Question

A patient that is 80 years old fell and fractured his hip. He lives by himself and his daughter lives 60 miles away from him and doesn't visit him often to help. During his care in the hospital, he was told not to do any activities like adduct his hip or internally or externally rotate his leg. he can not flex his hip more than 90 degrees. Yesterday he was found leaning over to tie his shoe during a physical therapy session. It seems like he needs multiple cueing to avoid the actions that put his hip at risk. We are reinforming these things repeatedly and the nurses said that he is communicating well but he is just not getting it. The interprofessional collaboration team wants to find a rehab facility close to where his daughter lives so she can visit more and reinforce what he needs to be doing and said that he is not fit to go home by himself.

What actions should the interprofessional team take to advocate effectively for this client?

Answer 1

The interprofessional team should stress the importance of follow-up care and movement restrictions

Physical therapy goals should be based on patient's abilities , needs and tolerance.

Mobility training and use of assisstive aids (canes,crutches and walker) are the major responsibility of physical therapist. Reinforce this instructions to the client and care.The patient with hip fracture usually starts mobility training when able to sit in the bed and dangle the feet over the side.

• Collaborate with the physical therapist to co-ordinate pain management before physical therapy
• When the patient begins to ambulate , know the patient's weight bearing status and the correct technique if the patient is using an assisstive device
• Provide proper instructions to the caregiver regarding assisstive devices
• Device for ambulation range from cane to walker or crutches
• Discuss with the patient his or her  lifestyle requirements and select a device with which each patient feels comfortable
• Provide a transfer belt around the patient's waist to provide stability while he or she is learning to use an assisstive device
• Discourage the patient for reaching from furniture or relying help from others for support
• If verbal coaching does not correct the problem, instruct instruct the patient in another form of ambulation(eg: Crutches or walker)
• Instruct the care giver interms of strenght and endurance exercises, assisstance with mobility training and promotion of activities that enhance the quality of daily living
• Evaluate the patient for post-traumatic stress-disorder

Other instructions for caregiver

Do's for the patient

• Use an elevated toilet seat
• Place the chair inside the tub and remain seated for washing
• Keep hip in neutral position while sitting, walking or lying
• Use pillow between legs while changing position from supine to lateral with affected extremity up

Do n't s for the patient

1. Force hip into greater than 90 degrees of flexion
2. Force hip into adduction
3. Force hip into internal rotation
4. Cross legs at knees or ankles
5. Put on own shoes or socks with adaptive device
6. Sit on chairs without arms . They are needed to aid raising from sittiong to standing position