders in line?


A slight misalignment can cause an unacceptable level of
pain
The patient will be more comfortable with the hips and
shoulders in line and the patients weight distributed
equally over the body.

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Safe Repositioning

Never pull the patient by the arm to help her/him roll


onto her side
Always use the pad or the flat part of your hand against
the largest firm patient structure- the hip, upper thigh,
mid back between the scapula to roll a patient to the
side.
Source: OPlasty, A . (2008). Positioning for pain control. Retrieved
from
http://allnurses.com/geriatric-nusrses-ltc/positioning-pain-control350770.html

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Elevation and Support

An affected limb may


require support or
elevation on pillows in
order to reduce swelling
and reduce strain on the
associated musculature.

( Nursing care of the


musculoskeletal system, Kindle
Edition, 2012)

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Immobilizing the Injured Part


(Roberts, 2007.)

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Prolonged Immobilization
(more than 3 to 4
weeks) of a joint can
cause stiffness,
contractures and muscle
atrophy.

Immobilization decreases
pain and facilitates
healing by preventing
further injury and is
helpful except for very
rapidly healing injuries.

These complications may


develop rapidly and may
be permanent,
particularly in the elderly

Joints proximal and distal


to the injury should be
immobilized.

Conclusion

Pain control is better attained when is managed by properly


assessing the patients previous experiences and how they
have managed it at home. Better outcomes are also
obtained when pain is managed using complementary and
alternative medicine.

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Questions???

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References
Nursing Care Related to the Musculoskeletal System.(2012). Kindle edition. Stanmore, New Zealand:
Powerhouse Publishing. ISBN 978-1-78258-128-4.
OPlasty , A. (2008). Positioning for pain control. Retrieved from http://allnurses.com/geriatricnursesltc/positioning-pain-control-350770.html
Pellino, TA., Gordon, DB, Engelke, ZK, et al. (2005) Use of nonpharmacological interventions for pain
and anxiety after total hip and total knee arthoplasty. Orthopaedic Nursing, 24 (3), 182-90
Roberts, J.R. (2007). Overview of musculoskeletal injuries. Merck Manual for Healthcare Professionals.
Retrieved from
http://www.merckmanuals.com/proffesional/injuries_poisoning/fractures_dislocations_and_sprains/over
view_of_musculoskeletal_injuries_html
Ware, A. (2013). The emerging field of harp therapy and its clinical implications. Journal of the
Australasian Rehabilitation Nurses Association, 162(2),15-17.
Wells, N., Pasero,C., McCaffery, M. (2008). Patient safety and quality: and evidence-based handbook for
nurses, Vol. 1, Chapter 17: Improving the quality of care through pain assessment and management.
Agency for Healthcare Research and Quality.

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