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Case Study Hip Fracture

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Case Study hip Fracture
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Case Study
Risk Factors for Hip Fracture Age, sex (women>men), osteoporosis, poor nutrition (decreased in calcium & Vitamin D), smoking, medications (such as cortisone), limited or very little physical activities or brittle bone area all risk factors.
Risk Factors for Hip Fracture related to S.P. *Age/Sex (women>men), *smoking, *medication (prednisone), *limited activity.
Post-surgical anticoagulation S.P. is receiving Lovenox and Coumadin as thromboprophylaxis, a common practice after surgeries. Lovenox is used to prevent clot formation and will be an injection form, while Coumadin is taken orally, interferes with the synthesis of vitamin K clotting factor. In addition, it is recommended because of increase with coagulation factor. Anticoagulation is continued for approximately 30 days. INR is measured with the use of Coumadin with a goal of 2-3.
A (arthroplasty) versus O (open reduction and internal fixation)
A is also known as total hip replacement. O is metal pins, screws, rods and plates are used to immobilize the fracture. A is replacement of the entire hip joint with a prosthetic (artificial) joint system.
Intraoperative blood salvage a. The blood that is lost from surgery is immediately re-administered to the patient.
b. The blood lost from surgery is collected into a cell saver.
c. The salvaged blood must be reinfused within 6 hours of collection.
Postoperative problems Dislocation of the hip, infection, shortening, blood loss, thrombotic events leg length discrepancies, reaction to medications, and tissue reaction,
Monitoring postoperative blood loss The nurse will monitor for blood loss by monitoring vital signs, signs and symptoms changes. Blood pressure will drop due to excessive blood loss, profuse sweating, confusion, and shallow respiration. Also the incision site will be carefully monitored for sanguineous blood loss. If a drain is placed the characteristic and output of the drainage will be measured as well. Pedal pulses are checked every shift to ensure good blood flow.
Goals for maintain proper alignment S.P.’s goal is to prevent prosthesis dislocation and coping strategies until the tissue surrounding capsule is healed sufficiently to stabilize prosthesis. This is achieved by using an abductor pillow or several pillows between the legs when turning or positioning, and do not turn her on the affected leg until the surgeon provide an approval to do so.
Postoperative wound infection Postoperative wound infection is a great concern for patients who undergo arthroplasty or ORIF surgeries. A CBC with differential is done daily to monitor white blood cells count. Also, the patient is monitored for signs of infections such as malodorous wound drainage, excessive redness, warmth and/or inflammation of the surgical site. Furthermore, a comprehensive appraisal of peripheral circulation including checking peripheral pulses, capillary refill, temperature of the extremities, sensation, and motor function to detect changes for S.P.
Management of RA to prevent immobility S.P. should be continued on her anti-inflammatory and pain medications in order to manage the RA. If her pain is not managed she will lack both the motivation and drive to be mobile. She will also require a walker to assist her with getting around until she has healed.
Predisposing factor S.P. was on Methotrexate which suppresses the immune system, may cause aplastic anemia and an increased loss of blood.
Nutritional Needs S.P. will be given instructions on how to maintain a wholesome diet or high protein in order to aid in her healing after the surgery. Due to the narcotics used for pain management she is at risk of constipation. She will therefore be advised to drink plenty of water (6-8 glasses per day), and increase her fiber intake. Additionally, protein is necessary for the healing process; she will be advised to eat an adequate amount of protein such as chicken, turkey, fish, and legumes. Also, she will be encouraged to add foods high in calcium & D vitamin to increase bone density.
Protection from infection
Keep the wound and dressings clean and dry. Monitor wound for signs of infection. Wash hands thoroughly before touching the wound and after. Also wash hands before eating. Avoid contact with sick persons when possible. During flu season, S.P. should get the flu vaccine. She should also check that her pneumococcal vaccine is up to date.
Choosing a rehabilitation facility One factor that is most important is choosing a facility that is close to her home. It will allow for nearing family and friends to visit and play a supportive role in her rehabilitation. Another factor is whether she is insured, and which facility they will pay for. Also, looking into what specialty the rehab facility focuses on is important; this will ensure that the nurses and therapists have the proper knowledge to manage her condition and collaborate with her care.

References
Ireland, A. W., Kelly, P. J., & Cumming, R. G. (2015). Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities. BMC Health Services Research. 15(1), 774-788. doi:10.1186/s12913-015-
0697-3
Kelley, T., & Swank, M. (2009). Role of navigation in total hip arthroplasty. Journal of Bone &
Joint Surgery American Volume. 1153-158. doi:10.2106/1471.01463
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014) Medical-surgical nursing:
Assessment and management of clinical problems (9th ed.).St. Louis, MO:
Mosby/Elsevier.
Rossini, M., Viapiana, O., Adami, S., Idolazzi, L., Buda, S., Veronesi, C., & ... Gatti, D. (2014).
Medication use before and after hip fracture: A population-based cohort and case- control study. Drugs & Aging Journal. 31(7), 547-553. doi:10.1007/s40266-014-0184-2
Semenowicz, J., Szymański, S., Walo, R., Czuma, P., & Pijet, B. (2012). Total hip arthroplasty with shortening subtrochanteric z osteotomy in the treatment of developmental dysplasia with high hip dislocation. Ortopedia, Traumatologia, Rehabilitacja, 14(4), 341-349.
doi:10.5604/15093492.1005094

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