Pelvic Fracture and skin care concerns

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Had a pt with an unstable pelvic fracture in this pelvic brace thing that looked like a girdle. I had never seen or dealt with a brace like this before, they had it on when I took her over. She was in ALOT of pain despite generous amts of IV dilaudid via PCA (h/o chronic back and neck pain, been on narcotics for a long time). The poor thing did not want to move even an inch. Even the slightest movement, even laughing, sent her through the ceiling. I felt so bad for her but I was also worried about her skin and wanted to reposition her. She was not having it.

Anybody have any advice on how to minimize her discomfort while maintaining her skin integrity? And if that girdle is supposed to stay on all the time, how can we make sure her bottom stays intact? Thankfully, she had a foley but what about BMs?

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Oh boy, is she surgical soon?

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Apparently it's non surgical.

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Well, poor thing! That is a tough deal. Hmmm. I hope somebody posts with some interesting tricks, as I would like to have a few myself to use!

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Specializes in pediatrics, palliative, pain management.

I would look at how "generous" her dilaudid dosing actually is. Often patients with chronic pain take opioids at home and develop a tolerance -- you comment that she was on opioids previously. I would want to know how much. She will need to be on the same amount previously + extra for this new pain. The actual dose (mg) may seem generous, but if she was on large dosing at home, you may actually be giving less than what she was taking at home! Remember to use the equianalgesic dosing guide to consider the route (po vs IV) and the drug (was she actually taking dilaudid at home). The fact that you say she can't even move tells me her pain is not well controlled. Ensure she is getting the dilaudid regularly not just PRN. Ensure that she is on acetaminophen if no liver concerns, and get her pain assessed and meds increased. Having this much pain is not acceptable and will greatly increase the likelihood of complications (bed sores, pneumonia etc).

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Specializes in Emergency, CCU, SNF.

Check the chart, see if the Ortho doc left instructions, if not call...it may be allowed off for care.

As for repositioning, you have to use several people to logroll her....all at once, no letting her flop, use pillows to help support her as you are rolling her. Important to move the body as a whole, tends to minimize the discomfort.

Long time narc use? Good luck with that!

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nopainnurse- I hear what your saying about making sure she gets what she she takes at home plus.. always drives me nuts when docs don't understand that for chronic pain pts when they coming in for an unrelated surgery! BUT, she is also a very serious COPDer and was desatting and becoming overly sedated on the amt that we had her on. She was also getting NSAIDs but no tylenol, at least not scheduled anyway.

and Kathy313- she's not even an ortho pt, just being seen by a PCP.. if our orthos don't see it as a surgical fix, they don't want any part of the pt. sigh..

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she needs to see a pain specialist stat.

once her pain is controlled, everything else will fall into place.

leslie

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