Hip Fracture Nursing Care Plan

Physical examinations include patient’s age, vital signs esp. blood pressure (for the possibility of orthostatic hypotension), LOC,
cognitive and thought process level, hearing and sight abilities, level of balance and coordination, degree of injury, ROM, pain scale,
weight and BMI.Also, muscular strength and agility, osteoporosis risk assessment and fall risk assessment.Diagnostic studies on
bone mass density and muscle mass.
Nursing
Medical history that affects strength, mobility, balance and coordination.
Assessment
Presence of hematoma, open wound, infection, inflammation and swelling on affected site obtained after injury.

Presence of environmental hazards.

Risk for injury related to weakness; Potential/Actual for physical injury; Altered protection; Potential/Actual for trauma; Potential
for disuse syndrome; Risk for peripheral neurovascular dysfunction related to swelling, constricting devices, or impaired venous
return; Risk for infection related to altered protein metabolism and inflammatory response; Impaired skin integrity related to edema,
impaired healing, and thin and fragile skin; Alteration in comfort, pain; Acute pain related to fracture, orthopedic problem, swelling,
or inflammation; Activity intolerance; Altered health maintenance; Impaired home maintenance management; Impaired physical
mobility related to pain, swelling, and possible presence of an immobilization device; Impaired tissue perfusion: Sleep pattern
Nursing
disturbance; Disturbed thought processes related to mood swings, irritability, anxiety and depression; Knowledge deficit; Impaired
Diagnoses*
communication; Altered verbal and thought process; Ineffective individual and family coping; Altered sensory-perceptual; Self-care
deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns; Altered role performance; Chronic low self-esteem;
Impaired social interaction; Social isolation; Spiritual distress; Risk for situational low self-esteem: disturbed body image and/or
functional impairment related to impact of musculoskeletal disorder; Disturbed body image related to altered physical appearance,
impaired sexual functioning, and decreased activity level; Altered compliance; Risk for ineffective therapeutic regimen management
related to insufficient knowledge or lack of available support and resources.
In the care for patients with hip fracture, the major goals include decreased risk for injury, prevention of another occurrence of fall
and injury, decreased risk for infection, improved skin integrity, relief of pain, improved mobility, adequate neurovascular function,
Planning
improved mental function, increased ability to carry out self-care activities (as indicated), positive self-esteem; improved body
image, health promotion and absence of complications.
Decreasing risk for injury:
Implementation*
Medications can facilitate in avoiding and stopping disruptive behavior of the patient as well as his/her depression and
anxiety.Creating a protective environment and ensuring the presence of side rails will help prevent falls, fractures and other forms of
injuries. The patient who is very weak may need help from the nurse for movement when NOT contraindicated to prevent falls or
bumping into sharp parts of furniture.

Passive physical activity is needed to strengthen muscles, enhance balance, avoid disuse atrophy, and stop progressive bone
demineralization. Passive exercises and massage can strengthen muscles. The nurse encourages good posture when lying on bed.

Food rich in protein, vitamin D and calcium are recommended to lessen muscle wasting and osteoporosis. Study have shown that
women with extremely low vitamin D levels had reduced lower extremity muscle function and increased falls 1 year later according
to LeBoff and colleagues (2008). Anemia management can also be added in the plan of care as research revealed that anemia impede
functional mobility thus decreasing physical performance during post hip fracture surgery rehabilitation (Foss et al, 2008).

Decreasing risk for infection:

The patient should prevent unnecessary exposure to others with infections.

The nurse regularly assesses the patient for minute signs of infection since the anti-inflammatory effects of corticosteroids may cover
the typical signs of inflammation and infection.

Meticulous handwashing and aseptic techniques in handling patient’s lines, injections or wound care, if any.

Dietary management that boosts immune system and tissue healing should also be included.

Promoting skin integrity:

Strict skin care is needed to prevent traumatizing the fragile skin of the patient. Use of lukewarm water or tap water with hypo-
allergenic soap for daily meticulous skin care. Always maintain the skin warm and dry from moist

Using adhesive tape is avoided since it can irritate the skin and tear the fragile tissue when the tape is removed.

The nurse regularly assesses the skin and bony prominences and assists and suggests the patient to change positions often to avoid
skin breakdown. Prevent sources of friction causing sores.

Relieving pain:
The nurse should properly evaluate pain related to musculoskeletal problems by determining the exact site, describing the intensity
and nature of the pain to help identify its cause, if applicable.

Psychological, pharmacologic and physical methods to control pain are also useful (e.g., guided imagery, distraction, focusing,
backrubs, quiet environment, etc.) as well as diversional activities may be use to lessen pain perception.

Discomfort is lessened with immobilization to prevent friction over fractured joints. Elevation of an edematous part helps venous
return and minimizes discomfort.

Cold compress if not contraindicated, relieves swelling and directly minimizes discomfort by diminishing nerve stimulation.

Analgesics are usually prescribed to control severe pain of muscular spasm and musculo-skeletal injury.

Improving mobility:

The patient’s mobility is affected by swelling, pain and/or any immobilizing equipments. The nurse must assess and support
edematous extremities with pillows or instruments.

Pain should be managed before an injured part is moved by giving medication in time for it to take effect and by supporting the
injured part when it is moved.

The nurse supports movement within the confines of therapeutic immobility.

