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Fractured Neck of Femur

Surgical Unit Done by Hind Al-Suwais

Objective:

Introduction Anatomy Clinical Manifestations Medical Management

Postoperative Nursing Management


Nursing Considerations Conclusion

Introduction
The prevention and management of hip fractures involves a wide range of disciplines and most people who sustain the injury require surgery followed by a period of rehabilitation.

Understanding

It is important to understand the anatomic and physiological components of a hip fracture and the treatment involved. Understanding hip fractures and the possible consequences is important for all members of the health care time.

A fractured neck of femur involves the largest bone in the body. It is one of the most important bones involved in ambulation. It is therefore extremely important to assess, educate and treat the patient with a hip fracture. Education of the patient and their family is critical to understanding the significance of the injury.
Linda Altizer 2005:283 -292

Fractures
There are two major types of hip fracture. Intracapsular fractures are fractures of the neck of the femur. Extracapsular fractures are fractures of the trochanteric region and of the subtrochanteric region.

Facts

Average age is over 80 80% are women Majority are post falls Best outcome if surgery is attended within 48hrs. Very High mortality rates

The Facts continued

One in three people who survive a hip fracture return to their previous level of independence. 50% require long term assistance with mobility and ADL.

Clinical Manifestations
With most fractures of the femoral neck, the patient is unable to move the leg without a significant increase in pain. The patient is most comfortable with the leg slightly flexed in external rotation. The diagnosis of fractured hip is confirmed with x-ray.

Medical Management

Temporary skin traction, Bucks extension, may be applied to reduce muscle spasm, to immobilize the extremity, and to relieve pain. Surgical treatment consists of (1) open or closed reduction of the fracture and internal fixation, (2) replacement of the femoral head with a prosthesis (hemiarthroplasty), or (3) closed reduction with percutaneous stabilization for an intracapsular fracture.

Postoperative Nursing Management

Relief of pain and prevention of complications are priorities. Encourages deep breathing, coughing, and foot flexion exercises every 1 to 2 hours. Aadministers prescribed intravenous prophylactic antibiotics and monitors the patients hydration, nutritional status, and urine output. A pillow is placed between the legs to maintain abduction and alignment and to provide needed support when turning the patient.

Reducing Thromboembolic complications


Avoidance of dehydration Early surgery Early mobilisation Teds Clexane/Heparin

Pain management

Nurses are the primary group of healthcare professionals responsible for the ongoing assessment and monitoring of patients to ensure that pain is effectively and appropriately managed. When pain is present or indicated (post-surgery) nurses should assume it is present and provide appropriate treatment.

Referrals
Referrals need to be made to; Physiotherapy- pre surgery for chest physio as well as post for mobility. Occupational therapy- may need home assessment and equipment arranged to make the transition from hospital to home easier. Discharge planner- to help arrange most suitable place for discharge and also help advocate patients needs and services Social worker may also be beneficial if the patient or patients family is having concerns about how things may change financially etc.

Rehabilitation

Starts from day of admission It is important for the patient and the patient family to outline a proposed plan of treatment along with provisional dates for discharge o allow the family to begin planning. Inform the patient that they may need to spend time in a rehabilitation setting post surgery.

Care of the Elderly Patient With a Fractured Hip

Nursing Diagnosis: Acute pain related to fracture, soft tissue damage, muscle spasm, and surgery

Nursing Diagnosis: Impaired physical mobility related to fractured hip


Nursing Diagnosis: Impaired skin integrity related to surgical incision Nursing Diagnosis: Risk for impaired urinary elimination related to immobility

Care of the Elderly Patient With a Fractured Hip

Nursing Diagnosis: Risk for ineffective coping related to injury, anticipated surgery, and dependence Nursing Diagnosis: Risk for disturbed thought process related to age, stress of trauma, unfamiliar surroundings, and medication therapy Nursing Diagnosis: Risk for ineffective health maintenance related to fractured hip and impaired mobility

Conclusion:
Hip # is the most common disabling injury and cause of accidental death in older people. The incidence and the public health and economic consequences of this injury have risen as the population has aged, and this is expected to continue for the foreseeable future.

Conclusion Contd
The prevention and management of hip # involves a wide range of disciplines, and most people who sustain the injury require surgery followed by a period of rehabilitation. The complexity of care needed for hip # makes the condition a real test and a useful marker of the integration and effectiveness of modern health care.

References

C. Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever, "Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 11th Edition Chapter 69

Linda Altizer (2005) Hip Fractures. Orthopeaedic nursing Vol 24. No 4 Pg 283 292

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