Module 13C Hip Fractures- Study Module

The nurse is teaching a patient's spouse about what to expect after surgery. Which statement by the spouse regarding ambulation after surgery requires reteaching by the nurse? "Walking as soon as possible after surgery can help prevent breathing problems." "Bedrest is no longer recommended after surgery because it can cause complications." "Walking as soon as possible after surgery helps increase bloodflow in the body." "Bedrest is recommended for the first day after surgery to allow the body to heal."

"Bedrest is recommended for the first day after surgery to allow the body to heal." Strict bedrest is no longer recommended after surgery because it can cause complications. The nurse is responsible for assisting the patient with ambulation as soon as the provider will allow. Early ambulation can help increase circulation, prevent skin injury, and prevent breathing issues such as pneumonia.

A 50-year-old patient has osteoarthritis of the hip related to long-term steroid use. The patient tells the nurse the healthcare provider has stated that they are too young for a hip replacement. Which response by the nurse is best? - "Hip replacement surgery is a very difficult surgery. Do you have any other comorbidities that could affect surgery?" - "I would discuss your concerns with your healthcare provider. If you are in this much pain, it needs to be addressed." - "Hip replacement surgery requires a long course of physical and occupational therapy after the procedure." - "Hip replacements may only last 10 years, and the revision surgery is harder than the original replacement."

"Hip replacements may only last 10 years, and the revision surgery is harder than the original replacement." Hip replacement prosthetics usually last around 10 years, and the surgical procedure to do a hip revision is more extensive than the original replacement surgery. Therefore, surgeons tend to wait to perform those in older adult patients, unless the surgery is necessary to repair a hip fracture. The nurse should not pass off the patient's concerns to the healthcare provider. The nurse can provide information to the patient. Although comorbidities can impact anesthesia and recovery, this is not the main reason for not performing the replacement. Hip replacements do require extensive physical and occupational therapy, but this would not keep a patient from undergoing this surgery.

An older adult patient is diagnosed with an intracapsular hip fracture. Which statement by the nurse explains this type of injury? "It is a fracture that involves the lesser trochanter." "It is a fracture of multiple bones within the pelvic region." "It is found in the head or neck of the femur within the capsule of the hip joint." "It is a fracture that is found in the iliac region."

"It is found in the head or neck of the femur within the capsule of the hip joint." Intracapsular hip fractures involve the head or neck of the femur within the capsule of the hip joint. Therefore, the nurse would provide this information to the family. The lesser trochanter, iliac region, and pelvic bones are not involved. Hip fractures may include the head of the femur, the neck of the femur, and the trochanteric regions of the femur.

The nurse is instructing the unlicensed assistive personnel (UAP) about the use an abduction splint for a patient who underwent an arthroplasty after sustaining a hip fracture. Which information should the nurse include? - "Keep the extremities always slightly apart." - "Keep the feet on two pillows." - "Keep weights alongside the hip to keep it from rotating." - "Keep the lower extremities together by using an immobilization binder around both legs."

"Keep the extremities always slightly apart." Keeping the extremities in slight abduction by using an abduction splint as ordered helps to maintain proper positioning and prevent dislocation of the hip. Elevating the feet on two pillows, placing weights alongside the hip to keep it from rotating, and keeping the lower extremities adducted by using an immobilization binder around both legs are not correct positioning.

The nurse is planning a presentation for community members about hip fractures and reviews the causes and risk factors. Which participant statement indicates a need for further teaching? "Premenopausal women have an increased risk for hip fractures." - "As a person ages, there is an increased the risk for developing hip fractures." - "A person with osteoporosis has an increased risk for hip fractures." - "Cancer, especially metastatic cancer to the bones, increases a person's risk for hip fractures."

"Premenopausal women have an increased risk for hip fractures." Postmenopausal, not premenopausal, women are at risk for hip fractures. Therefore, the statement made by the participant indicates a need for further teaching. Patients with osteoporosis are at risk for hip fractures. The incidence of hip fractures increases with age, and a history of cancer also places a patient at risk.

An 80-year-old patient recovering from total hip surgery asks, "Why do I need occupational therapy? I've been retired for 20 years." Which response by the nurse is appropriate? "The therapist will determine if your physical therapy is working." "This therapy improves the function of the new hip." "This therapy helps with activities of daily living." "The therapist will help identify appropriate volunteer activities for you to participate in."

