Question

Mrs. Lydia Martin, an 88-year-old widow, lives alone in her single-story home. She prides herself in being fully independent. During the middle of the night, Mrs. Martin fell in her home while walking to the bathroom. She was unable to get up, so she crawled to the telephone and dialed 911. She was transported to the emergency department and underwent diagnostic tests including hip and femur x-ray and computerized tomography (CT), which confirmed a left femoral neck hip fracture. Her past medical history reveals anxiety, osteoporosis, arthritis, and cataracts. Mrs. Martin underwent an open reduction internal fixation (ORIF) and a left hip replacement. Following surgery, she had a compression dressing with ice to the left hip, a Foley catheter, antiembolism stockings, a sequential compression device, a surgical drain and an order to use the incentive spirometer every hour while awake. Her medications included: Ampicillin 500 mg. IV q4hrs.; Morphine 1-2mg. IV q3-4 hrs. prn; hydrocodone bitartrate 7.5 mg/acetaminophen 750 mg (Vicodin ES) 2 tabs q4h po prn; and enoxaparin (Lovenox) 40 mg daily subcutaneously. On post-op day 1, the nurse and physical therapist began to work with Mrs. Martin; the goal of the session was to get her out of bed to a chair. During the attempted transfer, Mrs. Martin's surgical site was painful and her Foley catheter was pulled. She screamed in pain and refused to continue the process. Mrs. Martin was anxious and fearful of pain; she also became worried that she would never walk again and would end up in a nursing home. She was unwilling to move and declined physical therapy the next 3 days. Mrs. Martin became constipated and lost her appetite. She also developed a stage 2 pressure ulcer over her sacrum. Eventually, on post-op day 4 Mrs. Martin agreed to work with the physical therapist. By this time, she experienced significant weakness and fatigue and was unable to move independently. Mrs. Martin was later transferred to a rehabilitation center to continue regaining her mobility.

3. As the nurse, what other professionals would you collaborate with when caring for Mrs. Martin? Explain the importance of collaborating with the health care team when providing care for patients with hip fractures.

4. How would you apply principles of infection control when caring for a patient with a hip fracture?

5. Describe the nutritional needs of the patient with a healing fracture and the complications related to diet and medication use that could occur.

6. What interventions in the home would you assess to reduce the incidence of hip fractures?

7. You are planning to discharge Mrs. Martin. What community contacts and resources should you include in the teaching plan?

Answer 1

1-Treating a patient is a team work it collaborate with different section of health care department.in this case patient need regular follow-up with physiotherapist as she unable to walk and weakness of muscle,also need support from infection control nurse to care her surgery site and proper dressing.

Physychiatrist to support her and reduce the anxiety as she has tested for this.reapiratory therapist because she have pron to get pneumonia as related to confined in bed.

Urologist visit may be needed for the catheter evaluation and follow-up.

Nutritionist to maintain a diet plan based on his needs.

Opthalmologist for follow-up for cataract

Also need lab and radiology team for sample analysis and to check progress of surgery.

As she stay alone she may need social worker support.

2-maintain an strict aseptic technique is important in all surgical case especially in hip surgery..Proper dressing and progress evaluation is needed.if fail to maintain strict infection control practice patient may have complications like wound infection,delayed wound healing and even sepsis and can cause shock and death.

3-for the progress of this includes development of bone and wound healing patient need to take adequate around of nutritional food that includes adequate akong of calcium vitamin d and c.it helps in wound healing and bone growth.

Also take adeqte aming of fluid since he is taking medication and bedridden.it improve skin turgor and preventburinary infection.

4-provide proper position

Assist in activities

Arrange articles near to bed

Remove any items that can cause injury

Keep side rails on

Keep bed lower

Transfer the patient with adequate resources

Maintain safety

Remove wet items while helping the patient to walk.

5-as she stays alone she need assistance from different section.so arrange a community nurse visit and contact number

Emergency hotline number arrange social worker and his contact

Domestic helpers agency number

Police and emergency contact details.