Lilli
Ju
Jessica
Michelle Merza
Hip Fracture

Hip fractures commonly results from a fall and occurs more frequently among the elderly and patients with osteoporosis. Frequently hip fractures require surgical intervention.

Assessment Findings: Severe pain with leg movement the pain will radiate to the knee and patient will has a sensation of pressure in the outer area of the hip
There may be extensive bruising in the hip, groin and thigh area.. X-rays should be taken to confirm diagnosis.

There are different types of hip fractures: Intracapsular, subcapital, transcervical, extracapsular and Intertrochanteric.

Pre-operative care
Obtain medical history
Check the chart for any medication that needs to be discontinued prior to surgery
Obtain appropriate labs: ie( PT PTT INR)
Make sure any medical consults are done prior to surgery
Check chart to be sure that consent is signed
Explain to patient pain management
Explain to patient expected physical limitation post operatively
Teach pt the use of incentive spirometer, turn cough and deep breathe, isometrics, use of trapez abductor pillow
Inform patient of NPO status
Inform pt of the possibility of drain postoperatively
Inform pt of the use of Ted Hose

Post-operative Care
The first six weeks after surgery special precautions need to be observed to prevent dislocations:
Do not bend your hip beyond 90 degrees (at aright angle)
Don not bend your legs or knees together
Do not sit straight up in bed or bring your operative leg up toward your chest
Do not rotate the operative leg inward
Explain to client that there will be a hip adductor pillow in place to help prevent these movements
Explain the use of the reacher to pick up objects off the floor
Explain the possibility of traction
Monitor for pressure ulcers on heels
Implement CMP Machine
Remove TED hose each shift

Possible Post operative complications

DVT,
Dislocation
Hemorrhage
Hematoma

CARING FOR A PATIENT WITH A LIMB AMPUTATION

Preoperative Care:
- Presurgical nursing management includes reducing pain and anxiety and supporting the patient or she begins to grieve the loss of the limb and adapt to potential changes.
- Before surgery, the nurse explains all the routine preoperative preparations and reinforces what the physician has discussed with the patient and family regarding the extent of physical disability.
- The nurse reviews the postoperative management such as: deep breathing, coughing, positioning, and routine exercises and encourages the patient to practice the exercises if time and the patient’s condition permit.
- The nurse acknowledges the client’s feeling and remains objective and nonjudgmental as the patient expresses negative emotional responses. Reassuring the patient that his or her reaction is normal may provide comfort. The nurse should not shame, criticize, or trivialize the patient’s behavior.
- While the patient is preoccupied with the potential loss, the nurse should not make unnecessary demands or expect full participation in the plan of care. The nurse provides assistance with activities that at any other time the patient could carry out independently. The nurse also promotes adequate sleep and discusses coping techniques that have been used successfully in the past and encourages their repetition. Fostering communication with family members or friends promotes support.

Postoperative Assessment:
- The nurse monitors vital signs to determine any changes, particularly elevations in temperature, pulse, and blood pressure. Reviewing the client’s medical record provides information about the reason for and type and level of the amputation. The nurse inspects the dressing or plaster shell of infection, excessive drainage, or separation of wound edges. In addition, the nurse evaluates the client’s general condition as to relieve it. He or she also implements measure to prevent infection, promote healing, and avoid skin breakdown.
- Inform the patient of potential phenomenon of phantom limb sensation, which is a feeling that the amputated portion of the limb still remains. It is a normal frequently occurring physiologic response after amputation. Phantom sensations can persist for months or decades, or can come and go. Although clients are aware of phantom sensations, they usually learn to ignore them. Phantom pain is pain or other discomfort, such as burning, tingling, throbbing, or itching, in the missing limb. Pain felt from the phantom limb can be an extremely serious problem in relation to the client’s emotional status and ability to use a prosthesis. Severe, prolonged phantom limb pain may require surgical removal of nerve ending at the end of the stump.
- For arm amputees, there are three types of prostheses: a shoulder harness with cables that attach to a mechanical terminal device, referred to as a hook; a semifunctioning cosmetic hand that can be substituted for the hook; and a myoelectric arm. The hook performs the functions of the hand and fingers when the amputee moves the scapula and expands the chest activating the cables attached from a shoulder harness to the mechanical device. The device is strong, sturdy, and functional. The cosmetic hand has the appearance of a natural hand, but lacks the capacity for performing fine motor skills. The myoelectric arm has a realistic-looking hand that is activated by electrical impulses from muscles in the upper arm. It eliminates the need to wear a harder, but is not rugged enough to do the work of the mechanical terminal device.
- For leg amputees, a temporary prosthesis is attached to the plaster shell covering the residual lower limb immediately after surgery. It reduces psychological trauma for the client because it promotes a more intact sense of body image after surgery. Leg prostheses may be held in place by means of a pelvic belt or suction.

Patient and Family teaching
- Inform the patient and family the length of the hospitalization, the type and location of the amputation, the age and physical condition of the client, and the type of dressing or prosthesis the patient wears.
- Some patients need to adjust their living arrangements, use a wheelchair, or make other accommodations or changes.
- If the client has to bandage the stump at home, the nurse will teach how to apply the bandage and how to care for the stump, as well as how to wash the bandages, rinse them well, and lay them flat to dry because hanging tends to decrease the elasticity. When the bandages are dry, they must be rolled without stretching.

By: Tristan, Paolo, Charles, Dianna, & Chris
Sources: Introductory Medical-Surgical Nursing 9th Edition by Barbara K. Timby, Nancy E. Smith