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35 terms

Ch 63 - Nursing Management - Hip Fracture

STUDY
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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