"This therapy helps with activities of daily living." The occupational therapist will focus on exercises and activities to optimize the patient's ability to perform activities of daily living. Occupational therapy does not improve the functioning of the new hip. That is done through physical therapy. The occupational therapist does not evaluate the success of physical therapy. Occupational therapists do not identify volunteer activities for patients.

Parents of a 13-year-old child who sustained a hip fracture from a bicycle accident ask the nurse how long the child will be in a cast. Which response by the nurse is accurate? "Your child will be in the cast about 1-3 weeks." "Your child will be in a cast about 4-6 weeks." "Your child will not need a cast, only a walking boot." "Your child will be in the cast about 2-4 weeks."

"Your child will be in a cast about 4-6 weeks." Children's bones heal more quickly than adults' and therefore need prompt medical attention to set the fracture and immobilize the joint. Hip fractures in children may involve the epiphyseal plate, which lies between the head and neck of the femur; physicians must account for epiphyseal plates in bones when performing treatment. Treatment for hip fractures in children often requires casting or repair surgery rather than hip replacement surgery. Time of healing in a cast is usually 4-6 weeks. The child would not need a walking boot because they did not break a foot or ankle.

A 60-year-old female patient asks the nurse what they can do to prevent hip fractures. Which information should the nurse provide the patient? - "You should undergo bone density testing every 3 years to determine bone strength." - "Because you are postmenopausal, you should take estrogen to promote bone health." - "You should use assistive devices for ambulation to prevent any chance of sustaining a fall." - "Postmenopausal women like you who are not taking hormone replacement therapy should consume 1500 mg of calcium per day."

- "Postmenopausal women like you who are not taking hormone replacement therapy should consume 1500 mg of calcium per day." Postmenopausal women are at high risk for osteoporosis due to loss of estrogen. Therefore, those women not taking hormone replacement therapy should take 1500 mg of calcium per day. All women should not arbitrarily take hormone replacement therapy because it has risks that should be discussed with the healthcare provider (e.g., blood clots, breast cancer). If the patient can safely walk independently, there is no need for using an assistive device. Bone density testing should be performed annually in postmenopausal women.

The nurse is preparing to administer an anticoagulant to an older adult patient admitted with a hip fracture. The family asks why the patient needs the injection. Which response by the nurse is accurate? - "Anticoagulants are administered to all hospitalized patients to prevent pneumonia after surgery." - "Anticoagulants are administered to assist the patient in recovery from the surgical anesthesia." - "This is to prevent the patient from developing a blood clot, as hip fractures increase the patient's risk." - "This medication is used to prevent fat emboli from breaking loose after the injury and to prevent complications."

- "This is to prevent the patient from developing a blood clot, as hip fractures increase the patient's risk." Older adult patients with a hip fracture are at an increased risk for developing deep vein thrombosis. This is due to the surgical procedure itself and decreased mobility. Normal postoperative interventions would include the administration of anticoagulants to decrease this risk. Antibiotics decrease the risk of pneumonia. Time, turning, coughing, and deep breathing will help expel the effects of anesthesia. There are no interventions to prevent a fat embolism.

Statistics in older adult patients with hip fractures include:

- Approximately 20% will sustain a second fracture in 2 years. - About 50% will sustain a second fracture in 3-5 years. - The mortality rate is 9% and increases to 17% with other comorbidities. - Developing pneumonia after hip fracture increases the mortality rate to 43%. - Developing congestive heart failure after hip fracture increases the mortality rate to 65%.

Lifestyle alterations to prevent hip fractures include:

- Incorporating daily weight-bearing exercise. - Including vitamin D and calcium in the diet. - Clearing pathways of cords and throw rugs. - Having annual eye and bone density exams. - Using assistive devices for ambulation if needed.

Risk factors for hip fractures includes:

- Osteoporosis. - Metastatic cancer. - Postmenopause. - Age. - Endocrine disorders. - Intestinal disorders. - Physical inactivity. - Being Caucasian American.

Complications of hip fractures include:

- Pneumonia. - Atelectasis. - Deep vein thrombosis. - Skin breakdown. - Major loss of mobility. - Urinary tract infections. - Muscle atrophy. - Infections. - Avascular necrosis. - Mental deterioration.

