...Case Study hip Fracture NSG/340 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...
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...Background : Intertrochanteric and subtrochanteric fractures are leading cause of hospital admissions in elderly people. Aim: This study is done to analyze the surgical management of proximal third fractures of femur using Proximal Femoral Nail fixation. Materials and methods: 20 cases there were 15 male and 5 female patients of intertrochanteric and subtrochanteric fractures, who are treated with Proximal Femoral nail. Results: Mean age of 60.4 yrs. 50% of cases were admitted due to slip and fall and with slight predominance of right side. Out of 20 cases, 10 were trochanteric and 10 were subtrochanteric. In Trochanteric class 60% were Boyd and Griffin type 2, in Subtrochanteric class 40% were Seinsheimer type 3a and 20% were 2b. Mean duration...
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...the Risk of Fractures Authors : Title of Journal : The New England Journal of Medicine Volume : 354 Issue : 7 Year : 2006 Pages : 669-683 Literature Review There have been various studies performed from 1990-2006 of the effects of calcium plus vitamin D supplemental therapies on fractures. A 2 year study was conducted from February 1st 1999 to March 31st 2002 5292 participants were recruited across 21 hospitals in the UK and randomly allocated to four equal groups receiving 800 IU vitamin D3,1000mg calcium, vitamin D3 (8000 IU) combined with calcium (1000mg), or a placebo. Data was collected by postal questionnaire every 4 months with dietary intake of calcium and vitamin D monitored along with sun exposure. Time interval for follow up was between 24 and 62 months. There was difficulty with compliance concerning the allocated tablets as most patients were above the age of 70 limiting cognitive function as well as gastrointestinal complaints. This study measured dietary intake and sun exposure however participants above the age of 70 have a higher incidence of fractures form falls. Participants receiving supplemental therapy of intake of more than 200 IU vitamin D or more than 500 mg calcium supplements in the past 5 years were excluded. (Grant A.M., Anderson F.H., Avenell A.,Campbell M.K, Cooper C., Donaldson C., Francis M.R., Gillespie W.J., Robinson C.M., TorgersonD.J., &Wallace W.A.,2005). In another study, there only female participants...
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...Calcium and vitamin D combination therapy has been accepted as the baseline treatment for osteoporosis. Calcium and vitamin D3 supplementation reduced the risk of hip fractures and other non-vertebral fractures among elderly women in a three year clinical study and also show significant benefit after 18 months.60 Bisphosphonates Bisphosphonates are the most commonly prescribed drugs to treat osteoporosis. The first bisphosphonate approved by the FDA was Alendronate, a once daily oral medication. Now other drug have been added to the list such as pamidronate; alendronate; ibandronate; etidronate, clodronate; risedronate prescribed daily, weekly, or monthly at varying doses; Zoledronic acid with a single intravenous transfusion annually. Bisphosphates...
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...in patients with hip fracture Critical Appraisal In this quantitative research article, the authors have dealt with one of the most common clinical problem i.e. clamping of urinary catheter after hip surgery. Hip surgery is very common among the people of old age group especially above 75 years. Further, older women are more susceptible to hip fracture and commonly undergo hip injury (Johansson & Christensson, 2010). Bladder catheterization is a common clinical practice in surgeries. It helpful in monitoring urine output in patients. However, it is also associated with one of the major clinical problems, i.e. operative urinary retention (POUR). It can be defined as the inability of a patient to pass urine in spite of full bladder (Baldini, Bagry, Aprikian, & Carli, 2009). It is has been reported that patient of hip surgery are at higher risk of urinary retention (Balderi & Carli, 2010; Johansson & Christensson, 2010; Singh et al., 2010). In the case of hip replacement the incidence of POUR has been reported to be between 12- 84%. Similarly, in case of hip fracture the prevalence of POUR is 18% to 56% (Borghi et al., 2004; Oishi et al., 1995). The most effective intervention reported till date for reducing the risk of urinary retention is clamping of urinary catheter. The main objective of this paper was to investigate the efficacy of clamping of urinary catheter through randomized controlled trial in patients undergone hip surgery for fracture. Title: The title...
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...Prevalence of dementia in elderly patients with hip fracture.PUBMED.GOV Hip fractures occur commonly and are a cause of disability for older adults and lead to increased dependence and requirements for social support. Dementia is one of the possible risk factors for falling and hip fracture, a potential source for complications during surgery and during the postoperative period, difficulties in rehabilitation and a risk factor for hip fracture reccurence. However, in previous studies of hip fracture patients, cognitive status has not been formally assessed during the inpatient stay and diagnosis was based only on previous history. Additionally, no previous studies have compared prevalence of dementia between elderly patients with hip fracture and patients with other surgical pathology. Our aim was to define whether dementia was more prevalent in older subjects with hip fracture than in other elderly patients undergoing surgery. In this study, we prospectively assessed all patients aged 68 and older admitted to our hospital for hip fracture surgery during a one year period and compared them with age and gender matched patients attending other surgical departments. 80 hip fracture patients and 80 controls were assessed for dementia. Dementia was common in both groups, presumably reflecting the advanced mean age of both groups and cognitive deterioration due to hospitalization-status. Dementia was significantly higher in the hip fracture group (85%) compared to the control group (61...
