Use Of Middle Range Theory For Pharmacologic Pain Management And Physiologic Responses Of Children With Cerebral Palsy Following Orthopedic Surgery

2.50
Hdl Handle:
http://hdl.handle.net/10755/163766
Category:
Abstract
Type:
Presentation
Title:
Use Of Middle Range Theory For Pharmacologic Pain Management And Physiologic Responses Of Children With Cerebral Palsy Following Orthopedic Surgery
Author(s):
Conway, Alice
Author Details:
Alice Conway, PhD, Assistant Professor, Edinboro University of Pennsylvania, Department of Nursing, Edinboro, Pennsylvania, USA, email: aconway@edinboro.edu
Abstract:
"Finding ways to minimize the pain experience is a priority for all health care professionals" (Trentadue, Kachoyeanos & Lea, 1998, p. 15.). Children with cerebral palsy often have numerous orthopedic procedures to improve their quality of life. Post-operative pain management can be particularly challenging due to spasticity and additional disabilities. A retrospective chart review was done in a pediatric orthopedic hospital to compare three different regimens of morphine infusion and epidural analgesia following orthopedic surgery. The three modes of morphine delivery were continuous infusion, child initiated only, a combination of continuous and child. Bupivicaine with Fentanyl was used for epidural analgesia. Utilizing a hospital committee-developed pain flow sheet, 87 charts were reviewed. Children ranged in age from 2.6 years to 20.6 years and all had diagnoses of cerebral palsy requiring orthopedic procedures. Huth and Moore's 1998 middle range theory of acute pain management was utilized as a theoretical framework for the study. Pain scores were analyzed by a repeat measures ANOVA using standardized drug dosing and benzodiazapine administration as covariates. Categorical variables (incidence of spasms, urinary retention, emesis, pruritis, low oxygen saturation levels) were contrasted using Chi-squared tests. The level of significance for these tests was set at 0.05. Data from the first twelve hours and second twelve hours postoperatively were analyzed. Results indicated there was a statistical significance for patients low pain ratings receiving epidural analgesia versus other modes of delivery. There was an increase in the incidence of spasms and benzodiazapine administration in the continuous plus child administered PCA group. The incidence of urinary retention was high in the epidural group and non-existent in the continuous PCA group in the first 24 hours postoperatively. There was no statistical significance for the variables of oxygen saturation levels, pruritis or emesis in any of the 4 methods of analgesia delivery in the sample. Implications of these results indicate in this sample that epidural analgesia is a safe and effective means of pain management, and results in lower pain scores, in the first 24 hours postoperatively in children with cerebral palsy undergoing orthopedic surgery. Huth and Moore's (1998) model of acute pain management was helpful in organizing this research. Further refinement for its use in special populations is suggested. Lenz, (1995) & Cody's (1999) discourse on the use of middle range theory for the advancement of nursing science will be discussed.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2001
Conference Name:
ENRS 13th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Atlantic City, New Jersey, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleUse Of Middle Range Theory For Pharmacologic Pain Management And Physiologic Responses Of Children With Cerebral Palsy Following Orthopedic Surgeryen_GB
dc.contributor.authorConway, Aliceen_US
dc.author.detailsAlice Conway, PhD, Assistant Professor, Edinboro University of Pennsylvania, Department of Nursing, Edinboro, Pennsylvania, USA, email: aconway@edinboro.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/163766-
dc.description.abstract"Finding ways to minimize the pain experience is a priority for all health care professionals" (Trentadue, Kachoyeanos & Lea, 1998, p. 15.). Children with cerebral palsy often have numerous orthopedic procedures to improve their quality of life. Post-operative pain management can be particularly challenging due to spasticity and additional disabilities. A retrospective chart review was done in a pediatric orthopedic hospital to compare three different regimens of morphine infusion and epidural analgesia following orthopedic surgery. The three modes of morphine delivery were continuous infusion, child initiated only, a combination of continuous and child. Bupivicaine with Fentanyl was used for epidural analgesia. Utilizing a hospital committee-developed pain flow sheet, 87 charts were reviewed. Children ranged in age from 2.6 years to 20.6 years and all had diagnoses of cerebral palsy requiring orthopedic procedures. Huth and Moore's 1998 middle range theory of acute pain management was utilized as a theoretical framework for the study. Pain scores were analyzed by a repeat measures ANOVA using standardized drug dosing and benzodiazapine administration as covariates. Categorical variables (incidence of spasms, urinary retention, emesis, pruritis, low oxygen saturation levels) were contrasted using Chi-squared tests. The level of significance for these tests was set at 0.05. Data from the first twelve hours and second twelve hours postoperatively were analyzed. Results indicated there was a statistical significance for patients low pain ratings receiving epidural analgesia versus other modes of delivery. There was an increase in the incidence of spasms and benzodiazapine administration in the continuous plus child administered PCA group. The incidence of urinary retention was high in the epidural group and non-existent in the continuous PCA group in the first 24 hours postoperatively. There was no statistical significance for the variables of oxygen saturation levels, pruritis or emesis in any of the 4 methods of analgesia delivery in the sample. Implications of these results indicate in this sample that epidural analgesia is a safe and effective means of pain management, and results in lower pain scores, in the first 24 hours postoperatively in children with cerebral palsy undergoing orthopedic surgery. Huth and Moore's (1998) model of acute pain management was helpful in organizing this research. Further refinement for its use in special populations is suggested. Lenz, (1995) & Cody's (1999) discourse on the use of middle range theory for the advancement of nursing science will be discussed.en_GB
dc.date.available2011-10-27T11:13:27Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:13:27Z-
dc.conference.date2001en_US
dc.conference.nameENRS 13th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationAtlantic City, New Jersey, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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