A patient with a moderate displacement of a femoral neck fracture is being considered for hemiarthroplasty. The nursing team is prioritizing preoperative management, including glycemic control and prevention of complications. Which nursing intervention is most critical in optimizing the patient’s surgical outcomes and promoting recovery?

C) Monitoring and controlling the patient’s blood glucose levels to maintain them within target range.

A) Administering prescribed analgesics to manage pain effectively.

B) Educating the patient on deep breathing exercises to prevent atelectasis.

C) Monitoring and controlling the patient’s blood glucose levels to maintain them within target range.

D) Applying intermittent pneumatic compression devices to prevent deep vein thrombosis.

A 78-year-old female patient with a displaced femoral neck fracture and osteoporosis is scheduled for hemiarthroplasty. Her preoperative assessment reveals a fasting blood glucose level of 180 mg/dL. As the nurse, which of the following interventions is the most appropriate to prioritize in preparing her for surgery?

A) Administering prescribed insulin to manage hyperglycemia

B) Educating the patient about postoperative mobility exercises

C) Monitoring vital signs and pain levels every hour

D) Starting mechanical prophylaxis to prevent deep vein thrombosis

A patient who recently underwent orthopedic surgery reports increased hip pain radiating to the groin and lower back, and presents with elevated heart rate, blood pressure, and respiratory rate. The surgical site shows swelling and warmth. What is the priority nursing action in this situation?

B) Notify the orthopedic surgeon and primary care provider

A) Administer additional analgesics to manage the pain

B) Notify the orthopedic surgeon and primary care provider

C) Apply ice packs to the surgical site to reduce swelling

D) Monitor vital signs every 2 hours to detect further changes

A patient who recently underwent hip surgery is now reporting increased pain radiating to the groin and lower back, along with swelling and warmth around the surgical site. Her vital signs reveal tachycardia, elevated blood pressure, and a slight decrease in oxygen saturation. Laboratory tests are pending, but the nursing team has already started broad-spectrum antibiotics. Considering her current status and the risk of infection, what is the most important nursing intervention at this time?

D) Monitor blood glucose levels closely and administer insulin as prescribed.

A) Increase the frequency of pain assessments to every 30 minutes.

B) Administer oxygen via nasal cannula to maintain saturation above 95%.

C) Prepare the patient for possible surgical intervention by keeping her NPO.

D) Monitor blood glucose levels closely and administer insulin as prescribed.

A patient with an elevated white blood cell count, increased neutrophils, and decreased oxygen saturation is being managed with broad-spectrum antibiotics and supplemental oxygen. Which nursing intervention is most critical to prioritize at this time?

A) Increase the frequency of vital signs monitoring.

B) Educate the patient on deep breathing exercises.

C) Encourage oral fluid intake to prevent dehydration.

D) Administer antipyretics to manage fever.

A patient with an elevated white blood cell count, increased neutrophils, and elevated inflammatory markers is experiencing persistent pain and a decrease in oxygen saturation. Based on these findings, what is the most appropriate initial nursing action to address her respiratory status?

B) Reassess the patient's respiratory rate and lung sounds

A) Increase the oxygen therapy to 4 liters via nasal cannula

B) Reassess the patient's respiratory rate and lung sounds

C) Contact the physician to report the decreased oxygen saturation

D) Encourage the patient to use an incentive spirometer every hour

A patient recovering from a hip fracture has developed hospital-acquired pneumonia, presenting with respiratory distress and new infiltrates on a chest X-ray. The nursing team has initiated incentive spirometry and chest physiotherapy, while the infectious disease team adjusts antibiotics based on blood culture results. Which intervention should the nurse prioritize to optimize the patient's respiratory status?

C) Encouraging frequent use of the incentive spirometer

A) Administering the adjusted antibiotic regimen promptly

B) Increasing the oxygen flow to maintain saturation above 92%

C) Encouraging frequent use of the incentive spirometer

D) Consulting with the pulmonologist for potential non-invasive ventilation

A patient with a recent hip fracture is now exhibiting signs of hospital-acquired pneumonia, with an oxygen saturation of 89% on 4 liters of oxygen via nasal cannula and diminished breath sounds with crackles. What is the most appropriate nursing intervention to prioritize at this time to support the patient's respiratory function?

D) Position the patient in a high Fowler's position.

A) Increase the oxygen flow rate to 6 liters per minute.

B) Encourage the use of incentive spirometry every hour.

C) Prepare the patient for immediate intubation.

D) Position the patient in a high Fowler's position.

A patient with a recent hip fracture and respiratory infection is receiving targeted antibiotic therapy. Her oxygen saturation is stable at 93% on 4 liters of oxygen via nasal cannula, but she presents with a potassium level of 3.2 mEq/L and occasional episodes of hypotension. What is the priority nursing intervention to address her current condition?

B) Administer prescribed potassium supplements and monitor cardiac rhythm.

A) Increase the oxygen flow rate to maintain oxygen saturation above 95%.

B) Administer prescribed potassium supplements and monitor cardiac rhythm.