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...developments in Epidemiology 2 Definition, scope and use of epidemiology 4 Distribution 5 Determinants 5 Health- related states or events 6 Specified populations 6 Application 7 Scope 7 Epidemiology versus Public Health 7 Causation of diseases 8 Achievements in Epidemiology 9 Small pox 9 Methyl Mercury Poisoning 10 Rheumatic Fever and Rheumatic Heart Disease 11 Iodine Deficiency Disease 11 Tobacco use, Asbestos and Lung Cancer 12 Hip Fractures 12 HIV/AIDS 13 Global AIDS epidemic 1990–2003 13 SARS 14 Conclusion 15 Bibliography 16 Introduction This essay provides a brief summary of what epidemiology is, what it is used for and discusses the major successes epidemiologist have contributed towards control and eradication of major epidemics. The discussion will also touch on the historical context and development of the emergency of epidemiology as a science and art, and give example of some of the people that greatly contributed to the achievement scored in epidemiology studies and applications. The Historical Context Epidemiology originated from the Hippocrates` observation more than 200 years ago who identified environmental factors to have an influence on the occurrence of diseases. It was until the nineteenth century when the distribution of the disease specific in human population group was measured to a large extent as beginnings of epidemiology and road to the most spectacular achievement. The other aspect practice that became...
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...Bradley Kingery & Malik Barber 2/14/16 BIO 103-AC01 Professor John Law The Skeletal System Osteoporosis Summary Osteoporosis is a disease that makes bones fragile and more susceptible to fracture over time. It occurs when your body is losing bone cells faster than it can produce them, causing the bones to thin. It effects about half of all women over age 65, and close to one-fifth of men over 70. The most common injury in osteoporosis is ‘dowager’s hump,’ which is caused by the collapsing of the bones of the spine. This causes the curvature of the spine that the disease is so infamous for. Other common injuries include forearm fractures, knee fractures, and hip fractures which are often disabling and sometimes even fatal. On average, the United States spends around $14 billion on osteoporosis every year, according to the National Osteoporosis Foundation. Many people think of bones as hard, stone-like objects. Bones are actually living, growing tissue made up of cells that are constantly being lost and replaced. There are three major components that form bones and keep them strong: calcium, collagen, and living bone cells. Collagen is a protein that gives bone flexibility, calcium keeps them strong and solid, while living bone cells are constantly replacing old ones. Many people wonder how bone grows if it is constantly being lost and replaced. The answer is that children and teenagers actually form new bone faster than they lose old bone. Even when teens have...
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...Introduction: Total hip replacements (THR) happen for a multitude of reasons. Patient’s requiring a THR are in pain within the hip joint from a specific cause. For example, a THR could be done to relieve arthritis pain, repair a break in the bone, or repair the joint from a traumatic injury or disease. The hip joint is a ball and socket joint, made up of the head of the femur (ball) which moves within the acetabulum (socket) in the pelvis (Hasan & Akbar). Functionally, this joint allows movement of the lower body in relation to the trunk in a circumduction motion. At the time of the repair, usually patient’s have decreased function of that lower extremity because of pain. The joint itself does not have nerve endings, but bone does....
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...Nascha Kayani Case Study Nascha Kayani is 83 years old female who is a resident of Bitter Water Clan from Navajo Reservation. Her grandson Ahiga emailed yesterday stating that Nascha was suffering from severe pain in her left hip. Her grandson stated that the patient lives in a sedentary lifestyle of Navajo. There is not any other problem stated. The patient is 165 pounds with BMI 29.2. There is not any past medical history included according to the data given by her grandson. According to the data provided, the patient does not consume alcohol due to restriction in Navajo but she is a smoker. The patient is currently living in her Hogan. In Navajo, people are living under virtual isolation. So, it is difficult to contact patient directly from the phone to get more information. The only way to contact her is to contact her grandson and he will relay the information. As Nascha is from registered tribe, this makes her eligible for care at an Indian Health Service. For Nascha to arrive at the hospital, she will have to make arrangements for her travelling. She could make it to the hospital if there is no rain. Her grandson need to translate the English for Navajo because the people in Navajo cannot understand English including the patient. The vital statistics of the patient is as following: Vital Statistics: Nascha Kayani Blood Pressure 140/88...
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...kattu is a traditional way of bone setting practice, invented accidentally by K. Kesava Raju in 1881. Now, the fourth generation of his family is practicing this bone setting practice in hospitals at Puttur, Andhra Pradesh, with 200-300 patients per day. A prospective study was undertaken to analyze the techniques in diagnosis, way of management, medicine preparation, plants used and way of applications by traditional bone setter (TBS) Vaidyas, with special reference to Puttur. We also tried to understand the reasons which make lots of people go to Puttur for getting treatment, means of contact for treatment, pathology of fracture and outcome of some treated cases through this study. 54% of the studied patients came to Puttur TBS on the advice of old patients. It is observed that more educated people are patronizing this therapy and 23% patients of the observed cases took discharge from modern hospital voluntarily to receive Puttur kattu treatment. 80% patients believed that this therapy with home remedy would fasten the healing process. 44% patients opted for this therapy due to fear of pain, heavy plaster of Paris bandage, prolonged period of immobilization, surgery and amputation. 71% patients of the followed cases were satisfied with the treatment of TBS of Puttur with minimum complications. The authors also attempted to put forth the legacy of the tradition, the way of management and the plant used for bone setting by the Puttur bone setting Vaidyas. KEYWORDS: Bone, Puttur...
