Case Study Hip Fracture

Case study of hip fracture
Renad Bader Aljohani
4250199
Group B
Patient profile
39-years-old male weigh 54kg height 162cm with a past history of
epilepsy got admitted to the hospital after falling down. The admitting
diagnosis Was hip fracture. The patient is underweight suffering from
anemia and malnutrition. His Post operation vital signs were normal
With 75bpm, 140/73 mmHg and 37.2c. He was uncooperative and
irritated.
Hip fracture (femoral neck fracture)
Introduction
A hip fracture is a break in the upper portion of the femur
(thighbone). Hip fractures are common in older people and require
admission to hospital and surgical repair. They are associated with
high rates of morbidity and mortality, so skilled nursing assessment
and management, alongside collaborative interprofessional working,
are needed to optimise outcomes. Fracture care should include
secondary prevention of fragility fractures through the assessment and
management of osteoporosis and risk of falls. This case study will
describes the mainstay of nursing care on admission, during hospital
stay, before and after surgery, and in preparation for discharge.
Current diagnosis
Right hip fracture
Nursing diagnosis
Acute pain related to tissue trauma secondary to right hip fracture
after falling down.
Planning and goals

Relief of pain.
Achieve a pain-free, functional, and stable body part.
Maintain asepsis.
Maintain vital signs within normal range.
Exhibit no evidence of complications.
Current plan
The patient reported pain intensity 6 in a scale of 10 when he first
admitted to the ER, and over the days the intensity of pain decreased
to 1. Vital signs and asepsis is maintained. The functionality of the
body part is still not stable because the patient is still in recovery after
the operation.
Recommendation
The patient only got paracetamol he looked irritated and in pain and
The existing evidence regarding the impact of paracetamol on this
vulnerable group with unique analgesia requirements As bone
fractures -to- but maybe
The sedation choices is limited because the patient is epileptic.
Peri-operative care
In 2016, only 2% of patients with hip fracture received non-surgical
treatment. As many patients with hip fracture have complex medical
l be anxious at the
prospect of surgery, so when discussing diagnosis and treatment, it is
the opportunity to ask questions.
Open discussion with patients and relatives about the risks of surgery
is important; while good management reduces mortality, hip fracture
remains associated with a high mortality rate within the first year of
injury. Approximately 20% of hip fracture patients experience serious
adverse events during their hospital stay.
Time to surgery has been identified as a key factor in minimising

complications. Adults should have surgery on a planned trauma list on
the day of, or the day after, admission. This requires interprofessional
collaboration and coordination to ensure patients are optimised for
surgery in a timely manner. In most large hospital trusts, this is done
by a trauma coordination service which will prioritise patients.
Ongoing inpatient care

During their stay in hospital, patients should have physiological signs
regularly monitored using the National Early Warning Score
(NEWS). This involves assessing respiratory rate, oxygen saturation,
temperature, blood pressure, heart rate and neurological status.
Fluid and electrolyte balance needs attention, as abnormalities are

common and up to one-third of patients with hip fracture present to
hospital with some degree of renal impairment. Fluid balance should
be closely monitored, as patients are at risk of blood loss due to the
fracture and after surgery. While an initial blood pressure of
120/80mmHg may be satisfactory in many patients, it may reflect a
significant drop in those who are usually hypertensive. Some patients
may be dehydrated on admission and need intravenous fluids.
Current plan
vital signs is taken every six hours.
monitored.
Recommendation
Taking the vital signs more regularly because the difference in results
were significant. Monitor fluid And electrolyte balance.
Care in preparation of discharge
After surgery, a coordinated multidisciplinary approach is required to
ensure that patients have the best chance to regain mobility and return
to their pre-fracture level of independence.. At a 120-day follow-up of
mobilisation reduces the incidence of post-operative complications

and increases the chance of early recovery. Similarly, higher levels of
mobility are associated with a shorter length of stay.
A history of falls in the past year is a key predictor of further falls, so
risk factors. This requires multidisciplinary assessment and possibly

referral to a specialist falls assessment team. Factors to consider
include hazards in the home such as rugs, ill-fitting footwear and poor
lighting. Simple equipment such as rails, walking aides or perch
stools may support independent living and reduce the risk of falls.
Community assessment and follow-up should be arranged if
appropriate.
As many patients sustain their hip fracture from a fall, it is important
to consider the possible psychological impact of the fall. Fear of
falling is a significant predictor of poor quality of life, so
interventions aimed at reducing that fear may significantly improve
quality of life.
Nursing Interventions
Assess pain
Assess the factors that increase pain and eliminate those factors
Administer pain medication as prescribed by the physician
instruct the patient regarding proper methods to control edema
and pain.
It is important to teach exercises to maintain the health of the
unaffected muscles and to increase the strength of muscles
needed for transferring and for using assistive devices.
Plans are made to help the patients modify the home
environment to promote safety such as removing any
obstruction in the walking paths around the house.
Wound management. Wound irrigation and debridement are
initiated as soon as possible.
Elevate extremity. The affected extremity is elevated to
minimize edema.
Signs of infection. The patient must be assessed for presence of
signs and symptoms of infection.
Evaluation
The following should be evaluated for a successful implementation
of the care plan.
Pain was relieved.

