Orthopaedic nursing
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Orthopaedic nursing · Mar 2015
Gentle persuasive approaches: introducing an educational program on an orthopaedic unit for staff caring for patients with dementia and delirium.
Gentle Persuasive Approaches in Dementia Care (GPA), a curriculum originally designed for long-term care, was introduced into an acute care setting. This person-centered approach to supporting and responding to persons with behaviors associated with dementia was shown to be applicable for staff on an orthopaedic surgery unit where they had reported significant challenges and care burdens when faced with behaviors such as shouting, explosiveness, and resistance to care. ⋯ Some of the staff on the orthopaedic unit became certified GPA coaches. The passion of those champions, along with demonstrated success of the program on their unit, contributed to its spread to other units, including rehabilitation and acute medicine.
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Perioperative bleeding is a prevalent risk of elective joint replacement surgery that can lead to allogeneic blood transfusions, delayed discharge, and slowed physical therapy progress. Antifibrinolytics such as tranexamic acid (TXA) have been used in various surgical procedures to reduce bleeding; however, the use of TXA in orthopaedic surgery is not widespread. ⋯ Therefore, researchers conclude that intravenous TXA use does decrease total blood loss and allogeneic blood transfusion needs. Thus, its use should be included in orthopaedic clinical practice guidelines due to its overall positive effect on outcomes.
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Orthopaedic nursing · Sep 2014
Pain management after total knee arthroplasty: a case–control study of continuous nerve block therapy.
Continuous femoral nerve block infusions (CFNBIs) have been found to both decrease patient postoperative pain and improve postoperative joint mobilization, both of which impact patient satisfaction, outcome, and length of stay. When we began the use of CFNBIs, we needed to create a policy, process, standing order form, and staff education plan as well as a means to maximize therapy efficacy and believed that a research study would best meet those needs. ⋯ This study has added to previous research that supports CFNBI as a proven therapy to decrease postoperative pain in patients undergoing total knee arthroplasty. The structure of a research project facilitates the implementation, evaluation, and improvement of such new therapies. Evaluating patient data allows identification of process improvement areas—in our case, the change in drug concentration—as well as the need for staff education aimed at facilitating their active participation in CFNBI therapy.
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Orthopaedic nursing · Jul 2014
Comparative StudyThe traditional method of oral as-needed pain medication delivery compared to an oral patient-controlled analgesia device following total knee arthroplasty.
As-needed (PRN) oral pain medication is an essential part of multimodal pain therapy. Medication delivery is often delayed because of multiple demands upon nursing time in a busy postoperative nursing unit. Postoperative pain control was compared using either the manual delivery of PRN oral pain medication or a bedside oral patient-controlled analgesia device. ⋯ Device patients had significantly better pain scores than the usual care group on postoperative Day 2 and within the last 24 hours prior to discharge. The device group reported statistically less pain interference overall with general activity, mood, physical therapy, sleep, and appetite. Use of an oral patient-controlled analgesia device may improve pain management and patient function following total knee arthroplasty compared to the traditional delivery of oral PRN pain medication.
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Postoperative confusion is a common complication in older adults, particularly after total joint replacement (arthroplasty). Confusion after surgery can result in slower mobility progression, longer hospital stay, and increased patient distress. Postoperative pain has been shown to be a risk factor related to confusion; however, there is limited evidence regarding pain level, medication use, and confusion development in postoperative arthroplasty patients. ⋯ Patients receiving lower amounts of opioids in the first 48 hours after surgery were more likely to be confused on POD 1(p = .023) and POD 2 (p = .049).