Age-related issues for hip fractures include:

- Pneumonia. - Deep vein thrombosis. - Nutritional deficiencies. - Early mobility. - Sensory deprivation.

Information for the child/adolescent with a hip fracture include:

- The fracture may involve the epiphyseal plate. - The fracture requires casting or repair surgery (usually not hip replacements). - These fractures usually result from bike accidents, motor vehicle crashes, or sports injuries. - The fracture will be casted for 4-6 weeks.

Evaluation of nursing interventions include:

- The patient will achieve adequate pain control. - The patient will ambulate independently after surgery and rehabilitation. - The patient will have adequate wound healing of skin abrasions. - The patient will not develop an infection from wounds or surgical incisions. - The patient will demonstrate increased muscle strength and balance. - The patient will be oriented to time, location, and environment. - The patient will verbalize decreased anxiety with understanding of the rehabilitation process. - The patient will verbalize an understanding of treatment options for a hip fracture. - The patient will implement nonpharmacologic methods to reduce stress. - The patient's caregiver will ask for help when needed to provide relief from caregiver responsibilities.

Teaching points in case of sustaining a fall include:

- Turn on your stomach and crawl to a phone. - Scoot to the phone on your bottom or uninjured side. - Crawl to a stairway, and use the stairs to gradually lift yourself to a standing position. - Participate in a 24-hour emergency alert service. - Keep a bell or phone near the floor rather than on the wall or counter so it can be reached from a fallen position. - Keep a cell phone with you at all times. - Ask a friend or family member to check in daily. - Cover up with a blanket to stay warm until help arrives.

The nurse is assigned to care for four patients. Which patient should the nurse consider to be at highest risk for a hip fracture? 60-year-old male patient with coronary heart disease 50-year-old male patient with deep vein thrombosis 65-year-old female patient with osteoporosis 45-year-old female patient with pneumonia

65-year-old female patient with osteoporosis Older women who are postmenopausal and have osteoporosis are at a high risk for hip fractures. Therefore, the 65-year-old patient with osteoporosis is at the highest risk. Pneumonia and deep vein thrombosis are possible complications of hip fractures. Coronary heart disease is not a risk factor for hip fractures.

A patient who underwent surgical repair of a hip fracture is scheduled for the first physical therapy session in 1 hour. Which intervention should the nurse perform first? Administer pain medication. Have the patient perform stretching exercises. Provide hot packs to the surgical site. Give a stool softener laxative.

Administer pain medication. The first therapy session after a hip replacement may be especially painful. Therefore, the nurse should administer pain medication 30-60 minutes before the session. The nurse would not place hot packs on a fresh surgical incision because this could increase the risk of infection. The therapist, not the nurse, will perform the stretching exercises with the patients. Laxatives would not be given an hour before therapy because the medication may begin to take effect during therapy.

Hip fractures occur most often in or from the following:

Adults - Falls Children -Bike crashes -Sports injuries -Motor vehicle crashes

The nurse is assessing the hip incision of a patient who underwent an arthroplasty 3 days ago and notices purulent drainage. After a culture and sensitivity of the drainage has been obtained, which class of medication should the nurse expect the healthcare provider to prescribe? Anticoagulant Anticonvulsant Antiemetic Antibiotic

Antibiotic Purulent drainage from the incision is an indication of a postoperative infection. Therefore, the nurse would expect the healthcare provider to prescribe antibiotics. Anticoagulants are used to prevent blood clots, anticonvulsants are used to treat seizures, and antiemetics are used to prevent nausea and vomiting.

A patient underwent an arthroplasty after sustaining a hip fracture. The nurse notices decreased capillary refill on the affected side as well as decreased sensation. Which should be the nurse's next intervention? Obtain blood pressure. Determine pain level. Assess peripheral pulses. Auscultate lung sounds.

Assess peripheral pulses. This patient is demonstrating compromised neurovascular status secondary to a hip arthroplasty. The patient has decreased sensation and capillary refill. Therefore, the nurse would assess blood flow to the extremity by assessing peripheral pulses. Blood pressure, lung sounds, and pain levels are important, but the peripheral pulses are the priority here to prevent complications from decreased blood flow.