C) Encourage increased oral fluid intake to address potential dehydration.

D) Reassess pain management strategies to improve patient comfort.

A patient with respiratory infection and hypokalemia is being treated with antibiotics and potassium supplementation. Her blood pressure occasionally drops to 92/58 mmHg. Which nursing intervention should be prioritized to address her hypotension?

B) Encourage increased oral fluid intake to manage potential dehydration

A) Administer an additional diuretic to manage fluid balance

B) Encourage increased oral fluid intake to manage potential dehydration

C) Reduce potassium supplement dosage to avoid further hypotension

D) Increase oxygen flow rate to improve tissue perfusion

hip fracture - Nursing Case Study

Pathophysiology

• Primary mechanism: Osteoporosis leads to decreased bone density and structural integrity, increasing the susceptibility of the femoral neck or intertrochanteric region to fractures, especially after minimal trauma or falls.

• Secondary mechanism: Impaired blood supply to the femoral head, particularly in displaced fractures, can exacerbate bone weakening and impede healing, risking avascular necrosis.

• Key complication: Delayed or improper healing can lead to prolonged immobility, increasing the risk of complications like deep vein thrombosis, pulmonary embolism, and pressure ulcers, which are critical nursing concerns.

Patient Profile

Demographics:

67-year-old female, retired school teacher

History:

• Key past medical history: Osteoporosis, Type 2 Diabetes, Hypertension

• Current medications: Alendronate, Metformin, Lisinopril

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe pain in the right hip following a fall

• Key symptoms: Inability to bear weight on the right leg, swelling and bruising around the hip, low-grade fever

• Vital signs: Blood pressure 145/90 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 100.4°F, oxygen saturation 94% on room air

Section 1

As the clinical team continues to manage the patient’s hip fracture, new diagnostic results reveal a moderate displacement of the femoral neck fracture. An X-ray confirms this finding, indicating a higher risk for avascular necrosis due to compromised blood supply in the region. The patient’s osteoporosis has contributed to the fragility of the bone, and the displacement suggests an increased complexity in potential surgical intervention. The orthopedic team discusses the possibility of performing a hemiarthroplasty as opposed to internal fixation, given the patient’s age and bone health. Additionally, the patient’s blood glucose levels have been noted to be elevated, with recent laboratory results showing fasting blood glucose at 180 mg/dL, which requires careful management to optimize surgical outcomes and promote healing.

In response to these findings, the nursing team collaborates on a comprehensive care plan. Priorities include managing the patient’s pain with appropriate analgesics while monitoring for any adverse effects, particularly given her history of hypertension and diabetes. The nursing team also focuses on preoperative education, emphasizing the importance of glycemic control and the potential surgical options. Anticipating prolonged immobility, they initiate early interventions to prevent complications such as deep vein thrombosis, employing mechanical prophylaxis with intermittent pneumatic compression devices and considering pharmacological prophylaxis as per the provider’s orders. The patient is encouraged to participate in deep breathing exercises to maintain optimal respiratory function and prevent atelectasis, given her slightly elevated respiratory rate.

As the patient prepares for potential surgery, the clinical team remains vigilant for any signs of worsening condition or new complications, such as increased fever or signs of infection, particularly in light of her low-grade fever and elevated heart rate. They maintain an open line of communication with the patient and her family, ensuring they are informed and involved in decision-making processes. This approach not only addresses the immediate needs of the patient but also sets the stage for her postoperative care and rehabilitation, which will be critical in her journey toward recovery.

Section 2

As the patient progresses through her care plan, the clinical team notes a change in her status that warrants immediate attention. During a routine assessment, the patient reports increased pain in her hip, which is now radiating to her groin and lower back. Her vital signs reveal a slight increase in her heart rate to 102 beats per minute, and her blood pressure reads at 145/88 mmHg, which is higher than her baseline. Additionally, her respiratory rate remains elevated at 22 breaths per minute, and her oxygen saturation has decreased slightly to 94% on room air. Despite receiving analgesics, her pain remains at a 7 out of 10 on the pain scale, indicating that her current pain management strategy may need adjustment.

In light of these findings, the nursing team conducts a thorough assessment and discovers that the patient has developed swelling and increased warmth around the surgical site. This raises concerns about a potential infection or inflammatory response. The team promptly notifies the orthopedic surgeon and the patient’s primary care provider to reassess the treatment plan. Laboratory tests, including a complete blood count and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate, are ordered to evaluate for signs of infection or increased inflammation. Additionally, a blood culture is taken to rule out systemic infection, and the patient is started on broad-spectrum antibiotics as a precaution while awaiting results.

The team also revisits the patient’s glycemic control, as her blood glucose levels remain elevated with fasting levels at 185 mg/dL. The endocrinology team is consulted to optimize her diabetes management, particularly in light of the potential infection, which could complicate her recovery further. The patient and her family are informed about these developments, and the importance of adhering to the adjusted care plan is emphasized. This change in the patient's status highlights the need for vigilant monitoring and timely intervention to prevent further complications and ensure a smoother surgical and postoperative course.

