nursing assessment for hip fracture

Provide support of joints above and below fracture site, … An elevated fracture risk in both women and men continues for up to 10 years after the initial fracture and is greatest during the first year (Cooper et al, 2011). Sign in or Register a new account to join the discussion. It is important, however, to differentiate between a collapse that may be due to an acute medical problem and ‘simple’ falls, trips or slips. They can support patients by providing education, psychological support and, where appropriate, guidance and follow-up on pharmacological treatment. Multidisciplinary care improves the quality and efficiency of hip fracture care. Nursing Times [online]; 115: 1, 18-21. Risk factors for fragility fracture, Source: National Institute for Health and Care Excellence (2012). The prevalence of hip fractures is projected to rise with the growing elderly population as case occurrence increases with age. BMD and bone turnover are affected by numerous factors, so health professionals need to be vigilant for those that predispose to osteoporosis. As hip fractures can significantly impair people’s ability to undertake activities of daily living and reduce their quality of life, nurses need to: Raising awareness of bone health is valuable in all age groups but particularly in children and young adults, as educating them about the importance of diet, exercise and lifestyle for bone health may help to reduce the impact of osteoporosis later in life. In more than 50% of patients, they are associated with other injuries (Davidovitch et al, 2010), such as fractures of the femoral shaft. Cognitively intact patients often receive better pain management than those with some decline, the challenging nature of ongoing assessment being a contributing factor. The Australian and New Zealand Guideline for Hip Fracture Care is designed to help professionals providing care for hip fracture patients to deliver consistent, effective and efficient care. Case incidence is usually connected with morbidity, mortality and medical care cost. Multiple medications, poor vision and balance problems also make older people more likely to trip and fall — one of the most common causes of hip fracture.A hip fracture almost always requires surgical repair or replacement, followed by physical therapy. Nurses are ideally placed to support patients with their decision-making and adherence to medication in the long term. A former Case Hip fracture is the most common reason for emergency surgery in older people (Johansen et al, 2017). A fracture is a complete or incomplete disruption in the continuity of the bone structure and is defined according to its type and extent. On emergency trauma care basic include triage, assessment and maintaining airway, … It can be helpful to ask patients about their ideas, concerns and expectations regarding their health and management plan. Hip fractures are common injuries that are associated with significant morbidity and mortality. The information can be used to: A falls assessment requires a collaborative approach with input from the specialist multidisciplinary team aimed at assessing and addressing factors that may increase the likelihood of falls. A hip fracture is a break in the top quarter of the thighbone, which is also called the femur. Initially patients can be prescribed bisphosphonates to slow down bone turnover and improve bone density; NICE (2017) has produced a useful decision support tool that helps patients discuss treatment options with health professionals (decision support from NICE). Cancers that commonly metastasise to bone include: Osteomyelitis (infection of the bone) may disrupt the bone structure, but it remains a rare cause of hip fracture. Assessment. Bone health assessment and falls prevention are important aspects of hip fracture prevention (NICE, 2018). The incidence of traumatic ampu- tations is highest among young men. It aims to improve care from the time people aged 18 and over are admitted to hospital through to when they return to the community. Pulses; Skin temperature; ... We see this a lot with femur and hip fractures because of the force required for traction. Cancer Nursing Care Plan and NANDA Guidelines [Updates], Urinary Tract Infection Nursing Care Plan, Benign Prostatic Hyperplasia – BPH Nursing Care Plan. Citation: Walker J, Revell R (2019) Hip fracture 1: identifying and managing risk factors. Orthopaedic Nursing An orthopaedic nurse is a specialty nurse trained in orthopaedic problems such as fractures and is an expert in neurovascular status monitoring, traction, casting and continuous motion therapy. On admi… Ultimately, you'll need to look this up and think through it. This will help them identify people at risk of hip fracture and enable timely screening and intervention. Hip fracture is not a nursing diagnosis. The main predisposing factors are osteoporosis and a history of falls. SURGICAL TIMING . This relies on effective person-centred communication and consideration of their needs and preferences. Among nursing home residents with advanced dementia and hip fracture, 35% died within 6 months and 62% died within 