Achieved a pain-free, functional, and stable body part.
Maintained asepsis.
Maintained vital signs within normal range.
Exhibited no evidence of complications.
Laboratory tests
If the diagnosis of hip fracture is still under consideration after taking
into account the patient's history and presentation, laboratory studies
should be ordered based on the patient and the potential for surgery.
Laboratory studies to consider may include the following:
Complete blood cell (CBC) count
Electrolytes evaluation
Serum urea nitrogen value
Creatinine value
Glucose level
Urinalysis (UA)
Prothrombin time (PTT)
Activated partial thromboplastin time (APTT)
Arterial blood gas (ABG) determination
These studies are used to determine the patient's medical condition
before surgery and to allow correction of any abnormalities before
surgical intervention.
Current plan
The patient did the complete blood cell count, glucose level, serum
union nitrogen value, creatinine value, Arterial blood gas (ABG)
determination.
Recommendation
The patient still has some more recommended lab test to do like
Electrolytes evaluation, Urinalysis (UA), Prothrombin time (PTT),
Activated partial thromboplastin time (APTT).
Imaging Studies
In addition to the recommended laboratory studies in a patient
suspected of having a hip fracture, the physician should also
obtain a chest x-ray film and an electrocardiogram (ECG)
tracing to further assess the patient's medical condition before
any surgical intervention.
X-ray films are always indicated to determine which type of

fracture, if any, is present. Anteroposterior (AP) views of the
pelvis and hip and cross-table lateral x-ray films are usually
sufficient to evaluate potential fractures. Rotating the affected
leg internally or externally can increase the sensitivity of these
radiographs.
If the clinical picture is highly suggestive of a fracture and the x-

ray findings fail to demonstrate a fracture, magnetic resonance
imaging (MRI), linear tomography, or bone scanning can be
useful in defining otherwise imperceptible fractures.
A bone scan displays a radiographically occult fracture 80% of
the time 24 hours after an injury, and it also shows almost all
fractures after 72 hours.
MRI is able to show areas of decreased signal in the marrow of

the involved bone soon after the injury.
Current plan
The patient did Some x-rays And ECG. Because the chief complain
was falling down The patient needed to do punch of x-rays (chest x-
ray, right and left hip x-ray, knee x-ray right lateral, pelvis x-ray, hip
x-ray right lateral).
Recommendation
found MRI specificity and sensitivity was near 100% for hip and
pelvic fractures. MRI also offers the ability to identify other soft
tissue problems that may be the source of pain, such as tumors,
muscle tears, and hematoma. an MRI is recommended.
Medication
Nearly all patients with a femoral fracture are in significant pain, and
parenteral analgesia should always be a consideration. Preoperative
prophylactic antibiotics are recommended for the patient undergoing
immediate internal fixation.
Antibiotics
Antibiotic therapy must be comprehensive and cover all likely
pathogens in the context of the clinical setting.
Cefazolin (Ancef, Kefzol, Zolicef)

Tobramycin (Nebcin)
Ampicillin and sulbactam (Unasyn)
Gentamicin (Gentacidin, Garamycin)
Analgesics
Pain control is essential to quality patient care. Analgesics ensure
patient comfort, promote pulmonary toilet, and have sedating
properties, which are beneficial for patients who have sustained
trauma or who have sustained injuries.
Morphine (Astramorph, Depodur, Duramorph)

Ketorolac (Toradol)
Current plan
The patient is on Cefazolin (Ancef, Kefzol, Zolicef), paracetamol,
gentamicin, tramadol hydrochloride, enoxaparin sodium.
Recommendation
as mentioned before the patient is epileptic so you should be careful
about the opioid and sedative used and their dose.
Risk Factors for Hip Fracture

A risk factor is anything that may increase a person's chance of
developing a disease. It may be an activity, diet, family history, or
many other things.
Excessive alcohol and caffeine consumption
Lack of physical activity
Low body weight
Tall stature
Vision problems
Dementia
Medications that cause bone loss
Cigarette smoking
Increased risk for falls, related to conditions such as weakness,
disability, or unsteady gait
As we see the patient has three of the risk factors which led to a hip
fracture. low body weight, dementia, Increased risk for falls, related
to conditions such as weakness, disability, or unsteady gait (epilepsy).

Case Study Hip Fracture

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Case Study Hip Fracture

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Case study of hip fracture

Renad Bader Aljohani

Hip fracture (femoral neck fracture)

Planning and goals

Time to surgery has been identified as a key factor in minimising

Ongoing inpatient care

Fluid and electrolyte balance needs attention, as abnormalities are

mobilisation reduces the incidence of post-operative complications

risk factors. This requires multidisciplinary assessment and possibly

Pain was relieved.

X-ray films are always indicated to determine which type of

If the clinical picture is highly suggestive of a fracture and the x-

MRI is able to show areas of decreased signal in the marrow of

Cefazolin (Ancef, Kefzol, Zolicef)

Morphine (Astramorph, Depodur, Duramorph)

Risk Factors for Hip Fracture

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