Hip-fracture

Hip Fracture Nursing Diagnosis, Care Plan, and Interventions- A Student’s Guide

Introduction

Hip fractures are common injuries that affect people of all ages and genders. The most common age group for this type of injury is the elderly population. Hip fractures often lead to decreased mobility, reduced quality of life, and eventual death.

This blog post will outline nursing diagnoses for hip fractures, interventions that nurses and physicians may use to care for patients with hip fractures, and a general prognosis. As you read, keep in my that our professional nursing writers are ready to help with your assignment in case you get stuck. All you need to do is place an order with us.

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What is Hip Fracture?

A hip fracture is a type of injury that occurs when the ball at the top of the thigh bone (femur) breaks off from the shaft and moves out to one side, usually into or near your groin. When this happens, you may feel a sudden pain in your hip joint, as well as tingling and numbness down your leg.

Image: Hip Fracture

What Causes Hip Fracture?

-The most common way that people suffer hip fractures is from a fall. When you are moving, your bones support you and allow you to carry out movements such as walking, running, and sitting down safely. If there is an issue with the strength of your bones, for example, due to osteoporosis or a lack of calcium, you may be unable to support yourself adequately, and a fall can happen.

Image: Causes of Hip fracture

What Are the Risk Factors?

-Advanced age: This is because as you get older, your bones become less dense, and fractures can occur more quickly.

-Previous hip fracture: Research data has shown that patients who have already had one hip fracture are 2-3 times as likely to experience a second hip fracture. This is because they have less bone density than other individuals, making them more vulnerable to injury.

For example, some medications, corticosteroids, and anticonvulsants can weaken the bones and increase your chance of fracture.

Disease such as osteoporosis (weak bones), rheumatoid arthritis (swelling in the joints), and bone cancers.

Unhealthy diet and lack of physical activity – insufficient physical activity can make your bones less able to support you if you fall. In contrast, a poor diet will lead to lower bone density which increases your likelihood of fracture.

Menopause: If you have gone through menopause, you are at risk of developing osteoporosis, which weakens the bones.

How Can You Prevent Hip Fracture?

There are several things that you can do to reduce your risk of hip fracture.

– Stay active and eat a healthy diet.

-Maintain a healthy weight and avoid gaining too much or too little weight as this can place extra stress on your bones. It is believed that losing over 10% of your body weight in one year can significantly increase the chance of breaking a hip.

-A healthy diet with enough calcium and vitamin D will help to increase bone strength.

Avoid smoking or drinking too much alcohol as these things can lead to osteoporosis, making you more vulnerable to fractures.

-Avoid situations that may cause a fall is also essential in preventing hip fracture.

Avoid carrying weight-bearing loads or wearing high-heeled shoes as these things can add extra pressure onto your bones and make them more likely to break.

Be careful when using chairs and sofas as these may not be strong enough to hold your weight if you are older and frail.

Avoid slipping on the floor by wearing non-slip shoes and placing rugs on all high traffic areas. If possible, it is best not to wear slippers indoors as they make it harder for you to stay upright.

-Use a seat that can hold your weight so that you are less likely to fall over. Also, use non-slip mats in the bath and shower to ensure that you do not slip or fall.

Lastly, it is best to roll onto your side when getting out of bed then onto your hands and knees before sitting up. This will help to give you more stability on your feet and reduce the risk of falling.

Signs and Symptoms of Hip Fracture

– Pain in your thigh area, lower back, and groin.

-A weak grip, pain, or stiffness in your hip area is one of the main symptoms of a potential fracture.

-Your leg might look out of shape or deformed. You may also see a bump on your leg. These signs can appear 4 to 12 hours after the fracture, and you should seek medical help immediately if they occur.

A hip fracture is considered a medical emergency as it can lead to long-term disability. If you think that you may have broken your hip, then go and see your doctor right away so that they can treat you.