A patient with a history of lung cancer presents with right hip pain after sustaining a fall. X-rays are inconclusive, but the patient is in excruciating pain. Which diagnostic test should the nurse expect the healthcare provider to prescribe? CT scan Positron emission tomography (PET) scan Bone density scan Ortolani test

CT scan Because this patient has lung cancer and reports severe hip pain, the healthcare provider would use a CT scan or MRI to detect hairline fractures and/or metastatic disease. A PET scan detects cancer hot spots only, not hairline fractures. A bone density scan is used to detect osteoporosis. The Ortolani test is used to detect hip dysplasia in infants.

Dietary interventions to help prevent hip fractures include:

Calcium intake 1500 mg/day for postmenopausal women not taking estrogen. Calcium intake 1000 mg/day for postmenopausal women taking estrogen. Adequate vitamin D intake. Healthy diet.

The nurse is providing a teaching session about common conditions that impact older adult patients, including hip fractures. Which information about hip fractures should the nurse include? Frequently result from falls Frequently result from motor vehicle crashes Frequently result from improper use of assistive devices Frequently result from congenital anomalies

Frequently result from falls The biggest cause of hip fractures in older adult patients is falls. These usually occur because of falling at an angle from a standing position and landing on the hip. Children have an increased incidence of hip fractures from sports injuries and motor vehicle crashes. Congenital anomalies would affect children, not adults. Improper use of assistive devices does not usually cause falls.

A community nurse is conducting a wellness check for an older adult patient. Which finding indicates the patient is at increased risk for hip fractures? Has a sedentary lifestyle Uses an assistive device for ambulation Has annual eye and vision exams Takes calcium and vitamin D

Has a sedentary lifestyle The factor that places this patient at the highest risk for hip fractures is the sedentary lifestyle. Weight-bearing exercises are important to incorporate into daily life to promote bone strength. Using an assistive devise for ambulation, as needed, decreases the risk for hip fracture. Incorporating calcium and vitamin D and having annual eye exams are important measures to prevent hip fractures.

The nurse is caring for a patient who fell and sustained a hip fracture. Which clinical manifestation should the nurse expect to find during the assessment? Inward flexion of the hips Back pain radiating to the leg Change in patient's weight Inability to move or stand

Inability to move or stand A patient with a hip fracture will lack the ability to move or stand on the affected hip. A change in the patient's weight would not be anticipated because of the hip fracture. The patient will have outward flexion of the affected hip. Back pain radiating down to the leg is a sign of sciatica, not a hip fracture.

Clinical manifestations of hip fractures include:

Inability to stand or move the affected hip or leg. Outward turn of the leg. Hip pain. Shorter leg on injured side.

The nurse is assessing a patient who underwent a surgical repair of a hip fracture. Which finding warrants immediate notification of the healthcare provider? Lack of lower extremity sensation or movement No bowel movement for 4 days Pain rating of 8 out of 10 after therapy Urine output of 2500 mL/24 hours

Lack of lower extremity sensation or movement The nurse would immediately notify the healthcare provider if there is a lack of lower extremity sensation and movement, which is an indicator of paralysis occurring. No bowel movement in 4 days needs to be addressed, but does not require immediate intervention. The patient will have increased pain after therapy, which will be addressed with pain medication. Urinary output of 2500 mL/24 hours is a normal finding.

The nurse is assessing a patient who underwent a surgical repair of a hip fracture. Which finding warrants immediate notification of the healthcare provider? Urine output of 2500 mL/24 hours Pain rating of 8 out of 10 after therapy No bowel movement for 4 days Lack of lower extremity sensation or movement

Lack of lower extremity sensation or movement The nurse would immediately notify the healthcare provider if there is a lack of lower extremity sensation and movement, which is an indicator of paralysis occurring. No bowel movement in 4 days needs to be addressed, but does not require immediate intervention. The patient will have increased pain after therapy, which will be addressed with pain medication. Urinary output of 2500 mL/24 hours is a normal finding.

Physical assessment with hip fracture patients includes:

Neurovascular status. Pain. - Pallor. - Pulse. - Paresthesia. - Paralysis. - Mobility. - Incision site. - Gastrointestinal tract. - Mental status.

