Hazel, an 82-year-old female with major neuro-cognitive disorder has fallen and sustained an intertrochanteric fracture. Her treatment plan includes a short gamma nail, and she is awaiting surgery. 

Acute Pain: 

Hazel, an 82-year-old female with major neuro-cognitive disorder has fallen and sustained an intertrochanteric fracture. Her treatment plan includes a short gamma nail, and she is awaiting surgery.

What non-pharmacologic interventions will the nurse, use in the pre-operative phase of nursing care? Post-operatively, what non-pharmacologic interventions will be utilized by the health care team? Explain intervention and rationals

ANSWER

 Non-Pharmacological Interventions for Acute Pain Management in Older Adults with Intertrochanteric Fracture

Introduction: Acute pain management is a crucial aspect of nursing care for older adults, particularly in the pre-operative and post-operative phases. This essay aims to explore non-pharmacological interventions that can be employed by nurses and the healthcare team in the management of acute pain in an 82-year-old female, Hazel, who has sustained an intertrochanteric fracture. The non-pharmacological interventions discussed in this essay aim to optimize pain relief, minimize complications, promote comfort, and facilitat the overall recovery process.

Pre-operative Phase

Positioning and Support

Nurses should ensure proper positioning and support for Hazel to minimize pain and discomfort. Utilizing supportive devices such as pillows or cushions can help alleviate pressure on the affected area. Maintaining proper body alignment can reduce muscle tension and improve overall comfort, enhancing Hazel’s readiness for surgery.

Heat and Cold Therapy

The application of heat or cold therapy to the affected area can provide pain relief. Heat therapy, such as warm packs or warm towels, can promote vasodilation, increase blood flow, and relax tense muscles (Brosseau et al., 2003). Cold therapy, using ice packs or cold compresses, can help reduce swelling, inflammation, and numb the area, thereby alleviating pain.

Distraction Techniques

Engaging Hazel in activities that divert her attention from pain can be an effective non-pharmacological intervention. Nurses can offer her cognitive distractions, such as puzzles, music, or reading materials, to promote a positive distraction from the pain stimuli. By redirecting her focus, the perception of pain can be reduced.

Relaxation Techniques

Implementing relaxation techniques can aid in reducing pain and anxiety levels (Norelli, 2022). Techniques like deep breathing exercises, guided imagery, or progressive muscle relaxation can help Hazel relax and cope better with her pain. These techniques promote the release of endorphins, which are natural pain-relieving substances.

Post-operative Phase

Proper Wound Care

After the surgery, proper wound care is essential to prevent infection and promote healing. Nurses should ensure that the surgical site is clean, dry, and appropriately dressed. Maintaining good hygiene reduces the risk of complications and contributes to overall pain management.

Physical Therapy

Early mobilization and physical therapy play a crucial role in post-operative pain management and functional recovery. The healthcare team should collaborate to develop a personalized rehabilitation plan for Hazel, focusing on exercises that target strength, flexibility, and mobility. Gradual progression in physical activity helps reduce pain, prevent muscle stiffness, and expedite recovery.

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is a non-invasive technique that involves the application of low-voltage electrical currents to the skin through electrodes (Johnson, 2007). TENS works by stimulating nerve fibers, thereby reducing the transmission of pain signals to the brain. This technique can be effective in managing post-operative pain in Hazel, providing a non-pharmacological alternative for pain relief.

Massage Therapy

Gentle massage techniques, such as effleurage or kneading, can help reduce pain, muscle tension, and promote relaxation. Massage increases blood circulation, which aids in the delivery of nutrients and removal of waste products, thereby enhancing the healing process. Additionally, it promotes the release of endorphins, which act as natural pain relievers.

Conclusion

Non-pharmacological interventions play a vital role in managing acute pain in older adults, like Hazel, who have sustained an intertrochanteric fracture. These interventions provide an effective and safe alternative or complement to pharmacological approaches. By incorporating positioning and support, heat and cold therapy, distraction techniques, relaxation techniques, proper wound care, physical therapy, TENS, and massage therapy, healthcare professionals can optimize pain relief, promote comfort, and facilitate the overall recovery process. By adopting a holistic and individualized approach to pain management, nurses and the healthcare team can improve outcomes and enhance the overall well-being of older adults like Hazel.

References

Brosseau, L., Yonge, K., Welch, V., Marchand, S., Judd, M., Wells, G. A., & Tugwell, P. (2003). Thermotherapy for treatment of osteoarthritis. The Cochrane Library. https://doi.org/10.1002/14651858.cd004522 

Johnson, M. H. (2007). Transcutaneous Electrical Nerve Stimulation: Mechanisms, Clinical Application and Evidence. Reviews in Pain, 1(1), 7–11. https://doi.org/10.1177/204946370700100103 

Norelli, S. K. (2022, August 29). Relaxation Techniques. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK513238/