Question

A 79-year-old woman had a femur fracture for which she had an open reduction with internal fixation (ORIF) surgery 6 weeks ago. She has been going to physical therapy (PT) but finds that her pain and anxiety prevent her from following the instructions provided by PT. She continues to take her oral opioid on an as-needed basis and believes that she cannot function without it. Her physical therapist suggests that she look into nonpharmacologic methods of pain management, including improving her spiritual health. Today she is having her follow-up with the orthopedic surgeon. She asks you, the office nurse, for advice on what she should do. The surgeon wants her to discontinue the opioid medication immediately.

2. What are the concerns about her current pain management regimen?

3. Which nonpharmacologic methods might benefit her? How will you determine if they are appropriate for her values and beliefs?

4. Who else on the interprofessional team might be able to help this patient and how?

Answer 1

In this case the patient strongly believes that only opioids work for her to manage pain.The nurse can explain her about the risk factors associated with the long term use of opioids.Educate the the patient that long term use of opioids lead to drug addicton ,which has serious health problems and can lead to death also.Though temporarily it helps to reduce pain and anxiety ,it has majour adverse effects on the physical as well as mental health of the patient.

Pain is always associated with surgery.Advice her to continue the medications as prescribed by her doctor.Ask her to avoid opioids and to continue physiotherapy.Exercises during healing time is very important and helps to restore muscle strength.The best advice which can be given to the patient by the nurse is to follow the instructions of the physiotherapist and to do exercises as prescribed .Inform the patient that it may take 4 to 6 months to heal cmpletely and for a fully recovery.Certain physiotherapy machines and treatments are very helpful to reduce pain like ice application,hot fomentation,electrical stimulation ,taping and manual techniques.

Counselling can be helpful for such patients to make them aware about the importance of physiotherapy and exercises and to avoid the use of opioids.Proper nutrition is very much needed for the healing and speedy recovery of the patient.So the dietetian can help the patient to prepare a menu according to her age and her requirement.Apart from that certain relaxation theray like music therapy,meditation are also helpful.