The nurse admits a patient who sustained a hip fracture. Which medication should the nurse anticipate will be prescribed? Sodium bicarbonate to correct acidosis Diuretics to increase urinary output Pain medications to reduce discomfort Steroids to reduce inflammation

Pain medications to reduce discomfort Pain medications, such as opioids or patient-controlled analgesia, are administered to patients with hip fractures to reduce discomfort. Diuretics, steroids, and sodium bicarbonate are not indicated.

Medications used to treat patients with hip fractures include:

Pain medications. Antibiotics. Anticoagulants.

The nurse at the rehabilitation center is developing a plan of care for a patient who underwent a right hip replacement secondary to a hip fracture. Which outcome is most appropriate for discharge to home? Patient takes anticoagulants as prescribed. Patient requires assistance with getting dressed. Patient verbalizes need for pain medication before therapy. Patient ambulates independently with an assistive device.

Patient ambulates independently with an assistive device. On discharge from the rehabilitation facility, the patient should be independent with ambulation with an assistive device, such as a walker or crutches. Pain medication and anticoagulants should not be required by the time the patient is discharged from the rehabilitation center. If the patient requires assistance with getting dressed, the patient may not be ready for discharge to independent living.

Therapy with hip fracture repair includes:

Physical therapy: gait training, strengthening exercises, and range of motion exercises. Occupational therapy: regaining independence with activities of daily living.

A patient underwent surgical repair of a hip fracture this morning. The nurse provides an incentive spirometer to improve gas exchange. Which complication of hip fractures is the nurse attempting to prevent? Deep vein thrombosis Pneumonia Impaired mobility Impaired skin integrity

Pneumonia By providing an incentive spirometer to facilitate deep breathing, the nurse has a goal of preventing pneumonia. Anticoagulants, compression stockings, and exercise will help minimize the risk of deep vein thrombosis. Physical therapy and exercise will help improve mobility, and with improved mobility, the patient will be at a decreased risk for skin breakdown.

The nurse is preparing a patient who sustained a hip fracture for a hemiarthroplasty. Which risk should the nurse provide teaching for before surgery? Long-term use of a walker Postoperative infection Compliance with rehabilitation Need for a hip revision in 5 years

Postoperative infection The nurse should provide preoperative teaching about the risk for infection. This should be aimed at preventing pneumonia by teaching the patient how to use an incentive spirometer, the importance of coughing and deep breathing, and the value of early ambulation. For patients who develop pneumonia after hip fracture, the mortality rate increases to 43%. Hip replacements last around 10 years, not 5 years. Generally, as a patient heals properly and gains mobility with physical therapy, a walker will not be required for long-term use. Compliance with rehabilitation will come after the procedure, not before.

The nurse is assessing a patient who is 2 days' postoperative from a surgical repair of a hip fracture. Which information indicates a possible complication from this procedure? Hypoactive bowel sounds Oxygen saturation 93% on room air Purulent incisional drainage Pain level 5 out of 10 with movement

Purulent incisional drainage Purulent incisional drainage indicates a possible postoperative infection and should be reported to the healthcare provider. Hypoactive bowel sounds are a normal finding when a patient is 2 days' postoperative and taking narcotic analgesics for pain. A pain level of 5 on a scale of 1 to 10 when moving would be expected 2 days after a hip replacement. An oxygen saturation of 93% on room air is still within normal limits.

Preoperative surgical teaching includes:

Risk for infection. Risk for deep vein thrombosis. Hip dislocation. Delayed healing.

The nurse is providing a teaching session to a group of older adult patients about home safety. Which action should the nurse teach a patient to take in case of a fall? Scooting to the phone on their bottom or uninjured side Keeping a phone in the kitchen Having a family member check on them twice a week Attempting to stand on the injured limb

Scooting to the phone on their bottom or uninjured side The patient should scoot to the phone on the bottom or uninjured side after a fall with injury. Other measures include having a family member check on the patient daily, not weekly, and keeping a cell phone with the patient at all times. Trying to stand on the injured limb could cause further damage and should not be attempted.

Nursing interventions for hip replacement surgery include:

Signed consent form. Correct positioning (hip precautions, if ordered). Assisting with ambulation. Indwelling urinary catheter care. Administering anticoagulants, pain medication, stool softeners. Promoting safety.

The nurse is preparing a patient for immediate surgery for the repair of a hip fracture. Which intervention should the nurse include in the preoperative plan of care? Insert an indwelling urinary catheter. Administer a blood transfusion. Administer anticoagulants. Teach importance of early ambulation.

