Question

Mrs. H, 76-year-old, is brought to the emergency department by her friend who found her lying on the floor. Mrs. H is screaming that her right leg, which is severely rotated, is hurting so bad, and she can hardly breathe. Mrs. H’s medical record has been retrieved through the electronic medical record retrieval system. Her medical history includes the following:

HTN × 20 years

DM type 2 × 10 years

Thyroidectomy 5 years ago (benign lesions)

Stage 3 renal failure

COPD × 10 years (managed with daily prednisone)

Pernicious anemia × 5 years

Osteoporosis

Bursitis

(Learning Objectives: 1, 4, and 5)

1. Mrs. H is immediately taken to radiology, and a diagnosis of right hip fracture is confirmed. What findings in her history would increase her risk for a hip fracture and why?

Mrs. H is taken to surgery, and her hip is replaced. She does not understand why she is having pain all down her leg if the problem was the hip.

2. How will you respond?

3. What is bursitis?

Answer 1

1. WHAT IS THE RISK FACTOR OF HIP FRACTURE: Mrs. H has a history of Osteoporosis, in which there is demineralization of bone occur, with loss of calcium and phosphorus leading to fragile bones and subsequent risks of fractures. Thus it is the risk factor of her hip fracture as bones become fragile and weak due to osteoporosis and causes fracture.

REASON OF PAIN ALL DOWN HER LEG:- Hip bone, ball and socket joints of pelvic bones and end of femur bone are very strong and they are connected to each other strongly. When you feel pain in hip area also pain is felt along the whole leg and pelvic area as the nerves control the pain reflexes are also interconnected in this area. Sometimes the pain causes you to limp which in turn put strain on your calf muscles and patient feel pain all along her leg.

2. RESPONSE IN CASE PATIENT IS HAVING PAIN OR MANAGEMENT OF PAIN:

• ?Administer mediaction such as acetaminophen to relieve apin.
• Topical application or NSAIDS also be given
• Muscle relaxants are prescribed to relieve muscle spasms.
• Avoid flexion of hip and knees.
• Immobilize the affected area.
• Provide steroid medication to reduce inflammation.
• Make sure that the patient is calm and relax.
• Non pharmacological measures can be used such as, guided imagery, biofeedback etc.

3. BURSITIS:- It is defined as the paimful condition which occur due to the swelling or inflammation of the bursa which is the small fluid filled sac that prevents the friction of joints and tissues. Bursa is present in knees and its chronic inflammation leads to bursitis. It is also defined as inflammation of fluid sacs between joints.