Section 3

Following the initial assessment findings and immediate interventions, the clinical team closely monitors the patient for any changes in her condition. Within 48 hours, results from the laboratory tests indicate an elevated white blood cell count of 14,500/mm³, with a notable increase in neutrophils, suggesting an infectious process. The C-reactive protein and erythrocyte sedimentation rate are also significantly elevated, corroborating the suspicion of an inflammatory or infectious complication. The blood culture results, however, are pending, leaving the etiology of the infection uncertain. Meanwhile, the patient continues to report persistent pain, which now intermittently spikes to an 8 out of 10, particularly during movement or repositioning.

In light of these diagnostic results, the patient's clinical status is reassessed. Her vital signs show a further increase in heart rate to 108 beats per minute and a slight rise in temperature to 100.4°F, indicating a low-grade fever. The team notes that her oxygen saturation has decreased further to 92% on room air, prompting the initiation of supplemental oxygen therapy at 2 liters via nasal cannula. Given these changes, the decision is made to continue with the broad-spectrum antibiotics, while consulting with infectious disease specialists for tailored antimicrobial therapy once the culture results are finalized. The endocrinology team adjusts her insulin regimen, aiming for tighter glycemic control to aid in the resolution of the infection.

The patient's family is updated on her current status, the potential implications of these findings, and the ongoing efforts to manage her condition. The nursing team provides education on the importance of adhering to the revised medication schedule, the necessity of frequent monitoring, and the anticipated next steps in her treatment plan. The team emphasizes the critical role of multidisciplinary collaboration in optimizing outcomes and preventing further complications, setting the stage for potential interventions based on the forthcoming culture results. This situation underscores the necessity for continued vigilance and adaptability in the patient's care plan as her condition evolves.

Section 4

As the clinical team continues to manage the patient's condition, a new complication arises. Over the next 24 hours, the patient exhibits increasing respiratory distress despite the supplemental oxygen therapy. Her oxygen saturation drops further to 89% on 2 liters of oxygen via nasal cannula, prompting an increase in oxygen delivery to 4 liters. The respiratory rate rises to 24 breaths per minute, and auscultation reveals diminished breath sounds and crackles in the lower lobes bilaterally. A repeat chest X-ray is ordered, which reveals new infiltrates suggestive of hospital-acquired pneumonia, complicating her recovery from the hip fracture.

The nursing team initiates enhanced pulmonary hygiene measures, including incentive spirometry and chest physiotherapy, to improve lung function and prevent further deterioration. Concurrently, the infectious disease team, now in possession of the preliminary blood culture results, identifies gram-negative bacilli, guiding the adjustment of antibiotic therapy to a more targeted regimen. The patient's elevated white blood cell count persists at 16,000/mm³, and her C-reactive protein remains high, indicating an ongoing inflammatory response.

This development requires a reassessment of the patient's overall care plan. The multidisciplinary team, including pulmonology, is consulted to optimize respiratory management and determine if further interventions, such as non-invasive ventilation support, might be necessary. The nursing staff plays a pivotal role in monitoring the patient's response to the revised treatment strategy, ensuring that any changes in her respiratory status are promptly communicated to the medical team. This situation highlights the interconnectedness of her complications and the need for vigilant, coordinated care to prevent further setbacks and facilitate her recovery.

Section 5

As the patient continues to receive targeted antibiotic therapy and enhanced pulmonary hygiene measures, the nursing team closely monitors her response to these interventions. Over the next 48 hours, her respiratory status shows signs of gradual improvement. Her oxygen saturation stabilizes at 93% on 4 liters of oxygen via nasal cannula, and her respiratory rate decreases to 20 breaths per minute. Auscultation reveals a slight reduction in crackles, though diminished breath sounds persist in the lower lobes. The nursing staff documents these changes, noting that the patient is more alert and reports feeling slightly less short of breath.

Despite these positive indicators, new laboratory results present additional areas of concern. The patient's serum electrolyte panel reveals a potassium level of 3.2 mEq/L, indicating hypokalemia, potentially due to the combination of her antibiotic regimen and decreased oral intake. Her renal function tests remain stable, but the nursing team recognizes the importance of addressing the electrolyte imbalance to prevent cardiac complications. A potassium supplementation plan is initiated, with close monitoring of her cardiac rhythm and regular reevaluation of her electrolyte levels.

Meanwhile, the patient's blood pressure has fluctuated, with occasional episodes of hypotension, recording as low as 92/58 mmHg. The team considers the possibility of dehydration or the effects of infection and antibiotics on her hemodynamic status. As a precaution, her fluid balance is carefully managed, and she is encouraged to increase her oral fluid intake. The interdisciplinary team remains vigilant in their coordinated approach, ensuring that all aspects of her care are addressed comprehensively and that the patient is supported through this critical phase of her recovery. This collaboration aims to stabilize her condition, prevent further complications, and ultimately guide her towards a successful rehabilitation from both the hip fracture and the respiratory infection.