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...recommendations may be associated with better health outcomes. However, optimal serum concentrations of 25-hydroxyvitamin D [25(OH)D] have not been defined. This review summarizes evidence from studies that evaluated thresholds for serum 25(OH)D concentrations in relation to bone mineral density (BMD), lowerextremity function, dental health, and risk of falls, fractures, and colorectal cancer. For all endpoints, the most advantageous serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L (36 – 40 ng/mL). In most persons, these concentrations could not be reached with the currently recommended intakes of 200 and 600 IU vitamin D/d for younger and older adults, respectively. A comparison of vitamin D intakes with achieved serum concentrations of 25(OH)D for the purpose of estimating optimal intakes led us to suggest that, for bone health in younger adults and all studied outcomes in older adults, an increase in the currently recommended intake of vitamin D is warranted. An intake for all adults of 1000 IU (40 g) vitamin D (cholecalciferol)/d is needed to bring vitamin D concentrations in no less than 50% of the population up to 75 nmol/L. The implications of higher doses for the entire adult population should be addressed in future studies. Am J Clin Nutr 2006;84:18 –28. KEY WORDS 25-Hydroxyvitamin D, vitamin D intake, bone density, lower-extremity strength, colorectal cancer INTRODUCTION suppression of PTH or optimal calcium...
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...However, Boland, Satterlee, & Jansen (2014) suggest that in the case of low-level falls with hip injury in the elderly, this criterion should be eliminated. The purpose of the study was as follows: “because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined” (Boland, Satterlee & Jansen). After evaluating 1,394 patients, the study concluded that c-spine fracture is extremely rare in elderly patients who sustain a hip fracture that results from a low-level fall. When c-spine injury does occur, it appears to be in conjunction with other known predictors of spinal injury besides the distracting injury (Boland, Satterlee & Jansen). Because the elderly population is more susceptible to isolated hip injuries, and also to the discomfort of full spinal immobilization, this type of trauma should be specifically considered in the development of spinal clearance...
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...eap3am 8/20/02 1:20 PM Page 50 50 The Body Systems: Clinical and Applied Topics The Skeletal System 6 The skeletal framework of the body is composed of at least 206 bones and the associated tendons, ligaments, and cartilages. The skeletal system has a variety of important functions, including the support of soft tissues, blood cell production, mineral and lipid storage, and, through its relationships with the muscular system, the support and movement of the body as a whole. Skeletal system disorders can thus affect many other systems. The skeletal system is in turn influenced by the activities of other systems. For example, weakness or paralysis of skeletal muscles will lead to a weakening of the associated bones. Although the bones you study in the lab may seem rigid and permanent structures, the living skeleton is dynamic and undergoing continual remodeling. The remodeling process involves bone deposition by osteoblasts and bone resorption by osteoclasts. As indicated in Figure A-16, the net result of the remodeling varies depending on: 2. The applied physical stresses: Heavily stressed bones become thicker and stronger, and lightly stressed bones become thinner and weaker. Skeletal weakness can therefore result from muscular disorders, such as myasthenia gravis (p. 66) or the muscular dystrophies (p. 65), and conditions that affect CNS motor neurons, such as spinal cord injuries (p. 75), demyelination disorders (p. 72), or multiple sclerosis (pp. 72, 82). 3. Circulating hormone...
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...requires change. DEVELOPING OR CREATING AN INDEX TO MINIMIZE RISKS OFPRESSURE SORE 1. Describe the current nursing practice. An instrument specifically designed to aid health care workers evaluate the dangers of pressure sores that a patient faces is called the Braden Scale. After assessment, the victim is categorized depending on six aspects: capability of physical activity, hydration and nutrition status, capacity to alter position, the ability to respond after sensing discomfort related to pressure, shearing or exposure of the skin to friction during locomotion, and skin exposure to moisture. If the overall score is lower it means the risk of pressure sore is higher (Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies, n.d). Prior to this Change, Skin assessment was based on non- formalized risk assessment which varies with each clinical practice. 2. Discuss why the current nursing practice needs to be changed Using non-formalized risk assessment in Predicting pressure ulcer resulted in non-uniformity and personal clinical judgement which varies from one person to another. Using Clinical judgement is more effective where the staffs are experienced and their experience assist in appropriate predictability, but with novice staff, the use of clinical judgment is inappropriate. In a multisite trial, Braden scale was tested by clinics bringing together skilled nursing facilities, Veterans Administration or VA medical centers and hospitals providing tertiary...
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