Hip Fracture Nursing Diagnosis and Nursing Care Plan

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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

Clinical manifestations of a hip fracture are as follows:

  • 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).

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Nursing Stat Facts

Treatment for Hip Fracture

Treatment regimen for hip fracture includes surgery, rehabilitation and medication management:

  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

To avoid having a hip fracture starts in preventing the risk of fall in the first place. The necessary preventive measures are as follows:

  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 Interventions for Hip FractureRationale
Ensure the timely and accurate assessment of the patient’s pain levels through the Wong-Baker FACES rating scale or similar.Accurate and timely pain assessment aids the healthcare provider in assessing the effectiveness of therapeutic regimen. Furthermore, it also determines other factors that may affect the patient’s pain, such as level of anxiety, pain perception, etc.
Keep the affected limb immobilized as much as possible, through the use of splint, traction, bed rest, etc.Keeping the affected limb steady relieves pain and prevents further bone displacement and injury to surrounding tissues.
Ensure that the affected limb is supported and supported at all times.Elevating the affected limb ensures for proper venous blood return that leads to a decrease in edema and pain.
Administer pain medications before any nursing or medical interventions. Educate the patient the importance of pre-medicating before the pain becomes severe.Pain medications given before any procedures or before pain levels peak ensures for the patient’s full participation and promotes relaxation.
Provide encouragement to the use of stress management techniques (such as guided imagery) and emotional support to the patient.Stress management techniques can help the patient to refocus attention from pain and provide a sense of control for the patient. Doing so may increase the patient’s coping capabilities, especially those with associated stress from traumatic injury.
Administer medications as ordered such as: Analgesics,
both narcotic and nonnarcotic
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Muscle relaxants
The mentioned drug classes address the patient’s pain and muscle spasms. Adequate and timely giving of pain medication ensures the effectiveness and maintenance of pain relief for the patient.

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 Interventions for Hip FractureRationale
Determine the level of immobility caused by the injury, including the patient’s perception.Assessing the patient’s mobility, both physical and cognitive, will help in determining the appropriateness of the interventions rendered. Negative perception may affect treatment progress, and therefore would necessitate additional information and intervention from the healthcare provider.
Assess for the patient’s bowel sounds, taking note of elimination patterns and habits. Ensure privacy especially when the patient uses a bedside commode.The various therapeutic regimens for hip fracture, such as bed rest, use of analgesics, etc., can affect and slow down the peristalsis, therefore increasing the risk for constipation.
Encourage the patient to participate in diversional activities. Ensure that the patient has a conducive and stimulating environment.Diversional activities provide opportunity for the patient to refocus attention. It also enhances the patient’s self-control and self-worth that could be otherwise impeded by the present condition.
Encourage isometric exercises, ensuring to start with the unaffected leg.This type of exercise helps to maintain muscle integrity by contracting muscles without the need to mobilize the joints and limbs. However, isometric exercises are contraindicated in the presence of active bleeding and edema.
Ensure that the patient’s diet is high in macro and micronutrients, limiting protein until the first bowel movement.Adequate supplementation of macro and micro nutrients is needed for the rapid healing of the fracture. This is due to the rapid weight loss encountered in the presence of musculoskeletal damage. Protein supplementation should be increased once gastrointestinal integrity is established for protein-rich foods could result in gas-formation and constipation.
Include the expertise of an occupational or rehabilitation specialist for the patient.Coordination with specialists ensures that specific and patient-appropriate programs are formulated. Furthermore, they help in assessing and recognizing needs of the patient in the fulfillment of their activities of daily living.

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 Interventions for Hip FractureRationale
Provide thorough assessment of the patient’s skin focusing for the presence of open wounds, discoloration, rashes, blanching, etc.A thorough assessment will provide crucial information regarding the patient’s general skin health. This is particularly critical in recognizing problems that may arise from the therapeutic regimen or worsening of skin breakdown.
If not contraindicated, provide massage to the skin and bony prominences. Ensure that the linen is dry and wrinkle free. Place support pads under bony prominences, such as under the elbows, as needed.These measures help in alleviating pressure on injury-prone areas and reduce the risk of developing skin breakdown, like abrasions.
Assist the patient to frequent repositioning as much as possible and as indicated.Frequent position changes lessen the pressure encountered by potential problematic areas of the skin. This reduces the risk of skin breakdown that may compound the already compromised state of the patient.
Follow through with appropriate plaster cast application and skin care by: Clean the area with soap and water   Utilize using zinc or stearate powderUse the palm of the hand in holding and handling the cast   Remove excess plaster around the edges as soon as casting is completed.   Assess the skin around the cast, particularly at the edges.    Ensures a dry and clean skin prior cast application Ensures that the skin has added protection before cast application   Irregular plaster application is irritating and may promote skin breakdown.   Moisture can collect and be trapped on the excess plaster, consequently inducing skin breakdown.   This ensures monitoring of the patient’s skin integrity. It also prevents complications of cast application.

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 Interventions for Hip FractureRationale
Determine the limitations of the patient regarding self-care.Determining baseline information regarding the self-care needs of the patient aids the healthcare provider in formulating appropriate care plans for the patient.
Formulate with the patient an efficient exercise regimen that targets the particular activity deficit of the patient.Patients who have therapeutically immobilized limbs will require a well-formulated exercise regimen in order to regain muscle integrity and autonomy in self-care.
Involve the relatives or significant others on how they can assist with the patient’s self-care needs.Active participation of the patient’s significant others decreases reliance on skilled home service and reinforces the prescribed therapeutic regimen.
Ensure that the patient complies with the ordered adequate pain management.Poorly managed pain could result in limited attempts to move and therefore increase struggle in performing activities of daily living.
Coordinate and refer the patient to occupational therapists as indicated, including the use of assistive devices.Coordination with specialists can improve the patient’s ability in performing activities of daily living. They can also assist in recognizing other health needs that the nurse or patient may miss out.

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 Interventions for Hip FractureRationale
Retain bed rest as much as possible. Ensure joint support above and below the fracture site when mobilizing.Stabilization when manipulating and handling the affected area reduces destabilizing the fracture and promotes bone healing.
Make sure a bed board is under the mattress or if possible, have the patient use an orthopedic bed.An unstable mattress (either soft or sagging) could distort the plaster cast and inhibit proper wound healing.
Ensure adequate personnel are present when mobilizing the patient.Support of affected limbs is paramount in maintaining cast integrity and wound healing. Failure to do so will prolong the fracture and could complicate the patient’s health.
Evaluate frequently the splinted limb for improvement of swelling and edema.A subsiding edema usually indicates improvement of the fracture and would necessitate for readjustments of the splint or cast. It also prevents untoward complications that may arise.
Evaluate and follow-up x-rays of the affected limb.Serial x-rays offer evidence of an improving fracture. Looking for calculus formation can determine the level of healing and would require adjustments to the treatment regimen.
Anticipate administration of medications for bone growth if indicated.Certain medications assist in bone health and healing and would be beneficial for patients having difficulties in resolving their fracture.

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

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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.

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