Teach importance of early ambulation. The nurse should teach the patient preoperatively about the importance of preventing pneumonia during the postoperative period. The nurse should prepare the patient to expect early ambulation. This will help improve oxygenation, decrease risk of pneumonia, decrease risk of deep vein thrombosis, and improve strength, range of motion, and mobility. The patient would not need a blood transfusion before a hip replacement because there is minimal blood loss. The indwelling urinary catheter will be inserted in the operating room when the patient is sedated. Anticoagulants are administered after the procedure, not before.

A patient recovering from a hip replacement for a hip fracture develops pneumonia. The nurse creates an aggressive plan of care to promote mobility and treat the pneumonia. Which rationale supports the nurse's action? The older adult patient with a hip fracture has a 50% increased risk of having another fracture in 3-5 years. The mortality rate increases to 43% in older adult patients with hip fractures who develop pneumonia. The nurse and healthcare provider are receiving pressure that the patient is hospitalized too long. The nurse is pushing for resolution of the pneumonia since therapies are on hold during the treatment.

The mortality rate increases to 43% in older adult patients with hip fractures who develop pneumonia. The mortality rate of older adult patients who sustain hip fractures is 9%; however, if it is coupled with pneumonia, this increases the risk of mortality to 43%. Therefore, the nurse and healthcare provider will be aggressive in treating the pneumonia to facilitate recovery from the hip fracture. While pneumonia will increase the length of stay, this is not the primary reason for being aggressive in treatment. The older adult patient does have an increased risk of a secondary fracture within 3-5 years. The patient will continue to receive therapy while healing from the fracture.

The nurse is caring for a patient who is recovering from surgery for a fractured hip. How soon after surgery should the nurse assist the patient to ambulate? The patient can only ambulate after physical therapy has been consulted. The patient can only ambulate once all postoperative lab work comes back normal. The patient should wait at least 24 hours to ambulate after surgery. The patient should ambulate as soon as possible after surgery.

The patient should ambulate as soon as possible after surgery. It is the nurse's responsibility to assist the patient with ambulation as soon as possible after surgery, once it is approved by the provider. Strict bedrest is no longer recommended for postoperative patients because it can do more harm than good. Early ambulation prevents deep vein thrombosis, skin breakdown, and breathing problems. Ambulation also increases circulation. Waiting 24 hours after surgery is too long and could cause postoperative complications. It is not necessary to wait for physical therapy to initiate ambulation; it is within the nurse's scope of practice to assist in ambulation. Postoperative lab work does not affect the patient's ability to ambulate.

Complementary and alternative medicine approaches for hip fractures include:

Traction. Casting. Physical therapy. Occupational therapy.

The nurse is developing a plan of care for a patient who had a surgical repair of a hip fracture. The nurse assigns the following nursing diagnoses: Mobility: Physical, Impaired and Risk for Impaired Skin Integrity. Which intervention is appropriate for the nurse to include? Administer antibiotics as prescribed. Turn and reposition every 2 hours. Provide pain medication before therapy. Instruct on incentive spirometer use.

Turn and reposition every 2 hours. The patient who has decreased mobility related to having a hip fracture repair is at high risk for skin breakdown. Therefore, the nurse would turn and reposition the patient every 2 hours. Antibiotics would prevent infection, incentive spirometer use would help minimize the risk of pneumonia, and anticoagulants prevent the formation of blood clots. These interventions are appropriate for the patient, but they do not address the risk for skin breakdown secondary to decreased mobility.

A 70-year-old patient presents at the emergency department with trauma to the right hip from a fall. Which diagnostic test should the nurse anticipate being ordered by the healthcare provider? X-ray Abdominal ultrasound Doppler studies Complete blood count (CBC)

X-ray An X-ray is the gold standard for diagnosing a hip fracture. CBC, Doppler studies, and abdominal ultrasound are not used to diagnose a hip fracture.

Intracapsular fractures occur

at the head or neck of the femur within the capsule of the hip joint

Intertrochanteric fracture occurs

between the neck and the lesser or greater trochanter

Subtrochanteric fractures occur

immediately below the lesser trochanter

Extracapsular fractures occur

within the trochanteric region, which is between the neck and diaphysis of the femur