Hip Fracture Post-Operative Care Plan

This assignment focuses on developing a comprehensive post-operative care plan for a patient who has undergone surgery for a hip fracture. It emphasizes the importance of preventing infection, monitoring bone fragment positioning, managing pain and promoting physical rehabilitation. The plan includes details on physiotherapy sessions, medication adherence, dietary recommendations, sleep hygiene, and emotional support. Additionally, it highlights the role of self-management in disease prevention and recovery.

Running head: NURSING ASSIGNMENT
Nursing Assignment
Name of the student:
Name of the university:
Authors note:

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NURSING ASSIGNMENT
This assignment is about Mr. X who is a 65-year-old farmer. He was involved in a tractor
accident and suffered from a mid-shaft fractured femur. There are several surgical options for
Mr. X such as intra medullary nailing and it can be performed by two methods such as antegrade
or retrograde. In this method, a special metal rod is inserted in the canal of femur. The rod
provides support to the leg and keeps it intact. An intramedullary nail is inserted inside the canal
in the knee or in the hip region by making a small incision. It helps in maintaining the position of
both the nail and the bone during the healing process. There are other treatment methods such as
fixation of plate and screw and external fixation. The method of fixation depends on the type of
fracture as well as injuries associated with it. During the fixation of plates and screws, the
fragments of bone are initially brought in their normal alignment. External fixation involves
fixing of metal pins or screws in the bone above and below the site of fracture.
The potential post-operative complications which may lead to a negative impact on the
mortality and morbidity of patients following surgical repair of a fractured femur are potential
risk of infection to the surgical wound, blood clot and fat embolism leads to the risk of DVT
and improper positioning of the bone fragments due to fracture. The infection at the site of
fracture can be controlled by keeping the wound clean and taking antibiotics as prescribed by the
doctor. Nurses should also follow ANTT technique (Aseptic non-touch technique for wound
care) which involves a few steps to prevent infection. The surface of wound should be cleaned
with clean hands and the materials required should be collected beforehand. The wound is
cleaned by taking proper precautions such as disposal of waste. Nurses should be alert at all
times and protect Mr. X from all the risks of dangers and harmful situations. If they come across
any adverse situations they should inform the management team and ask for professional health
services (Swiontkowski & Resnick, 2015).

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Since, Mr. X has a past history of deep vein thrombosis (DVT) and hypertension he has
been prescribed nifedipine (CR) 60mg and warfarin 10 mg on a daily basis Nifedipine is used to
cure the patient suffering from high blood pressure and warfarin is an anticoagulant which is
used in thinning of blood. Hence, she should take his medicines regularly to prevent blood clot
and fat embolism which increases the risk of DVT.
The doctors and the nursing staff have to be careful while performing the surgery so that
the bone fragments are placed in a correct position to avoid to chances of surgery in the future.
There are various tools for the assessment of pain that can be used if he is feeling discomfort.
The nurses and other healthcare professionals should help him and provide psychosocial care
along with palliative care so that he gets well soon.
It is very crucial for the nurses and other health care professional to keep a track on the
health parameters such as blood pressure, pulse rate and oxygen saturation to prevent any risk in
future and provide proper care. They should follow six rights of medication which involves
giving him proper drug by considering his allergic reactions to drugs and expiry date, proper
route of administration such as oral, mouth, buccal, sublingual, gastric tube, and nasogastric
tube, correct timing, right client or patient, proper dosage as prescribed by the doctor and
documenting about the drug given to the patient (Murray et al., 2015).
There should be monitoring in appropriate manner and clinical assessments should be
repeated in order to keep a track on the signs and symptoms so that surgical complications are
recognized in an adequate manner. Monitoring of infection at the site of injury can be done by
regular checking of the wound and by making sure that there is no pus formation and foul smell

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after the surgery has been performed. The doctors should make sure that there is no swelling or
redness at the site of incision in Mr. X (Giannoudis, & Harwood, 2017).
Monitoring of blood clot formation and fat embolism after the surgery of mid-shaft
fracture femur can be done by keeping the risk factors in mind such as having a previous history
of deep vein thrombosis and hence he has been prescribed warfarin. The doctors should check
for fever and swelling in Mr. X which is a sign of developing a clot. Fat embolism syndrome can
be monitored by checking for various symptoms such as fever, anemia, respiratory issues, and
visual problems. Fat embolism syndrome involves clinical symptoms of tachypnea, tachycardia,
pyrexia and thromocytopnea. Hypoxea and pulmonary dysfunction also occurs in around 75% of
the patients undergoing mid shaft fracture femur. The patient should be taken for Head computed
tomography and magnetic resonance imaging of brain. Sublinical hypoxia should be monitored
along with pulse oximetry in a continuous manner to detect if Mr. X is suffering from fat
embolism. Nurses and other staff in the OT should provide proper post operative care so that he
does not suffer from any kind of infection. There should be proper follow-ups to keep a track on
any other symptoms developed after the surgery. Prioritizing patients can prevent further
complications, increased hospitalization and unnecessary deaths (Parameswaran et al., 2016).
Monitoring of improper positioning of the bone fragments can be done by a physical
therapist who designs a specialized treatment plan for the patient to monitor the progress of
recovery. He helps the patient in improving the balance of standing and the ability of walking
after the surgery has been done (Ozkan et al., 2015). He also monitors the motion of hip, leg and
back and the level of pain suffered by the patient. Self-management of disease such as having
well balanced diet, proper sleep and physical exercise should be taught. Maintenance of personal
hygiene and regular medication should be monitored (Ball et al. 2013).Psychosocial care will

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provide him emotional support. He should be provided proper physiotherapy sessions and
rehabilitation services if required. Information on prevention strategies should also be given to
him.
References
Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., & Griffiths, P. (2013). ‘Care left
undone’during nursing shifts: associations with workload and perceived quality of
care. Quality and Safety in Health Care, bmjqs-2012.
Detering, K.M., Hancock, A.D., Reade, M.C. and Silvester, W., 2015. The impact of advance
care planning on end of life care in elderly patients: randomised controlled
trial. Bmj, 340, p.c1345.
Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2015). Illness trajectories and palliative
care. BMJ: British Medical Journal, 330(7498), 1007
Giannoudis, P. V., & Harwood, P. (2017). Complications After Damage Control Surgery: Pin-
Tract Infection. In Damage Control Management in the Polytrauma Patient (pp. 297-
307). Springer International Publishing.
Swiontkowski, M., & Resnick, L. (2015). Treating Atypical Femoral Fractures Related to
Bisphosphonates. JBJS Case Connector, 5(1), e5.
Parameswaran, A., Krishnamoorthy, V. P., Oommen, A. T., Jasper, A., Korula, R. J., Nair, S. C.,
& Poonnoose, P. M. (2016). Is pre-operative assessment of coagulation profile with
Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE)
following orthopaedic surgery?. Journal of clinical orthopaedics and trauma, 7, 225-229.

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Akoh, C. C., Schick, C., Otero, J., & Karam, M. (2014). Fat embolism syndrome after femur
fracture fixation: a case report. The Iowa orthopaedic journal, 34, 55.
Ozkan, K., Türkmen, I., Sahin, A., Yildiz, Y., Erturk, S., & Soylemez, M. S. (2015). A
biomechanical comparison of proximal femoral nails and locking proximal anatomic
femoral plates in femoral fracture fixation: a study on synthetic bones. Indian journal of
orthopaedics, 49(3), 347.