MrsFirth is an 83 year old Female with a history of hypertension andrecurring UTI which sees her visit her local GP on frequentoccasions. She is otherwise healthy and was admitted to the hospitalfor treatment of a possible fracture after a fall in her garden. Shehadno recollection of how long she was on ground but was conscious.Reports severe pan in right leg and was unable to move right leg wasin an external rotation abduction position. Taken to ed by ambulance.X-rays led to diagnosis of fractured neck of femur. The patient isbooked for surgery later today or tomorrow.Worried she is not telling truth about pain. She declined panadineforte a few times since arriving in hospital. Has had no pain reliefand has not asked for any. She does not interact with staff unlessthey go and talk to her. Mrs. Firth says she does not want to botheranyone as she can see everyone is busy.
Temperature:37 degrees Celsius
Pulse:pulsenormally around 70-75bmp
Skinis moist and pale, dilated pupils, sutures intact and dry. Patient iscrunched down in bed which is squashing her abdomen so she’s nottaking deep breaths. Asked if we could give her pain med so we couldmove her so she could breathe more easily and be in better positionfor hip, she refused saying she did not want to be addicted to painmedication. Mrs. Firth never asks for pain med, do not know whatinformation she was given in ed. from conversations with Mrs. Firthshe seems really worried about being addicted to pain med andburdening staff.NursingDiagnosis
Acutepain related to fractured neck of femur. Injury secondaryintervention as evidenced by elevated respiration, dilated pupils,systolic blood pressure and restlessness. Patient also reported 8/10abdominal pain.
Forpain management, it is necessary for a comprehensive analysis of painto include the pain location, duration, onset, characteristics,severity, frequency as well as the precipitating factors.Additionally, there is need for cultural and social influence on painresponse to be taken into consideration due to the impact suchinfluences have on the patient’s attitude (Daniels,2014). Additionally, it is important for non-pharmacologic techniques suchas distraction, music therapy, massage and relaxation to be used dueto the attitude that Mrs. Firth has towards prescribed analgesics.Apart from that, it will be important for factors that increase thepatient’s pain experience such as lack of knowledge, monotony, fearand fatigue to be minimized or eliminated (Carr,Christensen & Layzell, 2010).This will include informing Mrs Firth about the importance of usingpain relieving drugs in her and how their administration would notnecessarily lead to addiction. The effectiveness of the pain controlmeasures also need to be evaluated through the assessment of thepatient’s pain experience (Gulanick& Myers, 2011).Moreeffective measures should be applied if the current measures emergeas being less effective.
Foran effective treatment plan to be created, it is necessary for theclient to describe the pain since it is a subjective experience.Cultural and social influences on pain should be taken intoconsideration because pain is always experienced in an individualmanner through various socio-cultural adaptation techniques (Turk & Gatchel, 2013).It is important for personal factors that enhance the client’s painto be eliminated due to the impact that these factors have on paintolerance. The elimination or reduction of these factors impacts theeffectiveness of the whole pain management program. UtilizationNonpharmacologic techniques have a positive impact on the therapeuticeffects of pain relieving drugs. This is achieved due to theinfluence that the techniques have on the release of endorphins(Carr,Christensen & Layzell, 2010).The evaluation of the effectiveness of the pain management techniqueis important because failure to carry out an evaluation may lead toclients suffering in silence. Studies report that failure to evaluatepain and pain relief approaches on a routinely basis is one of themain causes of for unrelieved pain (Barretal.,2013).
Beforea relaxation technique is selected, it would be important for thepreferences as well as the patient’s past experiences to be takeninto consideration. The relaxation strategy should be able toencourage behaviors such as peaceful imaging, abdominal breathing anddeep breathing which is condition to produce relaxation (Dossey etal.,2012). It will also be necessary for a quiet and comfortableenvironment to be created. The environment should be non-disruptivewith comfortable temperatures. The selected relaxation techniqueshould be shown and practiced with the patient. The patient’sresponse to the selected relaxation technique will also be recordedand evaluated.
Itis necessary for the client to feel comfortable when it comes totheir preferred type of pain management activity. The client shouldthus take part in the planning process of such activities in order tomake them more effective (Barretal.,2013).Behaviors that produce relaxation aid in relieving the pressure onskeletal muscles, which in turn leads to significant reduction in thepain intensity. Such behaviors should thus be encouraged. Creation ofa non-disruptive environment is important as it promotes the client’sfeeling of relaxation by making it possible for the client to keepmore attention of the relaxation approaches being used(Quinlan-Colwell,2014). Demonstrationand practicing of the relaxation techniques makes it possible for theeffectiveness of the techniques to be evaluated. The evaluation ofthe techniques enables the healthcare team to know the mostappropriate and effective strategies to eliminate or reduce pain(Ernst,Pittler, Wider & Boddy, 2007).
Outcomesnot fully met. The client verbalizes discomfort and pain but is yetto agree to take the pain relieving drugs. The patient showswillingness to try the relaxation approach to pain management. Theclient points out that the pain is a 4 on a scale of 0 to 10 afterusing the relaxation approach. Patient understands the utilizationof non-pharmacological approaches to pain relief but is stillreluctant to use pain medication. Assessment of pain will continue,with the goal being to reduce and maintain the levels as low aspossible.
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Daniels,R. (2014). Delmar`s guide to laboratory and diagnostic tests. CengageLearning.
Dossey,B. M., Certificate, C. D. I. N. C., Keegan, L., & Co-DirectorInternational Nurse Coach Association. (2012). Holistic nursing.Jones & Bartlett Publishers.
Ernst,E., Pittler, M., Wider, B., & Boddy, K. (2007). Complementarytherapies for pain management.Edinburgh: Elsevier/Mosby.
Gulanick,M., & Myers, J. (2011). Nursingcare plans.St. Louis, Mo.: Elsevier Mosby.
Quinlan-Colwell,A. (2014). Making an Ethical Plan for Treating Patients inPain. DimensionsOf Critical Care Nursing, 33(2),91-95. doi:10.1097/dcc.0000000000000032
Turk,D. C., & Gatchel, R. J. (Eds.). (2013). Psychological approachesto pain management: a practitioner`s handbook. Guilford Publications.