Critical Thinking in Nursing: Prioritizing Interventions for a Patient with Fractured Neck of Femur

Nursing assignment
Name of the student:
Name of the University:
Author’s note

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Introduction:
Nursing is a systematic process involving the process of assessment, diagnosis, planning,
implementation and evaluation. Critical thinking skills can be applied in each of these stages to take best
decision for health and being of patient. This essay demonstrates skills related to critical thinking by
analysing the case scenario of Mrs. Audrey Smith, a 75 year old female who came to the emergency
department after a fall in the kitchen and prioritizes nursing intervention for Mrs. Audrey based on her
health needs. The essay also examines the effect of 8 past medical diagnosis and past drugs provided to
determine its impact on care provided now. As Mrs. Audrey is scheduled for a left hip arthroplasty, the
essay also provides pre and post surgery nursing intervention and discharge plan for health and well-
being of the client.
1. Assessing and prioritising nursing interventions:
Safety:. To reduce discomfort due to fracture and promote safety of patient, some nursing intervention
that has been prioritised for Mrs. Smith are:
1. As Mrs. Smith has been diagnosed with a fracture neck of femur (NOF), soft tissue injury and
bruising to her left shoulder, head to toe assessment can help to find any unusual findings where
focussed assessment would be necessary.
2. Neurovascular assessment will be necessary to access blood supply to the fractured legs.
3. Fall risk assessment will be essential to determine the need for mobility support, prevent fall
(Ambrose, Cruz & Paul, 2015).
4. Call bell should be near to the patient and height of bed should be low
5. As Audrey is allergic to Bactrim, red identification should be provided to avoid medication error
Hygiene & comfort:
The nursing intervention that needs to be prioritized necessary for Audrey’s health and hygiene includes:
1. Assess the client’s ability to engage in self-care activity to determine hygiene needs for client.

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2. Assessment of pain is also necessary so that no safety issue arise while meeting hygiene needs
of client (Carvajal Carrascal & Montenegro Ramírez, 2015).
3. Head to toe hygiene will be important to control infection. Changing bed sheets and supporting
client in dressing and toileting will be necessary too.
4. As Mrs. Audrey has mild to moderate urinary incontinence, use of urinary catheter is a priority
(Maher et al., 2012)
5. It will be necessary to change position of Mrs. Smith quickly to reduce risk of developing pressure
ulcers. Keeping the skin dry will be necessary to prevent bedsores too (McInnes et al., 2015).
6. Braden scale should be used to evaluate skin integrity.
Nutrition:
Nutritional screening as Mrs Audrey is a patient with anorexia. Input and output data of patients
should be recorded and dietician should be consulted regarding diet chart and eating routine for patient.
Nutritional consultation would also support the nurse to identify oral nutritional supplementation and fluid
balance necessary for optimal recovery from fracture and prevention of future fractures (Maher et al.,
2018).
Elimination
In response to the issue of issue of chronic constipation in patient, assessment of eating habit
and pattern of elimination would help to identify characteristics of constipation and understand the cause
of constipation. Patient will be encouraged to take dietary fiber to make defecation easier. Laxatives need
to be provided to patient to soften stools and lubricate the intestinal mucosa (Huang, 2016).
Activity levels:
To achieve a functional and stable hip, the following nursing interventions are necessary for client:
 Maintain suitable positioning of hip to prevent stress
 Assist patient during position changes and transfer to reduce pain and discomfort

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 As Audrey is on bed-rest, providing pressure area care and assistance with daily life activities will
be necessary (Resnick et al., 2011).
Psychosocial needs:
Mrs. Audrey is worried about her dog; Rufus as she thinks no will be there to take care of Rufus when
her neighbour goes back to work. To reduce anxiety of patient, it is necessary to calm her and assure her
that suitable care for his dog will be taken. Mrs. Audrey is also at risk of psychosocial issues because of
fracture. She needs to be properly informed regarding the benefits of arthroplasty she accepts the
treatment with a positive approach .
2. Past medical history:
Atrial fibrillation: Atrial fibrillation is a condition associated with irregular and rapid heart rate and to
prevent risk of thrombotic events, patients like Mrs. Audrey need Warfarin or aspirin anticoagulation
therapy. However, as Mrs. Audrey is scheduled for arthroplasty, risk of wound drainage and hematoma
formation is high. Mrs. Audrey is also at risk of bleeding (Aggarwal et al., 2013). Regular assessment of
heart rate and blood pressure should be done to detect any abnormality.
Hypertension: Mrs. Audrey’s past medical history also reveals that she is hypertensive. Hypertension is
a condition that increases risk of stroke, heart failure and artery diseases. For patients going for surgery
like hip arthroplasty, hypertension can delay wound healing process and increase the likelihood of
infection (Ahmed et al., 2011). Low sodium diet and antihypertensive medication should be provided to
patient and blood pressure should be checked regularly.
Cerebrovascular accident: Mrs. Audrey had suffered from stroke in the past, which occurs due to the
interruption of the blood flow to the brains. Fall is one of the common consequences of stroke
(Andersson, Seiger & Appelros, 2013). To increase the degree of functional recovery for Mrs. Audrey, it
will be necessary to assess vitamin D status and use of anti-coagulants to reduce bone loss after stroke
(Ciobanu & Ciobanu 2017). She should be supported with every day exercise to overcome right side
shortcoming.