The RN is developing a plan of care for an 86-year-old patient who was admitted after falling at home.  The patient is confused to place and time and has a right hip fracture that will be repaired tomorrow. The patient has an intravenous infusion of normal saline infusing at 100mL per hour, and is NPO after midnight. The patient’s vital signs are stable. The RN has included these nursing diagnostic labels in the plan of care: Initial Discussion Post:

Introduction

When caring for an elderly patient with a hip fracture, it is crucial to develop a comprehensive plan of care that addresses the patient’s current condition and individual needs. This assignment will discuss the nursing diagnostic labels included by the registered nurse (RN) in the plan of care for an 86-year-old patient who was admitted after falling at home. The patient is confused, has a right hip fracture, and is scheduled for surgery. Their vital signs are stable, and they have an intravenous infusion of normal saline. This discussion will focus on the rationale for these nursing diagnoses and potential interventions that can be implemented to address the patient’s needs.

Nursing Diagnosis 1: Acute Confusion

The diagnosis of acute confusion is appropriate for this patient as they are disoriented to place and time. The patient’s confusion may have resulted from several factors, including the fall and the anesthesia for the upcoming surgery. Additionally, older patients have a higher risk of developing cognitive impairments, such as delirium, due to various physiological and psychosocial factors (Inouye, Westendorp, & Saczynski, 2014). This diagnosis is essential to guide nursing interventions aimed at promoting mental clarity and preventing further complications related to confusion.

Interventions:
1. Assess the patient’s cognitive status regularly using a validated screening tool such as the Confusion Assessment Method (CAM) or Mini-Mental State Examination (MMSE) to monitor changes in mental status over time (Inouye et al., 2014).
2. Provide a calm and soothing environment by minimizing noise, using soft lighting, and ensuring adequate rest periods to reduce sensory overload and promote sleep (Inouye et al., 2014).
3. Promote orientation by frequently reorienting the patient to their surroundings, including time, place, and care providers (Inouye et al., 2014).
4. Involve family members or caregivers in the patient’s care to provide additional orientation and emotional support (Inouye et al., 2014).
5. Implement preventive measures to minimize delirium, such as early mobilization, optimizing pain management, and avoiding unnecessary medications that can worsen cognitive impairment (Inouye et al., 2014).

Nursing Diagnosis 2: Risk for Falls

Given the patient’s recent fall and their confused state, the RN correctly identified the risk for falls as a crucial nursing diagnosis. Older adults with cognitive impairment, such as confusion or delirium, are at a higher risk for falls due to impaired judgment, decreased balance and coordination, and reduced awareness of environmental hazards (Volpato et al., 2011). This diagnosis allows nurses to implement interventions aimed at preventing falls and ensuring patient safety.

Interventions:
1. Conduct a comprehensive fall risk assessment using a validated tool, such as the Morse Fall Scale or Hendrich II Fall Risk Model, to identify specific factors contributing to the patient’s fall risk (Volpato et al., 2011).
2. Implement measures to reduce fall risk, such as placing the patient in a room close to the nursing station for closer supervision, ensuring the call bell is within reach, and providing non-slip footwear (Volpato et al., 2011).
3. Assist the patient with ambulation or provide mobility aids, such as a walker or wheelchair, to facilitate safe movement (Volpato et al., 2011).
4. Educate the patient and family members on fall prevention strategies, including the importance of using handrails, keeping walkways clear, and taking their time when getting up or out of bed (Volpato et al., 2011).
5. Implement a bed or chair alarm system to alert nursing staff when the patient attempts to move independently (Volpato et al., 2011).

Nursing Diagnosis 3: Impaired Physical Mobility

The patient’s right hip fracture restricts their physical mobility, making the diagnosis of impaired physical mobility appropriate. In addition to the hip fracture, they are also restricted from weight-bearing activities pre- and post-surgery, further exacerbating their limited mobility. This nursing diagnosis enables nurses to address the patient’s decreased physical independence and develop interventions to improve mobility and prevent complications associated with immobility.

Interventions:
1. Collaborate with the physical therapy team to develop an individualized mobility plan that includes range-of-motion exercises, active and passive exercises, and gradual progression to weight-bearing activities post-surgery (Hoyer, Brumback, & Roberts, 2013).
2. Use assistive devices such as a walker, crutches, or wheelchair, as appropriate, to facilitate safe mobility and independence during ambulation (Hoyer et al., 2013).
3. Implement a turning and repositioning schedule to prevent pressure ulcers and muscle contractures (Hoyer et al., 2013).
4. Provide pain management interventions, such as administering analgesics as prescribed, to alleviate discomfort and facilitate movement (Hoyer et al., 2013).
5. Educate the patient and family members on the importance of maintaining mobility and participating in prescribed exercises to optimize recovery and prevent complications such as muscle atrophy and joint contractures (Hoyer et al., 2013).

Conclusion

In conclusion, the RN has identified appropriate nursing diagnoses for this 86-year-old patient with a hip fracture and acute confusion. These diagnoses include acute confusion, risk for falls, and impaired physical mobility. By implementing the suggested interventions, the nursing team can provide comprehensive care that addresses the patient’s cognitive, safety, and mobility needs. It is essential to regularly reassess the patient’s condition and modify the plan of care as needed to ensure optimal outcomes for this elderly individual.