Assessment in the Emergency Room

If you go to the hospital with a hip fracture, your doctor will start by examining you. They will want to know if:

You are in acute pain (which can happen after an accident or fall)

Your leg is out of shape, or deformity has occurred (a part of your thigh might be pointing in an odd direction)

You have lost the use of your leg.

After examining you, the doctor will need to do a blood test to find out if any of your other organs are injured, and that could be causing severe pain or suffering.

If this is the case, then you might need surgery on areas such as your spinal cord, chest, and abdomen. The next thing that the doctor will do is examine your hip. They will look to see if you have bruising or breaking in your skin, and they will need to know whether any of your bones are sticking out.

Pinpointing the location of the fracture:

The doctor may ask you questions about what happened when you were hurt so that they can pinpoint where the break is. For example, if you fall from a great height, it will be easy for the doctor to work out where your fracture is because they can see where the impact occurred. This helps them to work out what treatment you need so that you can recover as quickly as possible.

If your thigh bone breaks in more than one place, then the doctor will need to do a CT (computed tomography) scan. This is because you will have to undergo surgery, and this helps the surgeon prepare for your operation as they can see where everything is positioned in relation to the break.

· Your doctor will also check that you are not dehydrated or hungry as these things can make your pain worse.

Hip Fracture Nursing Diagnosis:

Impaired physical mobility-

Deficient knowledge-

Injury-

Risk for Ineffective Airway Clearance

Risk for Falls-

Impaired Skin Integrity-

Functional level decline

Risk for Decreased Cardiac Output

Risk for Infection

Imaging tests

X-ray or an MRI scan.

The type of X-ray that you have will depend on where your hip or thigh bone is fractured.

CT scan

If they think that surgery may be required, then a CT scan can show them in detail how complicated the break is and what type of operation may be necessary.

Ps: We recommend that you check the nursing diagnosis for other common conditions, such as Hyperglycemia

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Nursing Care Plan for Hip Fracture

Short time care plans

-Focus on preventing falls

-Helping patient with walking

-Educating patients about their condition and treatment

Long term care plans

-Falls precautions – both at home and during transport, e.g., monitoring the intake of anticoagulant drugs with regular INR tests

Assess the risk of bleeding

Monitor for signs of circulatory overload

-Transport precautions – e.g., orthopedic patient transporter with brakes, seat belt, and safe operating instructions

Post Operative Care Plans:

-Monitoring respiratory and cardiovascular status

-Avoidance of activities that may exacerbate pain, such as long periods of walking or sitting in one position

-Removal of sutures and staples: wounds should be dressed regularly to ensure healing. Sutures must not be removed early. Wounds are allowed to heal from the inside out. The outer layer is sealed with a second-skin dressing (e.g., Bioclusive) that is changed approximately every 2-3 days.

After removal of sutures/staples, wound dressing needs to be changed daily. Ideally, dressings are kept in place for at least five days before a new dressing is applied over the wound. The patient should avoid soaking wounds or exposing them to water until they are completely healed.

-Pain control

-Neurologic complications: Stump pain, loss of sensation/hypoesthesia in the affected limb, and possible phantom sensations should be assessed and treated by physical therapy after discharge.

The patient should observe these sensations as a signal that the injury is healing correctly.

-Monitoring for thrombosis -Platelet disorders -To prevent blood clot formation, the patient should be kept mobile and active as soon as possible after surgery. Early mobilization is also essential to prevent venous thrombosis (clot formation in veins).

After discharge home, regular mobility assessment is recommended for up to 6 months postoperatively, and prophylactic usage of low molecular weight heparin (LMWH) is also an option.

-Paralysis: The patient should be restricted from pushing or pulling heavy objects for six weeks after surgery and complete bed rest with feet elevated for 24 hours postoperatively.

The feet should be kept elevated at all times to help reduce swelling.

