Client Scenario: Helen Maroney, an 81-year-old woman presents tothe emergency department after slipping on the ice in her driveway.She reports right hip pain and an inability to bear weight. She hasno prior history of hip pain and is ambulatory with the use of acane. She lives with her husband and performs all activities ofdaily living independently. Her medical history includes milddementia, hypertension, and osteoarthritis. She is currently onmetoprolol, Lisinopril, and acetaminophen.
Physical examination of the right hip demonstrates pain withrange of motion, external rotation of the right root, shortening ofthe right leg and then leg is adducted. The leg is neurovascularlyintact with good sensation, capillary refill, and pulses in thefoot. Radiographs demonstrate a displaced subcapital femoral neckfracture of the right hip.
The client receives an ultrasound guided regional nerve block inthe emergency department for pain control and is admitted to thehospital for treatment of her hip fracture. Preoperative tractionis not used but the client is placed on bed rest with use ofintermittent pneumatic compression devices. Adequate pain relief isachieved with acetaminophen following the administration of aregional block, which was used to minimize the risk ofdelirium.
The orthopedic surgeon had a discussion with the client andfamily regarding the overall long-term prognosis of possibledecreased mobility and independence as a result of the hipfracture. The discussion also includes the possibility ofmortality. After considering nonsurgical treatment measures, theclient makes an informed decision to proceed with surgery based onthe quality of life and mobility benefits associated with thismethod of treatment. The surgeon also discusses with the client theoption of a total hip arthroplasty for the benefit of improvedfunction and long-term results.After careful consideration, theclient decided to move forward with surgery.
Postoperatively, the client is mobilized. The client is placedon Hip Precautions. Weight-bearing exercises are introduced astolerated with physical and occupational therapy. She is placed onlow-molecular-weight heparin and continues on intermittentpneumatic compression devices because of the high risk of venousthromboembolic events in this client population. Her admissionalbumin level was low; the nutrition service is consulted. Theclient is started on nutritional supplements following surgery toimprove her protein levels and caloric intake. In addition, she isfound to be vitamin D deficient, calcium and vitamin Dsupplementation are initiated.
Pain is initially well controlled after surgery because of thelong-acting regional nerve block. A multi modal pain regimen isalso used, including celecoxib, acetaminophen, and Tramadol, thusminimizing narcotic use to avoid delirium.The client’s hemoglobinlevel decreases to 8.1 g/dL postoperatively; however, her bloodpressure is stable. Although she experiences some transientlightheartedness and tachycardia, this improves with hydration.
Teaching Plan Directions:
Reflective Questions: 1. What physical and/or sensorylimitations does the client have?
2. Will sensory or physical functioning create learningbarriers?
Explain. 3. Describe the teaching method you would utilize andwhy?
4. At the hospital, where would you obtain your audio-visualaides?
5. When would you complete teaching with this client?
6. Why is it important to document patient education?
