Transcript Hip Fractures

CONCEPT MOBILITY
HIP FRACTURES
HIP FRACTURE OBJECTIVES
 Explain the exemplar hip fractures (including definition,
antecedents, and attributes).
 Analyze conditions which place a patient at risk for hip
fractures.
 Recognize the negative and positive consequences of hip
fractures.
 Discuss the interrelated concepts that work together to ensure
positive outcomes related to hip fractures.
HIP FRACTURE OBJECTIVES
 Discuss the interrelated concepts that if depleted or impaired
can cause a negative consequence in ensuring positive
outcomes of hip fractures.
 Apply the nursing process (including collaborative
interventions) for individuals experiencing a hip fracture and
promote normal healing.
HIP FRACTURE
 Common among older adults
 90% due to fall
 320,000 hospital admission annually
 By age 90 approximately 33% of all women and 17%
of men
 30% will die within 1 year of injury
HIP FRACTURE DEFINED
 Fracture of the proximal third of the femur
 Intracapsular fracture- fractures that occur within the hip
joint capsule (femoral neck)
 These fractures are often associated with osteoporosis and
minor trauma
1. Capital – fracture of the head of the femur
2. Subcapital – fracture just below the head of the femur.
3. Transcervical – fracture of the neck of the femur.
 Extracapsular fracture- occur outside the joint capsule
 These fractures are usually caused by severe direct trauma or
a fall
FRACTURE OF HIP
Fig. 63-17. Femur with location of various types of fracture.
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RISK FACTORS
 Complete mobility and strength to immobility
 Chronic health problems
 65 years of age and older, more frequent
 Environmental hazards
 Women due to osteoporosis
 Post menopausal women
 Trauma
 Multiple medication usage
CLINICAL MANIFESTATIONS
 External rotation
 Muscle spasm
 Shortening of extremity
 Severe pain
 Radiograph (X-ray)
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COLLABORATIVE CARE
 Open reduction
 Surgical repair
 Closed reduction
 Buck’s traction
FRACTURE OF HIP
Fig. 63-18. Types of internal fixation for a hip fracture. A, Femoral head endoprosthesis.
B, Type of hip compression screw with side plate.
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affiliate of Elsevier Inc.
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BUCK’S TRACTION
Fig. 63-10. Buck’s traction. Most commonly used for fractures of the hip and femur.
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affiliate of Elsevier Inc.
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FRACTURES
Fig. 63-10. Buck’s traction. Most commonly used for fractures of the hip and femur.
Copyright © 2011, 2007 by Mosby, Inc., an
affiliate of Elsevier Inc.
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NURSING MANAGEMENT
NURSING ASSESSMENT
 Objective Data
 Complete
physical and focused assessment
 Deformity
or unnatural position of affected limb
 Edema and ecchymoses
 Muscle spasm
 Tenderness and pain
 Loss of function
 Numbness, tingling, loss of distal pulses
Copyright © 2011, 2007 by Mosby, Inc., an
affiliate of Elsevier Inc.
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NURSING MANAGEMENT
NURSING ASSESSMENT
 Subjective data
 Past health history



Traumatic injury

Bone or systemic disease

Prolonged immobility

Osteopenia

Osteoporosis
Medications
•
Use of corticosteroids (osteoporotic fracture)
•
Analgesics
Surgery or other treatments
•
Previous musculoskeletal surgeries
NURSING MANAGEMENT
NURSING ASSESSMENT
 Subjective data
 Health perception–health management
• Estrogen replacement therapy
•

Activity-exercise
•
•

Calcium supplements
Loss of motion or weakness
Muscle spasms
Cognitive-perceptual
•
•
Sudden and severe pain in affected areas
Numbness, tingling, loss of sensation
NURSING MANAGEMENT
NURSING ASSESSMENT
 Neurovascular assessment:

Peripheral vascular assessment
 Color
 Temperature
 Capillary
refill
 Peripheral pulses
 Edema

Peripheral neurologic assessment
 Sensation
 Motor
 Pain
function
NURSING MANAGEMENT
NURSING DIAGNOSIS
 Acute Pain
 Risk for Peripheral Neurovascular Dysfunction
 Risk for Infection
 Impaired Physical Mobility
 Disturbed Sensory Perception: Tactile
 Ineffective Self-Health Management
 ND related to Postoperative Surgical Procedure
NURSING MANAGEMENT
PLANNING
 Overall goals
 Have
physiologic healing with no associated
complications
 Achieve maximal rehabilitation potential
 Obtain pain relief adequate to allow for rest and
comfort
 Experience no complications as a result of
fracture or treatment
 Experience no ongoing loss of function as a
result of fracture
Copyright © 2011, 2007 by Mosby, Inc., an
affiliate of Elsevier Inc.
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NURSING MANAGEMENT
INTERVENTIONS
 Closed Reduction
 Buck’s
Traction – immobilization and manage
muscle spasms
Maximum of 24 to 48 hours
• inspect exposed skin regularly
• assess bony prominences
• maintain appropriate extremity alignment
• NV assessment
• monitor and maintain weights
NURSING MANAGEMENT
INTERVENTIONS
 Open Reduction and Internal Fixation
 Surgical
repair
Early immobilization
Decreases risk of major complications
Includes internal fixation with use of wires,
screws, pins, plates, intramedullary rods, or
nails
NURSING MANAGEMENT
INTERVENTIONS

Preoperative Care:



Pain control
 Traction
 Analgesics
 Muscle relaxants
 Comfortable positioning
 Safety measures
Neurovascular assessment
Teaching
 Exercising unaffected leg and arms
 Overhead trapeze bar
 Post operative surgical ex: TCDB, infection control, DVT
prevention
NURSING MANAGEMENT
INTERVENTIONS
 Post operative Care:
 Monitor VS and Neurovascular assessment
 I &O
 Respiratory activities ex: TCBD and Incentive Spirometry
 Pain control
Analgesics
 Muscle relaxants
 Comfortable positioning/alignment
 Safety measures
 Elevate extremity



Incision Care
Constipation
 Explain collaborative care of hip fracture.
PATIENT AND CAREGIVER TEACHING
 Prevent prosthesis dislocation
 Large pillow between legs when turning
 Avoid extreme hip flexion
 Avoid turning onto affected side
NURSING MANAGEMENT
NURSING IMPLEMENTATION
 Health promotion
 Public should be taught to take appropriate safety
precautions.
 Nurses should advocate for personal actions to
decrease injuries.
 Encourage moderate exercise to keep muscles strong
and maintain balance.
 Calcium and vitamin D intake
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affiliate of Elsevier Inc.
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NURSING MANAGEMENT
AMBULATORY AND HOME CARE
• Psychosocial problems


Short-term rehabilitative goals
• Transition from dependence to independence
in performing simple activities of daily living
• Preserve or ↑ strength and endurance
Long-term rehabilitative goals
• Prevent problems associated with
musculoskeletal injury
Copyright © 2011, 2007 by Mosby, Inc., an
affiliate of Elsevier Inc.
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