-Monitoring for signs of bleeding or infection

-Continued pain control

-Fracture: After surgery, the limb will need to be immobilized in a hard cast or splint for 4-6 weeks. During this time, pain control and physical therapy are continued while the bone heals. After 4-6 weeks, a physical therapist can help the patient remove the cast/splint and begin learning to walk with crutches or a cane.

-Pain control

-Monitoring for complications

– Spasms, edema (swelling), bowel obstruction, respiratory distress, infection, or bleeding at the operation site.

Long term care plans

-Helping to avoid infection and skin breakdown in long-term care.

Positioning in bed rest

Education about activity restrictions

Moving from sitting to standing positions frequently

Proper nutrition & hydration

Monitoring vital signs constantly

Assessing sensory impairment or changes in the level of consciousness.

To enhance your knowledge on care plans, check the care plans for Asthma

Pain management strategies for discomfort or chronic pain due to their injuries

Nursing interventions may include medications such as opioids, muscle relaxers, and anti-seizure drugs, depending on individual needs.

Nursing Interventions for Fractured Hip

-Teaching patient how to perform gentle range-of-motion exercises;

-providing written instructions on proper exercise techniques;

-teaching patient how to maintain balance while performing activities of daily living (ADLs);

-Providing adequate protection from falls through modification or elimination of hazard(s) in the home or environment.

-Providing a safe environment

-Teaching patient to use assistive devices, e.g., cane, walker;

-providing written instructions on proper exercise techniques; and

-encouraging patients to perform physical therapy exercises.  

Pain management strategies for discomfort or chronic pain due to their injuries

Hip Fracture Complications

Hip fracture impacts may lead to complications such as pneumonia or blood clot formation in a deep vein.

Upon recovery from surgery, the patient must limit their movement to avoid risks of further injury and complications. If not adequately managed, a hip fracture may result in disability or death.

Treatment of Hip Fracture

The treatment for a hip fracture can be in two primary forms: non-surgical, which is when an older person is kept in hospital for several weeks where their leg will be immobilized with a cast, or surgical, which involves putting metal plates and screws in the leg to hold the bone in place.

Pain Management

Patients generally experience moderate pain following surgery. Pain is managed with medications and non-pharmacologic techniques such as relaxation therapy.     

Physical Therapy   

-Patients learn a series of exercises to promote healing and rehabilitation, including:

-Range of motion exercise for hip

-Exercises that improve balance, reduce weakness in the upper body, and improve coordination

-Breathing exercises to help prevent pneumonia and rib cage deformities

-Stretching, strengthening, and cardiovascular exercise.   

Hospital stay for hip fracture treatment is typically one to two weeks. After the final hip surgery procedure or after pain has eased significantly with conservative care methods, patients are evaluated and assigned a therapist to complete an individualized rehabilitation program.

Physical Therapy Management  

HIP Flexibility – A physical therapy evaluation will focus on the flexibility of the hip joint and its surrounding soft tissue. For a patient with hips that exhibit a limited range of motion, various treatment options can improve joint range of motion. 

Discharge planning after surgery or rehabilitation has been completed.

The patient will be expected to complete physical therapy exercises at home for:

  • Range of motion of the hip joint
  • Balance and gait training
  • Strengthening and stretching exercises in lower body musculature
  • Strengthening upper body musculature.

These are critical components for a patient to learn and practice to improve function and prevent their hip fracture condition from worsening. 

To learn more about treatment for other common conditions/diseases, check our guides on Hypertension

Summary

A hip fracture is a significant injury with severe consequences. It can lead to painful complications, prolonged hospitalization, and an increased risk of death. The nursing diagnosis for this condition includes impaired mobility, Deficient Knowledge, Risk for Decreased Cardiac Output, and Risk for Infection.

The care plan includes interventions such as Positioning in Bed Rest; Education about Activity Restrictions; Moving from Sitting to Standing Positions Frequently; Proper Nutrition & Hydration; Monitoring Vital Signs Constantly; Assessing Sensory Impairment or Changes in Level of Consciousness.

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