Question

History of present illness: Client sustained hip fracture and open reduction internal fixation of left hip approximately 2 weeks ago.Admitted now for rehabilitation.Concern may exist regarding current living arrangements. Findings: Patient currently lives with 50-year-old son, Mark Doyle, and has so for past 9 months. Up until that time,she lived and managed her own home--husband died approximately 2 years ago. Patient indicates living with son was his idea--She did not feel she should live alone at her age. She sold her home and although she has her own checking account,for the most part her son manages nearly all her finances.Living arrangement with son was acceptable to patient until about 4 months ago--Mark's"new girlfriend"Staci(patient states her age is about 34)and her 17-year-old son Trevor moved into the home .Since girlfriend has moved in,she feels Mark ignores her and her needs. States Mark has become increasingly controlling,does not allow her to do anything without his permission,and does not allow her to drive. Client also indicates she is some what afraid of Trevor--she denies he has hurt her,but suspects he has taken money from her .Client indicates she has attempted to talk to Mark about this situation,but he is not receptive to any criticism involving Staci. Client indicates she is not sure she wants to return to Mark's home,but does not feel she has many options at this point. Impression:Possible or potential l elder neglect. Plan: Plan a meeting including me,Mark Doyle,Ms.Doyle,physician,and the nurse discharge coordinator to discuss post discharge needs and current or optional living arrangements.

1, Nursing diagnosis: Impaired physical mobility R/t Left hip fracture    As evidence by---------   

Goals

Nursing intervention

Rationale

Evaluations

2, Nursing diagnosis: Fear R/t --------

As evidence by---------

Goals

Nursing intervention

Rationale

Evaluations

Answer 1

Hip fracture occurs in any location of the hip in the femoral neck or in the intertrochanteric region. The common treatment measures are surgical management,medical management and rehabilitation these measures helps the patient to regain the strength.

Open reduction internal fixation is a surgical procedure involves in insertion of metal screws and plates into the broken bones. Total hip replacement involves the usage of prosthesis to replace affected pelvic bone. Rehabilitation includes physical therapy to teach patients to learn basic skills like toilet, bathing,brushing,dressing,eating. It support patient to regain mobility and to function independently.

Nursing diagnosis: Impaired physical mobility R/t Left hip fracture As evidence by implantation of metals and screws.

Goals: Patient will perform activity of daily living independently with in the normal limits of mobility.

Patient understands and demonstrate the measures to increase mobility.

Patient uses safety measures effectively and protected from any external risks of injury.

Patient protected from all complications results as a result of immobility as evidenced by maintaining skin integrity, normal bowel pattern, absence of thrombophlebitis.

Nursing interventions:

- Assess the patient functional level of movement as it helps to plan care accordingly. Examine the ability to perform activity of daily living this helps to determine strength of the patient.

- Maintain skin hygiene by providing periodical skin care, changing of position every 2 hours, applying skin friendly moisturizer to prevent decubitus ulcer.

- Provide air bed or gel or foam mattress to relieve constant pressure over the bony prominences.

- Take safe and secure environment by providing side rails, lower down the bed to prevent falls.

- Encourage patient to initiate early ambulation by dangling legs then slowly moving to the chair and then ambulation with the help of crutches.

- Plan adequate rest and activity to facilitate conservation of energy. Position the affected part in good alignment using supportive devices like pillows, sand bags, splints.

- Encourage patient to do deep breathing exercises,coughing exercise and teach incentive spirometry techniques to improve lung compliance.

- Plan for high fiber diet and adequate fluid intake to prevent constipation.

- Teach light weight bearing exercises with assistance. Teach proper sitting and standing balance to improve circulation.