Nursing Care Plan and Clinical Reasoning for Mrs. Y: Hip Fracture Care

This assignment presents a clinical case study focusing on the nursing care of Mrs. Y, an 84-year-old patient admitted with a right hip fracture. The study details a nursing care plan developed for the next eight hours before surgery, addressing key nursing diagnoses such as pain, movement of bone fragments, and weakness. It emphasizes the prioritization of interventions, particularly immobilizing the fracture to prevent further complications. The plan includes specific nursing interventions like orthopedic bed placement, limb support with pillows, and pain management through medication. Evidence-based criteria, including critical thinking and patient feedback, are used to evaluate the effectiveness of the care provided. The case study highlights the importance of a patient-centered approach and the application of the clinical reasoning cycle to improve patient outcomes and satisfaction. The document also includes a literature review to support the nursing interventions and care plan.

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Part A: Database search
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Reference list
Brent, L., Hommel, A., Maher, A. B., Hertz, K., Meehan, A. J., & Santy-Tomlinson, J. (2018).
Nursing care of fragility fracture patients. Injury, 49(8), 1409-1412.
doi:10.1016/j.injury.2018.06.036
Kim, L. H., & Leland, N. E. (2016). Rehabilitation Practitioners' Prioritized Care Processes in
Hip Fracture Post-Acute Care. Physical & Occupational Therapy In Geriatrics, 34(2-3),
155-168. doi:10.1080/02703181.2016.1267295
Leland, N. E., Lepore, M., Wong, C., Chang, S. H., Freeman, L., Crum, K., … Nash, P. (2017).
Delivering high quality hip fracture rehabilitation: the perspective of occupational and
physical therapy practitioners. Disability and Rehabilitation, 40(6), 646-654.
doi:10.1080/09638288.2016.1273973
MacDonald, V., Maher, A. B., Mainz, H., Meehan, A. J., Brent, L., Hommel, A., ... & Sheehan,
K. J. (2018). Developing and testing an international audit of nursing quality indicators
for older adults with fragility hip fracture. Orthopaedic Nursing, 37(2), 115-121.
Maher, A. B., Meehan, A. J., Hertz, K., Hommel, A., MacDonald, V., O’Sullivan, M. P., …
Taylor, A. (2012). Acute nursing care of the older adult with fragility hip fracture: An
international perspective (Part 1). International Journal of Orthopaedic and Trauma
Nursing, 16(4), 177-194. doi:10.1016/j.ijotn.2012.09.001
Meehan, A. J., Maher, A. B., Brent, L., Copanitsanou, P., Cross, J., Kimber, C., … Hommel, A.
(2019). The International Collaboration of Orthopaedic Nursing (ICON): Best practice
nursing care standards for older adults with fragility hip fracture. International Journal of
Orthopaedic and Trauma Nursing, 32, 3-26. doi:10.1016/j.ijotn.2018.11.001
Mitchell, P., Åkesson, K., Chandran, M., Cooper, C., Ganda, K., & Schneider, M. (2016).
Implementation of Models of Care for secondary osteoporotic fracture prevention and
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orthogeriatric Models of Care for osteoporotic hip fracture. Best practice & research
Clinical rheumatology, 30(3), 536-558.
Prestmo, A., Hagen, G., Sletvold, O., Helbostad, J. L., Thingstad, P., Taraldsen, K., ... &
Johnsen, L. G. (2015). Comprehensive geriatric care for patients with hip fractures: a
prospective, randomised, controlled trial. The Lancet, 385(9978), 1623-1633.
Stade, D., & Dykes, P. (2015). Nursing Leadership in Development and Implementation of a
Patient-Centered Plan of Care Toolkit in the Acute Care Setting. CIN: Computers,
Informatics, Nursing, 33(3), 90-92. doi:10.1097/cin.0000000000000149
Zullo, A. R., Zhang, T., Banerjee, G., Lee, Y., McConeghy, K. W., Kiel, D. P., ... & Berry, S. D.
(2018). Facility and state variation in hip fracture in US nursing home residents. Journal
of the American Geriatrics Society, 66(3), 539-545.
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Part B: Writing task
A nursing care plan is a detailed process that includes identifying the needs of a patient, potential
risk, and potential needs. The plan provides an alternative means of communication between
nurses and other healthcare workers in the same organization. It is essential to have a nursing
care plan in order to achieve healthcare delivery outcomes and improve the consistency and
quality of patient care. A nursing care plan is developed as soon as the patient is admitted and is
updated, according the patient response (Leland et al., 2017).
