Ch 63 - Nursing Management - Hip Fracture

Created by cjkitti3 

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what to consider with older adults

chronic health problems
diabetes
hypertension
heart failure
pulmonary disease
arthritis
surgery may be delayed until stabilized of conditions

before surgery - painful complication/treatment

muscle spasms
analgesics
muscle relaxants
comfortable positioning
properly adjusted traction

hip surgery - teaching where

emergency department
quick surgical intervention is now standard of care
if possible teach exercises - unaffected leg & both arms
encourage overhead trapeze
use opposite side rails to assist in changing positions

hip fracture - teaching - ambulation

PT can begin to teach otu of bed & chair transfers
inform caregiver about weight bearing status after surgery
length of stay just a few days

hip surgery - postop - initial management after open reduction w/internal fixation (ORIF)

similar to any other surgical patient
vitals
I&O
supervise respiratory activities - deep breathing & coughing
pain meds
observe dressing & incision for bleeding/infection

hip surgery - there is potential for neurovascular impairment - assess

color
temp
capillary refill
distal pulses
edema
sensation
motor function
pain

hip surgery - postop - to relieve edema

elevate leg when in chair

hip surgery - postop - pain management

keep pillows (or abductor splint) between knees when turning
keep in proper alignment
sandbags & pillows used to prevent external rotation

hip surgery complications - when

if an endoprosthesis was placed
risk for hip dislocation
teach patient hip precautions/demonstations

hip surgery - PT

supervices active-assisted exercises
ambulation

hip surgery - ambulation

first or second postop day
with PT
monitor status for proper crutch walking or use of walker

hip surgery - to have patient discharged - have patient demonstrate

proper use of crutches or walker
ability to transfer into & from chair & bed
ability to ascend & descend stairs

hip surgery - complications with femoral neck fracture

nonunion
avascular necrosis
dislocation
degenerative arthritis

hip surgery - complications with intertrochanteric fracture

affected leg may be shortened
cane or built-up shoe may be used

hip surgery - if treated by insertion fo femoral head prosthesis with a posterior approach (assessing hip joint from back)

measures to prevent dislocation must be used
avoid extremes in flexion initially after prosthetic replacement

hip surgery - positions - what to be aware of

fully aware of positions & activities that predipose to dislocation

hip surgery - positions that predispose to dislocation

more than 90 degrees of
flexion
abduction
internal rotation

hip surgery - activites that predipose to dislocation

putting on shoes & socks
crossing legs or feet while seated
sidelying position incorrectly
standing up or sitting down while body flexed more than 90 degrees relative to chair
sitting on low seats, especially toilet seats

hip surgery - activites that predispose to dislocation - teaching

tell patient to avoid until hip healed to stabilize the prosthesis
at least 6 weeks

hip surgery - anterior approach (joint reached from front of body) - describe what's intact

hip muscles are left intact

hip surgery - anterior approach - results in

more stable hip postop
lower rate of complications
precautions r/t motion & weight bearing few
just avoid hyperextension

hip surgery - dislocation - indications

lump in buttock
limb shortening
external rotation

hip surgery - dislocation - to correct

closed reduction
conscious sedation
or
open reduction - to realign femoral head in acetabulum

hip surgery - dislocation - intervention

Keep NPO
anticipate possible surgery

hip surgery - to prevent dislocation

large pillow between patient's legs when turning
avoid extreme hip flexion
avid turning patient on affected side until approved by surgeon
some places prefer leg abductor splints on except while bathing

hip surgery - out of bed when

first postop day
weight bearing varies - may be restricted until x-ray
usually 6-12 weeks

hip surgery - hospitalization stay length

3 or 4 days

hip fracture - complication with older adults

falls
inability to correct a postural imbalance
inadequacy of local tissue shock absorbers (fat,muscle bulk)
underlying skeletal strength

hip fracture - older adults - what complicates fall risks

gait & balance problems
decreased vision & hearing
decreased reflexes
orthostatic hypotension
meds

hip fracture - leading hazards of falls

loose rugs
slippery or uneven surfaces
getting in or out of chair or bed

hip fracture - falls - which usually leads to hip fracture

falls to the side more than forward fall

hip fracture - falls - protective devices

external hip protectors

two most important factors that influence amount of force on hip

presence of energy-absorbing soft tissue over greater trochanter
state of leg muscle contraction at time of fall

hip fractures - problem with older woman

osteoporosis

to reduce hips fractures in elderly

calcium & vitamin D
estrogen replacement
bisphosphonate drugs

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