Hip Fracture Nursing Diagnosis and Nursing Care Plan

Hip Fracture Nursing Care Plans Diagnosis and Interventions

Hip Fracture NCLEX Review and Nursing Care Plans

Considering the different types of injury that the hip may endure, having a hip fracture is recognized as a serious injury that can have potential life-threatening complications.

Susceptibility in developing hip fractures increases as the person ages. Poor vision and balance issues of an elderly person increase the risk for fall and consequently, hip fractures.

In addition, elderly patients suffering from osteoporosis wherein the bones are weaker and prone to damage are at high risk for hip fracture.

Most of the time, surgical intervention through either replacement or repair is the standard in correcting a hip fracture. Coupled with maintaining bone density, avoiding falls can help prevent this kind of fracture.

Signs and Symptoms of Hip Fracture

• Inability to get up or walk, usually after a fall
• Pain in the hip or groin area, usually severe
• Inability to put weight on the lower limbs, particularly on the injured side of the hip
• Presence of bruising or swelling in the hip area
• Shorter leg on the injured side
• Turning of the affected leg outward

Causes of Hip Fracture

The hip bone, otherwise known as the os coxae or innominate bone, is a paired and irregularly shaped bone located at the pelvis. It is composed of three smaller bones namely:

1. ischium, the lower and back part of the hip;

2. ilium, the uppermost and largest part; and

3. pubis, the most ventral and anterior out of the three

Because of its anatomic location, the hip bone plays a crucial role by:

1. supporting the weight of the upper body (while sitting) and transferring of this weight to the legs (when standing)

2. protecting the vital organs in the pelvis

A hip fracture can happen on the following instances:

A severe force, impacting the hip area (e.g., car crash) that can happen to people of all ages

In the elderly, a fall is usually the precursor in them acquiring hip fractures

In special cases, just merely standing and twisting of the leg may lead to hip fractures for patients with severely weakened bones.

Risk Factors of Hip Fracture

There are various risk factors in developing hip fractures and they are as follows:

Age – Decreasing bone density, declining muscle mass, vision problems, and balance issues of older people increases their susceptibility to hip fracture.

Sex – Women are three times more prone to hip fracture than men, especially when menopause starts. As menopause sets in and drops in estrogen is observed, acceleration of bone loss occurs.

Osteoporosis – The bone weakness associated with this condition increases the risk for fractures due to the inability of the bone to support the body.

Other chronic conditions – An overactive thyroid results in excessive thyroid hormone production. This overproduction increases the rate of bone replacement and lost, consequently raising fracture risks. A reduced intestinal absorption of calcium and vitamin D, important micronutrients for bone development, can render bones weak and prone to injury.

Medications – Cortisone medications has been linked to bone weakness when taken long term. Drugs that affect the central nervous system, like sleep medications and sedatives, can make patients dizzy and increase risk for fall.

Nutritional issues – Inadequate calcium and vitamin D in the diet leads to dietary deficiencies and in turn lowers bone mass.

Inadequate physical activity – Lack of weight-bearing exercises, such as running, can lead to weaker bones and muscles that increases susceptibility to fall and fractures.

Tobacco and alcohol use – Alcohol and tobacco has been linked to impede the normal bone capabilities of the body.

Diagnosis of Hip Fracture

Medical history and physical assessment – The physician can diagnose hip fracture through its clinical manifestations (i.e., abnormal position of the hip and leg).

Medical history is asked to inquire for other conditions that may affect the treatment plan that will be given.

Radiologic imaging – Imaging techniques for determining a hip fracture will start with an x-ray, which can usually reveal and confirm a hip fracture diagnosis.

If it cannot be determined and if the patient is still with pain, the doctor may order for a CT-scan, MRI or bone scan in order to determine a hairline fracture. Common fracture areas can be found on the femoral neck (upper part of the femur, just below the femoral head) and the intertrochanteric region (farther in the hip joint, near the upper femur).

Treatment for Hip Fracture

1. Surgery. The kind of surgery for hip fracture will depend on the location, severity, the bone displacement, and other underlying conditions that may affect the management. An injury damaging the circulation of the ball part of the hip joint would warrant a total or partial hip replacement. This is due to the likelihood that the bone will not heal properly given the location. The types of surgery for hip fracture are as follows:

• Internal repair with screws – This is a surgical treatment using metal screws inserted into the bones to keep it in place until the fracture heals. Metal plates are sometimes used in conjunction with the screws to stabilize the area more.
• Total hip replacement – In this surgery, the upper femur and the socket of the pelvic bone is replaced with prosthesis. This surgery is given to otherwise healthy patients who live independently due to the cost-effectiveness and associated long term benefits.
• Partial hip replacement – This involves the installation of a metal replacement to the damaged or displaced bone, either the head or neck of the femur. This surgery is done when the patient has other health conditions, such as cognitive impairments, that render them dependent on others.

1. Rehabilitation. Rehabilitation of the patient post-surgery involves two types and they are:
2. Physical Therapy – This involves helping the patient regain normal function of the affected limb. It will initially start first with range-of-motion and strengthening exercises and progressing to more complex therapy in order for the patient to regain normal physiology.
3. Occupational Therapy – This involves working with an occupational therapist who will determine if the patient needs assistive devices in order to do the activities of daily living, such as the use of walkers.

Prevention of Hip Fracture

1. Ensure adequate supplemental calcium and vitamin D in the diet.
2. Exercise regularly to improve balance and strengthen the bones.
3. Avoid smoking and alcoholic beverages.
4. Assess hazards in living spaces to avoid opportunities for fall.
5. Have regular eye check-ups to assess for vision problems, particularly if the patient has diabetes or eye disease.
6. Monitor medication side effects that may increase fall incidents.
7. Avoid orthostatic hypotension, which can lead to dizziness and fall, by standing up slowly.
8. For patients with mobility issues, ensure the use of walking aids such as walkers or canes.

Nursing Diagnosis for Hip Fracture

Nursing Care Plan for Hip Fracture 1

Nursing Diagnosis: Acute Pain related to the movement of bone fragments and injury to surrounding soft tissues secondary to hip fracture as evidenced by reports of pain and guarding behavior.

Desired Outcome: The patient will be able to verbalize relief of pain and demonstrate ability to perform activities of daily living with minimal complaints of discomfort.

Nursing Care Plan for Hip Fracture 2

Nursing Diagnosis: Impaired Physical Mobility related to neuromuscular skeletal impairment and pain secondary to hip fracture as evidenced by inability to move purposefully due to imposed therapeutic restrictions.

Desired Outcome: The patient will be able to regain mobility and function at the appropriate and optimum level.

Nursing Care Plan for Hip Fracture 3

Nursing Diagnosis: Impaired Skin Integrity related to physical immobilization secondary to hip fracture as evidenced by reports of skin itchiness and disruption of the skin surface.

Desired Outcome: The patient will be able to verbalize relief of discomfort and demonstrate techniques to prevent further skin breakdown.

Nursing Care Plan for Hip Fracture 4

Nursing Diagnosis: Self-Care Deficit related to physical limitations of cast application to affected limb secondary to hip fracture as evidenced by inability to fulfill activities of daily living such as bathing, dressing and toileting.

Desired Outcome: The patient will be able to demonstrate activities of daily living to the best of his abilities.

Nursing Care Plan for Hip Fracture 5

Nursing Diagnosis: Risk for Fall related to loss of skeletal integrity secondary to hip fracture

Desired Outcome: The patient will be able to demonstrate body mechanics at the fracture site with careful consideration and promotion of the patient’s stability.

Nursing Reference

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.