The patient must do passive/active range-of-motion exercises of uninvolved joints, and, if not contraindicated, the nurse teaches
gluteal-setting and quadriceps-setting isometric exercises to maintain the muscles needed for ambulation (see if the use of assistive
devices (e.g., crutches, walker, wheelchair) is anticipated, the nurse encourages the patient to practice with them to facilitate their
safe use and to promote earlier independent mobility.

Encouraging rest and activity:

Pain, fatigue, weakness, and muscle wasting makes it hard for the patient to perform normal activities. Nonetheless, the nurse should
encourage moderate, if not contraindicated activities to avoid complications of immobility and encourage better self-esteem.
Insomnia usually contributes to the pain and fatigue of the patient. It is essential to help the patient plan and space rest periods for
the entire day. Efforts are made to support a relaxing, quiet environment for sleep and rest.
Maintaining adequate neurovascular function:

Edema, trauma, or immobilization may adverse affect tissue perfusion. The nurse must regularly evaluate neurovascular status (i.e.,
temperature, color, pulses, capillary refill, motion, edema, pain, sensation, occurrence of pressure sores) of the extremity and report
the findings. When circulation is compromised, the nurse performs measures to restore sufficient circulation, which include
immediately notifying the physician, elevating the extremity and releasing constricting wraps or casts as prescribed.

Improving thought processes:

Explanations to the patient and family members about the cause of emotional instability are important in helping them cope with the
mood swings, irritability and depression brought about by pain and debilitating conditions. Psychotic behavior may occur in a few
patients and should be reported.

The nurse encourages the patient and family members to communicate their feelings and concerns.

The nurse must orient the patient and family of the hospital set-ups and all the procedures to be made. It is also essential that the
patient is oriented to time, place and persons surrounds him/her.

Providing self-care:

Thorough care in providing activities of daily living is recommended. Privacy must be observed during the performance of ADL.
Movements on the affected fractured sites are contraindicated.

Helping the patient maintain self-esteem and improving body image:

Patients may require help in accepting changes in body image, reduced self-esteem or incapacity to do their roles and
responsibilities.

The nurse promotes a trusting relationship to enable patients to verbalize concerns and anxieties and helps them assess their feelings
about changes in self-concept.

The nurse clarifies any misconceptions the patients and family may have and assists them work through modifications required to
adapt to alterations in physical capacity and to reclaim positive self-esteem. The patient and family may benefit from the discussion
of the effects the changes have had on his/her self-concept and relationships with others. Edema and weight gain might be changed
by a low-sodium, low-carbohydrate diet and a high-protein intake may minimize a number of the other problematic symptoms.

Promoting health

The nurse helps the patient in tasks that encourage health.

The nurse evaluates hydration and nutritional status. The nurse monitors fluid intake, urinary output, urinalysis findings, and
complaints of burning on urination. Sometimes, patients may minimize their fluid intake to lessen bedpan use. A little fracture pan or
diaper may be more comfortable for the patient to use. An indwelling catheter must be employed if absolutely needed to lessen the
risk of urinary tract infection. UTI should be addressed before surgery when surgery is imperative.

Deep breathing, coughing and use of the incentive spirometer are done to improve respiratory function during the debilitated stage.

The nurse offers skin care, paying special attention to pressure points. It is necessary to implement the use of pressure-reducing
surfaces (i.e., special mattresses) to prevent skin breakdown.

The nurse orients the patient and the family on the need for assistance with ADL and the therapeutic regimen during convalescence
so that sufficient support is accessible when the patient is discharged.

Altering the home environment may be necessary to adjust to the altered mobility of the patient.

Referral to the social worker and the case manager may be required to make sure of a smooth transition to home care.

Referral to a dietitian may help the patient in choosing proper foods that are also low in calories and sodium.

Improving bowel elimination:

Constipation is a problem associated to medications and immobility. Early institution of a high-fiber diet, increased fluids and the
use of prescribed stool softeners assist in preventing or minimizing constipation. Thus, the nurse monitors the patient’s food intake,
bowel sounds and bowel activity.
Evaluation
Good prognosis and complete healing of hip fracture rely on the prevention of occurrence of another fall and injury—fall prevention
is a must during rehabilitation and to prevent recurrence of hip fracture.Fast bone healing and recuperation is attainable without the
presence of infection, it is also important that heath care providers should maintain aseptic and clean techniques in handling the
patient. Prevention of nosocomial infection is also a great concern.Rest, sleep, relaxation and cooperation to interventions are
parallel to relief of pain. Pain can be managed by the use of bio-behavioral interventions and pharmacological management.

Bed sores, skin problems and poor tissue perfusion are preventable complications of immobility.

Hip fracture is a debilitating condition, it is the responsibility of the nurse to provide and/or assist with self-care and ADLs.

Immobility causes muscle wasting, make sure that both affected and unaffected site will have proper form of exercises to maintain
muscular mass, strength and agility in preparation of early ambulation and prevention of disability.

It is important that care giver, patient, family and the health team are cooperating during the entire course of treatment. Cooperation
from both parties and consent is a must for every planned interventions or activities. The health team should explain every procedure
properly before seeking for consent. It is important to include the patient, family, care givers in the plan of care.

Improved mental function, thought process, self-esteem and body-image.

Prevent respiratory, urinary and bowel complications brought about by immobility.

Adequate food intake should be monitored to gain back strength and energy for patient’s fast recovery and in preparation for
rehabilitation.