Hip Fracture
The nurse is presenting a program at a senior center on how to survive a fall. Which statement by a program participant indicates that this person needs clarification about what emergency actions to take after a fall? A) "I should crawl to a phone on the affected side to keep it stable against a hard surface." B) "I should try to cover myself with a blanket while I wait for help to arrive." C) "To call for help, I can scoot on my bottom to a low wall-mounted phone." D) "If possible, I can crawl to a stairway and use the stairs to lift up to a standing position."
Answer: A Clients at risk for falls and hip fractures should be taught how to notify emergency services in the event of a fall and injury. These clients should be instructed to turn onto the stomach and crawl to the phone, or to scoot to the phone using the buttocks on the uninjured side. And another option is to crawl to a stairway and use the stairs to gradually lift the body to a standing position. While waiting for help to arrive, clients should cover themselves with a blanket if possible to help prevent shock.
The nurse is assessing an older adult client in a long-term care facility after a fall. Which finding requires priority action? A) The injured leg is shortened and externally rotated. B) Redness and severe swelling are found at the hip joint. C) Pain is relieved by moving the affected extremity. D) The client is repeatedly flexing the injured leg at the hip.
Answer: A The client with a fractured hip is often in extreme pain and assumes a position with the leg on the affected side shortened and externally rotated because of gravity and the pull of the muscles. Any movement of the leg on the side of the affected hip is likely to cause severe muscle spasms and further pain. Redness and swelling are the classic signs of inflammation not immediately present after hip fracture. Extreme pain associated with hip fracture prevents any voluntary movement in the leg.
The nurse is providing discharge instructions to an older adult client who is recovering from a fractured hip. The client is planning to stay with an adult child, who is included in the discharge teaching. Which statements on the part of the client indicate appropriate understanding of the information presented by the nurse? Select all that apply. A) "I have signed a contract with Lifeline." B) "We are removing the area rugs in the hallway." C) "I've borrowed a toilet seat riser from the equipment closet." D) "I will be sure to take oxycodone before I go downstairs in the morning." E) "I can help with housework while I'm staying at my child's house."
Answer: A, B, C Statements regarding the use of an emergency alert service and a toilet seat riser indicate appropriate understanding of the information presented. Picking up loose area rugs can help decrease the risk of falls. Pain medication should not be taken when there is a risk of a fall, particularly prior to going down a set of stairs. The nurse should assess the housework that the client wants to help with while living with the adult child. Many housework tasks will be inappropriate.
The nurse gives discharge instructions to an adult client who sustained a bicycle fall and underwent open reduction and internal fixation of a fractured hip. After the teaching is complete, which statements by the client indicate appropriate understanding of the information presented? Select all that apply. A) "I will use my abduction pillow while sleeping to maintain proper hip alignment." B) "I will use a high toilet seat to prevent excess flexion of my hip." C) "I only need to use my walker during physical therapy appointments." D) "I will take my prescribed ibuprofen to decrease the risk for deep vein thrombosis." E) "I might experience bruising because of the warfarin I've been prescribed."
Answer: A, B, E Statements regarding use of an abduction pillow to maintain proper hip alignment; use of a high toilet seat to prevent excess flexion of the hip; and awareness that warfarin presents an increased risk for bruising all indicate client adequate understanding. The nurse should remind the client to use the walker at all times until told otherwise. The nurse should also explain that warfarin, not ibuprofen, is prescribed to decrease the risk for deep vein thrombosis.
A postmenopausal client asks the nurse what she can do to prevent fracturing her hips, as her mother and grandmother both experienced this health problem. Which response by the nurse is most appropriate? A) "You should avoid all types of exercise." B) "You should consider a smoking cessation program." C) "You should limit your exposure to the sun." D) "You should use throw rugs throughout your home."
Answer: B One modifiable risk factor for hip fractures is smoking. Women who smoke have a greater risk of fracture because smoking reduces bone density in menopausal and postmenopausal women. The client should not be instructed to avoid exercise; exercise will enhance the client's gait, balance, and musculoskeletal strength. Limiting sun exposure will not impact the client's risk of experiencing a hip fracture. The nurse should not instruct the client to use throw rugs throughout the home because this could cause tripping, leading to a fall.
A client with a BMI of 35 is recovering from total hip replacement surgery and experiencing pain that is exacerbated with movement. The client says to the nurse, "I live alone. How will I ever be able to return to my home?" Based on this information, which is the priority nursing diagnosis for this client? A) Overweight B) Acute Pain C) Impaired Physical Mobility D) Ineffective Coping
Answer: B The priority nursing diagnosis is Acute Pain. Unless this pain is controlled, the client will not be able to participate in interventions to address the nursing diagnosis of Impaired Physical Mobility. The diagnoses of Ineffective Coping and Overweight can be addressed after Acute Pain and Impaired Physical Mobility have been addressed.
A client is recovering from surgery to repair a fractured hip. Which actions by the nurse may reduce this client's risk for osteomyelitis in the postoperative period? Select all that apply. A) Assess for pain every 1-2 hours. B) Use sterile technique for dressing changes. C) Assess wound for size, color, and drainage. D) Administer antibiotics as prescribed. E) Administer anticoagulants as prescribed.
