acute pain post TKR

I am currently on my ortho inpatients prac and have come to realise just how much pain people who have had TKR`s must have to experience in the first few days. Although they have a PCR and all sorts of drugs available to them, there are still those patients who are in so much pain they find it so hard to bend their knee, which is so important to do as soon as possible. The situation I faced recently involved a 47 year old lady who was day 1 post-op and I was assigned to treat her. She was very teary and in so much pain, and I felt so bad making her do all her exercises. So instead of really pushing her, especially since she was only getting to 30 degrees on the CPM, I would just let her carry on getting to that range, seeing as she was already almost in tears at this stage.

So on day 2, I was assuming she would be automatically better, but again she was at the same range and still in tears. So I started to feel really bad and that I must be really doing something wrong. So eventually I asked my supervisor to go in and see her, which she was happy to do. My supervisor had enough confidence and knowledge that she was able to push her CPM right up to 55 degrees, even though the woman was in so much pain. I felt really bad after this and spoke with my supervisor and said that I felt that I had failed the patient because I had not been cruel to be kind with her. But I also explained that at this stage I did not have the confidence to do what she did without fearing I would really damage the patient.

My question to her was, `when do you learn how far you can push someone`, and `how do you deal with your feelings of guilt when you know you are really hurting someone, even though what you are doing is for their own good`. My supervisor was great and made me realise I had done nothing wrong and that I had done the right thing coming to her for help instead of carrying on as I was, because the patients knee would have suffered. So she made me realise its ok to admit that we cant handle every kind of situation yet, even though we feel we should be able to. So I did learn from this that you can push these patients past their limits and it wont damage their knee, we just need to make absolutely sure they have enough pain cover as possible and always check with your supervisor first so they are aware of the situation.

After this situation, with another patient, I did manage to be a bit firmer with his exercises, and it had such a good result that my confidence in dealing with patients with such bad pain has increased, although it still has a long way to come.