NURSING DIAGNOSIS: Pain: hip

related to fracture of the bone, tissue trauma, and muscle spasms.

Desired Outcome
The client will experience diminished hip pain as evidenced by:
  1. verbalization of a reduction in pain
  2. relaxed facial expression and body positioning
  3. stable vital signs.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of pain (e.g. verbalization of pain, grimacing, reluctance to move, clutching hip or thigh, restlessness, diaphoresis, increased B/P, tachycardia).
  2. Assess client's perception of the severity of pain using a pain intensity rating scale.
  3. Assess the client's pain pattern (e.g. location, quality, onset, duration, precipitating factors, aggravating factors, alleviating factors).
  4. Implement measures to reduce pain:
    1. perform actions to reduce fear and anxiety about the pain experience (e.g. assure client that his/her need for pain relief is understood, plan methods for achieving pain control with client)
    2. perform actions to reduce fear and anxiety (see Preoperative Diagnosis 1) in order to promote relaxation and subsequently increase the client's threshold and tolerance for pain
    3. administer analgesics before activities and procedures that can cause pain and before pain becomes severe
    4. perform actions to promote rest (e.g. minimize environmental activity and noise, limit the number of visitors and their length of stay) in order to reduce fatigue and subsequently increase the client's threshold and tolerance for pain
    5. perform actions to maintain effective traction on the injured extremity (client is usually placed in Buck's or Russell's traction preoperatively to stabilize and reduce the fracture and reduce muscle spasms and pain):
      1. ensure that weights are hanging freely
      2. do not allow footplate or ropes to rest on end of bed
      3. keep affected heel off bed
      4. keep knots away from pulley device
      5. do not remove traction unless specifically ordered
      6. do not lift the weights in order to facilitate moving the client or performing other care (this reduces traction pull and can cause severe muscle spasm)
      7. limit head of bed elevation to 20-25° except for meals and toileting in order to maintain the prescribed traction force
    6. avoid bumping the traction device
    7. place a trochanter roll or sandbag firmly against the lateral aspect of injured hip and upper thigh (should extend from iliac crest to midthigh) in order to maintain leg in proper alignment
    8. consult physician if extremity appears out of alignment; do not attempt to realign extremity (an attempt to realign the extremity may cause further tissue trauma)
    9. move client carefully, keeping injured extremity well supported
    10. if turning is allowed, place pillow between legs before turning in order to prevent adduction and further strain on the fracture site
    11. provide or assist with additional nonpharmacologic measures for pain relief (e.g. relaxation exercises; diversional activities such as watching television, reading, or conversing)
    12. administer analgesics and muscle relaxants if ordered.
  5. Consult appropriate health care provider (e.g. physician, pharmacist, pain management specialist) if above measures fail to provide adequate pain relief.