Initial Discussion Post: An 87 year old female is admitted to the hospital with a diagnosis of a hip fracture secondary to a fall in her home. What clinical manifestations would you expect to see when assessing this patient? What would be three nursing management considerations for this patient pre-operatively? What would be three nursing management considerations post-surgical repair?  What would your neurovascular assessment of the lower extremity include? Are there any positioning considerations, if so what are they?

Clinical manifestations of a hip fracture in an 87-year-old female can vary depending on the severity of the fracture and the overall health status of the patient. However, there are some common manifestations that can be expected during the assessment of this patient.

One of the key clinical manifestations of a hip fracture is severe pain in the hip or groin area. The patient may also experience pain while moving or bearing weight on the affected side. In addition to pain, there may be swelling and bruising around the hip and groin region. The affected leg may appear shorter and may have limited range of motion. It is important to assess for any deformity or abnormal positioning of the leg, as this can indicate a fracture. In some cases, the patient may also experience difficulty walking or being unable to bear weight on the affected side.

When considering nursing management for this patient pre-operatively, there are several key considerations. First, pain management is crucial to ensure the patient’s comfort and minimize further complications. Adequate analgesia should be provided, keeping in mind the patient’s age and pre-existing medical conditions. Second, immobilization of the affected leg is important to prevent further injury and decrease pain. This can be achieved through the use of splints or immobilizers, as well as proper positioning. Lastly, the patient’s overall health status needs to be assessed thoroughly to determine if any additional interventions or precautions are necessary. This may include assessing for comorbid conditions, ensuring proper hydration and nutrition, and evaluating the patient’s ability to tolerate anesthesia and surgery.

Post-surgical repair, there are three key nursing management considerations. First, monitoring and managing post-operative pain is essential to ensure the patient’s comfort and facilitate early mobilization. Adequate pain control measures, such as administration of analgesics or local anesthetics, should be provided promptly. Second, the patient’s mobility and rehabilitation should be initiated as soon as tolerated to prevent complications such as pneumonia, venous thromboembolism, and pressure ulcers. This may involve physical therapy, ambulation, and exercises to strengthen the hip and leg muscles. Lastly, wound care and infection prevention strategies should be implemented to reduce the risk of surgical site infection. This may include proper dressing techniques, administration of antibiotics if indicated, and regular assessment of the wound for signs of infection.

A neurovascular assessment of the lower extremity should be conducted to assess for any compromise in circulation or nerve function. This assessment involves checking the patient’s pulses, color, temperature, and capillary refill of the foot and toes. Peripheral nerve function can be assessed by evaluating the patient’s sensation, motor strength, and range of motion of the foot and toes. Any abnormalities or changes in the neurovascular status should be reported immediately to the healthcare provider.

Positioning considerations are important in the management of a patient with a hip fracture. The affected leg should be immobilized and kept in a neutral alignment to promote healing and prevent further injury. This may involve the use of pillows, splints, or specialized devices to maintain proper alignment. Additionally, the patient’s overall body alignment should be optimized to prevent complications such as pressure ulcers and respiratory infections. Regular repositioning and providing adequate support to pressure points are integral in maintaining proper positioning.

In summary, clinical manifestations of a hip fracture include severe pain, swelling, bruising, limited range of motion, and difficulty walking. Pre-operative nursing management considerations include pain management, immobilization, and assessing the patient’s overall health status. Post-surgical nursing management focuses on pain control, mobility and rehabilitation, and wound care. Neurovascular assessment of the lower extremity is essential to monitor circulation and nerve function. Positioning considerations involve immobilization of the affected leg and maintaining proper body alignment. Effective nursing management strategies can help optimize patient outcomes and promote healing after a hip fracture.