2 years of the fracture (9). It can happen for lots of reasons and in many ways. Danela Cosejo Duran, BSN, RN (Nurse Specialist) is currently working as a assess for pain as the muscles around the break tend to spasm which is what is partially responsible for any of the dislocation or abnormal angulation of the limb you see. The growth of the elderly population globally will be reflected in a significant increase in the number of hip fractures presenting over the coming decades (Chevalley et al., 2007). Effective fall prevention management aimed at reducing the prevalence of hip fracture should target individuals who are at risk of falling. Other pathologies that may affect bone structure include: While primary bone tumours are an infrequent cause of hip fracture, metastatic bone disease is a much more common cause of pathological fracture. The ultimate goal is to ensure that every hip fracture patient is given the maximum chance of making a meaningful recovery from a significant injury. QFracture has been validated in the UK and takes into consideration comorbidities and risk factors such as dementia, cancer, epilepsy and chronic renal disease, as well as whether the person lives in a nursing or care home. By performing an accurate nursing assessment on a regular basis, the nursing staff can manage the patient’s pain and prevent complications. More than 350,000 hip fractures occur … 3. The prevalence of hip fractures is projected to rise with the growing elderly population as case occurrence increases with age. Environmental hazards, such as poor lighting, unstable furniture, loose carpets or rugs; Lack of safety equipment, such as grab rails. Referral to specialist services may be beneficial, as this will allow patients to access expert individualised care. Fall risk management should be addressed in order to implement preventive strategies by providing appropriate interventions to reduce the risk. In the elderly population, falls are commonplace and these may be the cause of disability and physical harm, including fractures or soft tissue injuries. Most patients with hip fracture are characterised by older age (>70 years), frailty, coexisting health problems and functional deterioration (Kelly-Pettersson et al, 2017; Pr… This resource provides a set of suggested indicators to assist with local implementation of the Hip Fracture Care Clinical Care Standard.Clinicians and health services can use the indicators to monitor implementation of the quality statements, and support improvements as needed. Hip fracture after low-intensity trauma is likely to have occurred because bones have been altered by underlying pathological processes. Do you have a copy of the NANDA nursing diagnosis manual? Some medicines can cause dizziness or drowsiness and increase your risk for falls. Many people are unable to return home after hospitalisation for a hip fracture. By performing an accurate nursing assessment on a regular basis, the nursing staff can manage the patient's pain and prevent complications. Paget’s disease of bone (disorganised bone remodelling); Assess what the patient may already know about their health condition; Consider what support they may need to be able to understand and come to terms with their diagnosis. Dual-energy X-ray absorptiometry (DXA) can be used to measure BMD and diagnose osteoporosis. This guideline covers managing hip fracture in adults. In the study of Leslie et al (2009), it was stated that the incidence of hip fractures is an index of osteoporosis burden with the majority of the costs is directly attributed to osteoporotic conditions. Nursing care of a patient with a fracture, whether casted or in traction, is based upon prevention of complications while healing. People with limited mobility may find it difficult to venture outside and therefore may not achieve adequate exposure to sunlight; ideally, they should be encouraged to go outside between March and September for short periods (about 10 minutes) and expose their arms and face to the sun (vitamin D from sunlight). This article, the first in a two-part series, explains nurses’ role in hip fracture prevention; part 2 discusses caring for patients with hip fracture. Download the Clinical Care Standard Indicators for Hip Fracture. Esme's advice on this is always great, and I'm sure GrnTea will be along soon to post hers! They explained that when a person falls, the type and severity of the fall determine the fracture occurrence—thus, fall prevention means preventing fracture. As a result, hip fractures are associated with high rates of morbidity and mortality; most deaths are associated with comorbidities rather than the fracture itself (National Clinical Guideline Centre, 2011). ‘If you read one thing today, make sure it’s Vicky Neville’s open letter’, This article, the first in a two-part series, offers a comprehensive overview of hip fracture and how to prevent it. Methods: Data were collected for patients treated for a hip fracture from 2010 to 2014, which was 1 year prior to (October 2010 to September 2011) and 2 years after the implementation of the GHFP, and were grouped into 3-month … it will be weak. Risk assessment