HS2261/HS2232 Adult Nursing: Hip Fracture Case Study and Care Plan

Case Scenario:
Mona, aged 65, slipped and fell at home. She is unable to bear weight on the left lower limb. She reports severe pain localized to the left hip. Radiographic imaging confirmed a fractured left femoral neck, and she is scheduled for a left hemiarthroplasty.

Physical Examination:

General appearance: Alert, conscious, appears distressed due to pain

Extremities: Both lower limbs warmth to touch. Distal pulses present and strong over bilateral lower limbs.

Musculoskeletal: Mild swelling, tenderness, and ecchymosis noted over the left hip region. Severely restricted and painful passive range of motion of the left hip, especially in internal rotation. Height: 159cm

Weight: 90kg

Vital Signs:

Temperature:37.7°C

Pulse Rate: 92 beats/ min

Respiratory Rate:23 breaths/min

Blood Pressure: 154/93 mmHg

SpO₂: 96% on room air

Pain Score: 8/10

Past medical history: Osteoporosis, Diabetes, and Hyperlipidaemia

Past surgical history: Nil

Social History: Mona is a widowed with no children and is staying alone.

Current Medication:

P.O Arcoxia 90 mg OM	P.O Lovastatin 20 mg ON
P.O Omeprazole 20 mg BD	P.O Calcium Carbonate 625 mg ON
P.O Metformin 250 mg BD	P.O. Colecalciferol 1,000-unit OM -3 times per week

Laboratory Results:
FBC	Reference Range	Biochemistry	Reference Range
WBC: 8.2 x 10⁹/L	4.0 – 10.0 x 10⁹/L	Sodium: 138 mmol/L	135-145 mmol/L
RBC: 3.0 x 10¹²/L	3.6 – 4.9 x 10¹²/L	Potassium: 4.2 mmol/L	3.5 – 5.1 mmol/L
HB: 10.5 g/dL	11.5 – 15.0 g/dL	Chloride: 97 mmol/L	95-110 mmol/L
PLT: 250 x 10⁹/L	150 – 400 x 10⁹/L	Urea: 6.5 mmol/L	2.8 – 7.6 mmol/L
Other results	Reference Range	Creatinine: 95 µmol/L	50 – 90 µmol/L
HbA1c: 7.8%	< 6.4%	Venous glucose: 5.0 mmol/L	4.0 – 7.0 mmol/L
Albumin: 38 g/L	40 – 51 g/L	Calcium: 2.0 mmol/L	2.2 – 2.7 mmol/L
Vit D: 18 ng/mL	≥ 30 ng/mL	Phosphate: 1.45 mmol/L	1.12 – 1.45 mmol/L

Questions:

Define neck of the femur fracture and list the clinical manifestations of hip fracture.
List the possible risk factors of hip fracture for Mona.
Describe hemiarthroplasty.
Discuss the post-operative care for Mona.
Plan a health education and discharge plan for Mona.

Expert Answers on Above Nursing Case Study

Neck of femur fracture and clinical manifestations

Neck of femur fracture: It is defined as a kind of break that takes place in the narrow region just below the ball of the hip joint. As a result of this, there is a description in the supply of blood and also with hip stability.
Clinical manifestations: It leads to severe pain in the Hip, and there are chances of inability to bear weight on affected Limb. There is swelling and tenderness and difficulty in mobilising.

Possible risk factors of hip fracture for Mona

As a result of hip fracture, Mona may experience reduced bone density and balance, weak and brittle bones. With her diabetes, there are chances of impaired healing, neuropathy and fall risk. The vitamin D deficiency could lead to reduced bone strength. Calcium level is also there and high obesity would lead to mobility issues. She is living alone which increases the risk of unnoticed falls. There is also the risk of possible dizziness and reduced balance and bone loss.
Hemiarthroplasty: It is a kind of surgical procedure whereby replacement of the femoral head is performed with the prosthetic implant. There are no changes done to the acetabulum in the process. It is carried out in case of femoral neck fractures in older adults as it helps in pain reduction and early mobilization.
Post operative care for Mona: The post operative care required pain management, monitoring of vital science such as infection, shock or complications, neurovascular checks such as pulses, sensation etc. She also needs to be checked for wound care, respiratory care, pressure injury prevention, blood glucose monitoring as she is suffering from diabetes, and also for other complications such as dislocation, infection etc.

Health education and discharge plan for Mona

For health education, she need to be made aware of hip precautions, fall prevention, proper use of walking aid, wound care by keeping it clean and dry, medication compliance to deal with diabetes, nutritions diet with high protein and Calcium, and follow up appointments and physiotherapy. The discharge plan includes arranging home assessment, referral to Physiotherapy for mobility training, regular nurse visit for wound check, and schedule follow-up with Orthopaedic surgeon.

This model answer is reviewed by Amanda Wun, Nursing Graduate from Ngee Ann Polytechnic
Disclaimer: This answer is a model for study and reference purposes only. Please do not submit it as your own work.

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HS2261/HS2232 Adult Nursing: Hip Fracture Case Study and Care Plan

Expert Answers on Above Nursing Case Study

Neck of femur fracture and clinical manifestations

Possible risk factors of hip fracture for Mona

Health education and discharge plan for Mona

Want a Full Worked Out Answer with References?

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