Answer: B, C, D Interventions that can reduce the client's risk for infection include using sterile technique for dressing changes; assessing the wound for size, color, and drainage; and administering antibiotics as prescribed. Assessing for pain every 1-2 hours is appropriate for the nursing diagnosis of Acute Pain, but it does not help reduce the risk of osteomyelitis. Administering anticoagulants per order is appropriate for the client who is at risk for deep vein thrombosis (DVT), but again, it does not help reduce the risk of osteomyelitis.
A client is undergoing surgery for a fractured hip. The surgeon has stated that careful attention will be paid to preserving the epiphyseal plate. Which client will require this precaution during surgery? A) A postmenopausal woman with paraplegia B) A 32-year-old man who is a competitive body builder C) A prepubescent girl who is a vegetarian D) An 85-year-old woman with osteoporosis
Answer: C Epiphyseal plates are unique joints that produce growth of bone length in children. There is an epiphyseal plate that lies between the head and neck of the femur that must be preserved during hip surgery in pediatric clients to prevent obstruction of bone growth. Of the clients listed here, only the prepubescent girl is young enough to have an epiphyseal plate. All of the other clients are older than 18-25 years of age, when the epiphyseal plate closes.
The nurse is evaluating care provided to a client recovering from hip replacement surgery. Which piece of documentation in the medical record indicates that the client has achieved the expected outcome for pain management? A) The client states pain is a 6 on a numeric pain scale of 0 to 10 prior to evening care. B) The client is crying and requesting pain medication prior to morning care. C) The client is using a PCA pump around the clock and rates pain as a 2 on a numeric pain scale of 0 to 10. D) The client refuses pain medication prior to physical therapy. Pain is rated as a 7 on a numeric pain scale of 0 to 10.
Answer: C Expected outcomes for pain management following hip replacement surgery are to minimize pain to a client rating of 3 or lower via medication administration, including use of patient-controlled analgesia (PCA) as appropriate. Completely eliminating pain is an unrealistic goal. Thus, only the client who is using the PCA pump and has a pain rating of 2 on a 0-to-10 scale has achieved an expected outcome for pain management.
A hip fracture that occurs in the trochanter region would be classified as a(n) A) intracapsular fracture. B) intercapsular fracture. C) extracapsular fracture. D) subcapsular fracture.
Answer: C Hip fractures are broadly classified as either intracapsular or extracapsular. Intracapsular hip fractures occur at the head or neck of the femur within the capsule of the hip joint. Extracapsular hip fractures occur within the trochanter region, which is between the neck and diaphysis of the femur. Extracapsular fractures can be further divided into intertrochanteric or subtrochanteric. The terms intercapsular and subcapsular are not used to describe fractures of the hip.
The first day after surgery to repair a fractured hip sustained from a fall, an older adult client refuses to ambulate but states, "I will consider it tomorrow." In this situation, which is the priority action by the nurse? A) Coordinate personnel to assist with ambulation B) Document the client's refusal C) Assess why the client is refusing to ambulate D) Notify the healthcare provider
Answer: C The first thing the nurse should do is assess why the client is refusing to ambulate. The client might be fearful of falling, given that a prior fall resulted in a fractured hip. Following this assessment, the nurse could plan interventions that would facilitate ambulation, such as controlling pain and reducing the fear of falling. It is premature to notify the healthcare provider. The nurse should not force the client to get out of bed. Documenting the client's refusal is appropriate, but after determining the reason for the refusal.
For non-elderly adult clients who fracture a hip, why is internal fixation or casting of the fracture generally preferred over hip replacement? A) Internal fixation or casting is preferred because it does not disturb the client's epiphyseal plate. B) Internal fixation or casting is preferred because of the lower risk of deep vein thrombosis. C) Internal fixation or casting is preferred because of the shorter recovery time. D) Internal fixation or casting is preferred because of the limited longevity of hip prostheses.
Answer: D Non-elderly adults are likely to live beyond the decade or so anticipated lifespan of a replacement hip. Internal fixation and casting are the preferred treatment methods for these clients because hip replacement may eventually necessitate revision surgery, which carries a greater level of risk than the initial hip replacement surgery. Protection of the epiphyseal plate is not a concern in adult clients, because they no longer have epiphyseal plates. Internal fixation, casting, and hip replacement all carry a similar risk of deep vein thrombosis, and none of these methods offers a definitive benefit in terms of recovery time.
An older adult client experiences a hip fracture. Prior to the injury, the client had an active lifestyle. Based on this information, which surgical procedure should the nurse anticipate? A) Total hip replacement B) Open reduction and external fixation C) Arthroplasty D) Open reduction and internal fixation
Answer: D Open reduction and internal fixation is the preferred surgical procedure to repair a fractured hip for older adult clients who are active and will be able to use crutches with partial weight bearing following surgery. A total hip replacement, also called arthroplasty, is generally performed only when severe arthritis or an underlying bone condition is present, which does not appear to be the case given this client's activity level prior to the injury. Open reduction and external fixation is not a surgical option for a fractured hip