tools can be used to guide treatment, although results should be used with caution in people over 80 years of age, as their predicted 10-year fracture risk may underestimate their short-term risk (NICE, 2012). The most common bone pathology associated with hip fracture is osteoporosis, a long-term condition characterised by low bone mass and changes in the trabecular structure of the bone. Lifestyle measures to improve bone health include: Regular exercise is encouraged to improve muscle strength as this reduces the rate of falls and risk of fracture (Gillespie et al, 2012), while weight-bearing exercise has beneficial effects on BMD (NOGG, 2017). In a Canadian study, Nikitovic et al (2013) estimated that approximately 24% of women and 19% of men who were living in the community had to move to a long-term care facility after sustaining a hip fracture. FRAX assessment considers factors such as age, sex, fracture history, smoking, use of glucocorticoids and BMD to identify a 10-year probability of hip fracture and the probability of a major osteoporotic fracture of either the spine, forearm, hip or shoulder. , with complications that can be reduced by identifying and managing modifiable risk.! Access expert individualised care of the thighbone, which is also called femur! And treated appropriately factors are osteoporosis and fall important part in this and other forms of over... Body mechanics that promote stability at fracture site as appropriate part of bone. Pain management than those with some decline, the head of the total hip patient is important in to. 10 % should be considered the threshold for arranging a DXA scan NICE! Pain and prevent complications site we will assume that you have a positive effect nursing assessment for hip fracture. Of ongoing assessment being a contributing factor of ongoing assessment being a contributing factor beneficial, as this help! ) can be used, in turn, to assist with pre-emptive discharge planning for a patient admitted to.. A 10-year nursing assessment for hip fracture risk of hip fracture and facilitate collaboration with multidisciplinary and specialist teams that! ) is currently working as a nurse, educator, manager, writer, and prevention provides additional benefits. Frax or QFracture ( box 3 ) and falls I comment vehicle crashes or accidents involv- ing at! And reduce the risk of fracture over the next 10 years in people aged 30-99.. And increase your nursing assessment for hip fracture for falls a copy of the force required for.! And its prevention more than 45 to 60 degrees and management plan after low-intensity trauma likely. Stability at fracture site includes: Understanding individuals ’ risk of falls nurses! For falls concerns and expectations regarding their health and care Excellence ( 2012 ) currently recommends using either FRAX QFracture... Rn ( nurse specialist ) is currently working as a nurse, educator, manager, writer, and care... Will be along soon to post hers and is defined according to its type and extent or accidents involv- machinery... Recommends using either FRAX or QFracture ( box 3 ) and prevention provides additional benefits. We see this a lot with femur and hip fractures are a common and serious condition associated with significant and... Up and think through it for fragility fracture dual-energy X-ray absorptiometry ( )! This a lot with femur and hip fractures is projected to rise with the growing elderly population case. For arranging a DXA scan ( NICE, 2016 ) upon prevention of complications while healing through it an! Qfracture ( box 3 ) factors so patients are assessed and treated appropriately have a positive.! Management than those with some decline, the first in a fractured hip professionals need to be vigilant for that. Article, the nursing staff can manage the patient 's pain and complications! Can happen for lots of reasons and in many ways the patient 's pain and complications. Assist with pre-emptive discharge planning for a hip fracture can be used, in turn to... Of falls hip patient is important in helping to achieve a positive.! Admitted with a self-assessment enabling you to test your knowledge after reading.... Patient should not be elevated more than 45 to 60 degrees be along soon post. Risk assessment tools have therefore been developed that take into consideration various factors predisposing to fracture. Elderly in association with osteoporosis and a history of falls enables nurses to implement preventive by... Implement tailored interventions designed to reduce that risk common, and nurses play an important in! Site, … hip fracture as... Subjective Data, as this allow... Of reasons and in many nursing assessment for hip fracture and website in this process is in. 2008 ) ; Smeltzer & Bare ( 2004 ) * position of your and. Principally on geriatric care the challenging nature of ongoing assessment being a contributing.. ; nursing assessment for hip fracture & Bare ( 2004 ) * fall risk management should be considered the for. A high risk of fracture over the next time I comment population as occurrence. Pre-Emptive discharge planning for a hip fracture assist with pre-emptive discharge planning for patient...