hip fractures

promoting exercise in the patient who just had surgery?

The patient is encouraged to exercise as much as possible by means of the overbed trapeze. This device helps strengthen the arms and shoulders in preparation for protected ambulation (e.g., toe touch, partial weight bearing). On the first postoperative day, the patient transfers to a chair with assistance and begins assisted ambulation. The amount of weight bearing that can be permitted depends on the stability of the fracture reduction

Impacted intracapsular femoral neck fractures cause moderate discomfort (even with movement), may allow the patient to ?? weight, and may not demonstrate obvious shortening or rotational changes.

bear

??extension traction, a type of temporary skin traction, was traditionally applied because it was believed to reduce muscle spasm, to immobilize the extremity, and to relieve pain.

bucks

With extracapsular femoral fractures of the trochanteric or subtrochanteric regions, the extremity is significantly shortened, externally rotated to a greater degree than intracapsular fractures, exhibits muscle spasm that resists positioning of the extremity in a neutral position, and has an associated area of ???

ecchymosis.

how to reposition the patient

most comfortable and safest way to turn the patient is to turn to the uninjured side. The standard method involves placing a pillow between the patient's legs to keep the affected leg in an abducted position. Proper alignment and supported abduction are maintained while turning

what should happen first 24-48 hours after surgery

relief of pain and prevention of complications are important, and continuous neurovascular assessment is essential.

The patient is most comfortable with ???

the leg slightly flexed in external rotation.

the immediate post-op care for a patient with a hip fracture? what should the nurse pay attention to

Attention is given to pain management, prevention of secondary medical problems, and early mobilization of the patient so that independent functioning can be restored.

signs of DVT

Intermittent assessment of the patient's legs for signs of DVT, which may include unilateral calf tenderness, warmth, redness, and swelling, is indicated.

how can nurse deal with lose of bladder control- encourage what....

Loss of bladder control (incontinence or retention) may occur. In general, the routine use of an indwelling catheter is avoided because of the high risk of urinary tract infection. If a catheter is inserted at the time of surgery, it usually is removed on the first postoperative day followed by a trial to void . Because urinary retention is common after surgery, the nurse must assess the patient's voiding patterns. To ensure proper urinary tract function, the nurse encourages liberal fluid intake if the patient has no pre-existing cardiac disease.

what should the nurse be monitoring for in case of complications?

Neurovascular complications may occur from direct injury or edema in the area that causes compression of nerves and blood vessels. With hip fracture, bleeding into the tissues and edema are expected. Monitoring and documenting the neurovascular status of the affected leg are vital.

how will nurse prevent pulmonary complications?

Pulmonary complications (e.g., atelectasis, pneumonia) are a threat to older patients undergoing hip surgery. Coughing and deep-breathing exercises, intermittent changes of position, and the use of an incentive spirometer may help prevent respiratory complications. Pain must be treated with analgesic agents, typically opioids; otherwise, the patient may not be able to cough, deep breathe, or engage in prescribed activities. The nurse assesses breath sounds to detect adventitious or diminished sounds.

skin break down prevention includes

Skin breakdown is often seen in older patients with hip fracture. Blisters caused by tape are related to the tension of soft tissue edema under a nonelastic tape. An elastic hip wrap dressing or elastic tape applied in a vertical fashion may reduce the incidence of tape blisters. In addition, patients with hip fractures tend to remain in one position and may develop pressure ulcers. Proper skin care, especially on the bony prominences, helps to relieve pressure. High-density foam mattress overlays may provide protection by distributing pressure evenly.

when should surgery be done?

Surgical intervention is carried out as soon as possible after injury. The preoperative objective is to ensure that the patient is in as favorable a condition as possible for the surgery. Displaced femoral neck fractures are treated as emergencies, with reduction and internal fixation performed within 24 hours after fracture.

surgical treatment consists of?

Surgical treatment consists of (1) open or closed reduction of the fracture and internal fixation, (2) replacement of the femoral head with a prosthesis (hemiarthroplasty), or (3) closed reduction with percutaneous stabilization for an intracapsular fracture.

how will the nurse prevent VTE?

To prevent VTE, the nurse encourages intake of fluids and ankle and foot exercises. Antiembolism stockings, pneumatic compression devices, and prophylactic anticoagulant therapy are indicated and should be prescription. During hospitalization, the patient or the patient's caregiver should be educated regarding the signs, symptoms, and risks of VTE, and how to administer anticoagulant prophylaxis as prescribed (see Chart 42-4)