Mrs Y is an 84-year-old female patient who has been admitted to hospital with a fracture on her
right hip. The patient will require a nursing plan for the next eight hours before she undergoes
surgery. Below is the nursing plan that will be used (table 1).
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Table 1: Nursing care plan for Mrs. Y
DIAGNOSIS RISK FACTORS DESIRED
OUTCOME
NURSING
INTERVENTION
Increased risk of
trauma
Weakness, pain,
alteration of skeletal
integrity, getting up
without assistance,
and movement of the
bone fragments
Patient demonstrates
fewer pain symptoms
Maintain stabilization
to help in the
alignment of the
fracture (Meehan et
al., 2019).
Maintaining of limb
rest of the leg
The pelvic bone and
the bones below the
right femur will be
supported with
pillows and blankets
and minimal
movement
The client will be
placed on an
orthopedic bed to
increase
comfortability
The current position
will be maintained to
encourage the
integrity of traction
Position in a suitable
manner to ensure
appropriate pull of the
femur bone is
maintained along the
long axis of the bone
The serial x rays and
any other follow up
will be reviewed.
Paracetamol,
Ibuprofen or any other
suitable pain killer
will be administered.
The client will be
given any other
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regular medication
she may require for
hypertension or
congestive cardiac
failure.
No food or liquids
should be
administered to the
patient (Kim &
Leland, 2016).
There are three potential nursing problems in Mrs Y case; pain related to the broken femur and is
evidenced by the patient response to touch on areas surrounding the femur; movement of bone
fragments related to the fall and is evidenced by the need to turn and sit upright; and weakness
caused by side effects of pain medication and excessive bleeding from the fall it is evidenced by
the self-report from the patient (MacDonald et al., 2018)
The highest priority statement is movement of bone fragments related to the fall and is evidenced
by the need to turn and suit upright. This is a high priority because change may result in further
complications of the injury. It may result in bone tearing into flesh, leading to the formation of
new wounds. According to past literature, bones have a dense supply of blood vessels.
Movement of a broken bone could result in rupturing of a blood vessel, and excessive bleeding
may occur, especially if an artery is ruptured. Movement of a broken limb can result in a lot of
pain to the patient (Maher et al., 2018)
First aid for a fracture mostly involves immobilizing the injured area. A splint may be required to
limit the movement. If there is any bleeding or open wounds around the injury area, attend to the
bleeding. The bleeding can be stopped by applying pressure to the wound. If a bone is
protruding, pressure can be applied to the sides of the injury. Broken bones that are sticking out
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should not be pushed inside the body. In addition, realigning of a deformed lib due to fracturing
should be done by a qualified healthcare worker. After application of a splint, support the limb
with as much comfort as possible. Place pillows and blankets below the broken femur (Prestmo
et al., 2015).
Patient-centered goals will be developed for Mrs. Y. these goals will be SMART (Specific,
measurable, achievable, realistic, time-specific). The first goal is to reduce movement to the
specific limb that is affected. The patient will give a self-report on the pain levels during various
stages to measure the patient care level. Movement can be reduced through pillows and blankets
found in the hospital. The patient should be comfortable, well-rested, and risk-free by the time
they enter surgery (Brent et al., 2018).
There are nursing interventions that will be applied in order to achieve the goals above (Stade &
Dykes, 2015). The first nursing intervention will be to place the patient on an orthopedic bed.
The rationale behind this is a soft mattress, or a sagging bed may interfere with the pull of
traction. The second nursing intervention is the application of pillows and blankets below the
fractured limb. The rationale behind this is that it prevents any unnecessary movement and
reduces the pressure exerted on the leg. The final nursing intervention will be the administration
of paracetamol or an equivalent. The rationale behind this is to reduce the level of pain that the
patient is experiencing as a result of the broken bone (Zullo et al., 2018).
Evidence-based criteria will be used to evaluate Mrs. Y response to patient care. The criteria
used will be critical thinking. Subjective and objective data will be obtained from the patient.
The patient will explain how they feel in general. Previous clinical experience will be reflected
upon. Critical thinking and intellectual thinking attitudes will be applied. The nurse will then
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review the expected outcomes and the observed outcomes and compare the two (Mitchell et al.,
2016).
In conclusion, nursing care is an essential aspect of patient care. Using the principle of patient-
centered care and applying a clinical reasoning cycle, it is possible to improve the care and
achieve the nursing outcomes of the nursing plan. It is also possible to increase patient
satisfaction in the healthcare facility through evidence-based nursing.
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