Nursing Care Interventions and Discharge Planning for Femur Fracture

This report analyzes nursing care interventions and discharge planning needs for a patient, Mr. Brown, recovering from a femur fracture following a tractor injury. It emphasizes crucial interventions such as pain management through medication, careful weight bearing according to physician's instructions, and early motion exercises to prevent stiffness. The report also addresses discharge planning, highlighting the importance of reducing hospital readmissions and considering the patient's specific needs, especially given his lack of family support. Key aspects include medication management (addressing hypertension and deep vein thrombosis), self-care instructions, symptom recognition, and coordination of follow-up appointments and community resources like home health care. The report underscores the nurse's role in educating the patient throughout the care continuum and ensuring a smooth transition back home.

Running head: NURSING CARE INTERVENTIONS 1
Nursing Care Interventions and Discharge Planning Needs
Student’s Name
University Affiliation

NURSING CARE INTERVENTIONS 2
Nursing Care Interventions
Although femoral fractures are common among the elderly, it is a condition that can be
difficult to manage when the nursing staff does not take proper interventions following a post
operative surgery (Avenelll and Handoll, 2010). To ensure quick recovery for Mr. Brown, a
patient who has had surgery to repair his fractured femur after being involved in a tractor injury,
a nurse will take appropriate interventions to ensure quick recovery and mobility of the patient.
Some of the recovery measures will include;
Pain management; Pain following a surgery or an injury is a natural part of the recovery
process (Black et al., 2010). As a nurse, I would work towards reducing the pain of Mr. Brown to
help his leg recover faster by ensuring that he adheres to the prescribed medications. The drugs
are usually prescribed to reduce pain for a short period following an injury or surgery. According
to Nosbusch et al., (2011), there are different types of medicines used to help curb pain such as
local anesthetics, non-steroidal anti-inflammatory drugs and opiods to mention just a few.
Although a doctor can use a combination of these drugs, for pain relief it is vital to consider the
past medical history of the patient (Nosbusch et al., 2011). For the case of Mr. Brown, I would
use anti-inflammatory drugs alongside Warfin to prevent blood clotting because he has a history
of deep vein thrombosis.
Weight bearing; to avoid further complications, it is of great importance to follow the
physician’s instructions for putting weight on the injured hip. Ha et al., (2010), asserts that
whether a fracture is treated with surgery or not, a healthcare officer is supposed to discourage
weight bearing until the time recovery occurs. To achieve this, the patient may require up to 10
months or more of recovery before weigh bearing can be done without the risk for complications
(Ha et al., 2010). One can also put on a knee brace for extra support. For the case of Mr. Brown,

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I would ensure that he adheres regularly to the scheduled X-ray for close monitoring on how the
hip is healing. When a patient is treated with a cast or a brace, regular X-ray check-ups help a
doctor to know whether the fracture is stable enough to start weight bearing activities (Ha et al.,
2010). Although one can still put weight on the leg, a walker or crutches are important at time to
reduce the weight.
Early motion; although this intervention may not work immediately for the case of Mr.
Brown due to surgery, it will be a mandate of the nurse to decide on the best time for the patient
to begin moving the knee to prevent stiffness. According to Black et al., (2010), this period
depends on how the soft tissues including the muscles and the skin of the patient are recovering
as well as how secure the fracture is following a surgery. On the other hand, Rhudy et al., (2010)
holds that early motions usually begin with passive exercises. For the case of Mr. Brown, a
therapist would gently move the knee in case the patient cannot move or would place it in a
continuous passive motion machine that will cradle as well as move the leg. For the bone that has
fractured into multiple pieces or in cases where bones are weak especially for the elderly, the leg
may take longer to recover, hence longer time before a physicist recommends motion activities
(Schilcher et al., 2011). The rationale for this intervention is that it will prevent the leg from
being stiff and ensure passive exercise which will make sure that no movement complications
after recovery.
Discharge Planning Needs
One of the key reasons for discharge planning is to reduce avoidable readmissions in the
hospital (Rhudy et al., 2010). In the healthcare set ups, the doctor will ensure that Mr. Brown
needs are considered as well as put in a detailed discharge plan with input from the patient and
family. Unfortunately, Mr. Brown is a widower, has no relatives or neighbors around to take care

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of him after discharge from the hospital. Patient needs for care following discharge are
categorized into three sections; activity related needs which includes needs equipment or
assistance due to restrictions in physical capabilities that limit daily functioning’s at home; needs
related to an aspect of self-sufficiency and lastly is the need for treatment related needs (Sugi et
al., 2012) .
Treatment related needs can be assessed using items such as the need for nursing care,
receipt of current medication, recommended treatment or procedures , rehabilitation or need for
therapy and the need for dietary instructions (Shepperd et al., 2013). Although no pain
management drugs are mentioned for the case of Mr. Brown, he is currently prescribed two
medications to treat hypertension and deep vein thrombosis. In the vital signs, the patient had
high blood pressure at 160/95mm/Hg that is why he was prescribed Nifedipine and Warfarin to
prevent clotting of blood by blocking the formation of vitamin K dependent clotting factor. For
the medications to be taken after discharge, the patient has to understand pretty well the purpose
for medication, how he is supposed to take the drug (is it twice or thrice a day?), how to take
medication and how he can obtain other medications when he runs shot of the current drugs
(Nosbusch et al., 2011).
There should also be the need for self-care activities such as diet, weight monitoring and
activity levels or limitations as mentioned above. The hospital should prove nursing care to
monitor the progress of a patient by ensuring that they adhere to the right diet and activity levels
for a quick recovery. Shepperd et al., (2013) holds that it would also be necessary to identify the
supplies that the patient will require for care purpose for the supplies as well location to obtain
the supplies.

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In the discharge plan for Mr. Brown, there should also be the need for symptom
recognition as well as management especially when the nurse is not around to take care of his
needs. This will include what to do if a condition or a problem arises such as symptoms that
show a nurse needs to be notified who to contact, how to contact as well as the emergency
contact to be used. Needs linked with restrictions in activities of daily living are; instrumental
activities, activities of daily living or mobility and based on the patient report, such tasks can’t be
executed or can be executed but with equipment, assistance or both. Although Mr. Brown had
been involved in a tractor injury and sustained mid-shaft fractured injury, he is concerned about
his daily living activity to manage his farm work.
According to Ha et al., (2010), there should also be the need for coordination as well as
planning for follow-up appointments. For the case of Mr. Brown, the hospital should make
appointments before his discharge, and be within a known number of days of discharge basing
on the patient’s condition. There should be coordination for follow up of both tests plus studies
for which the confirmed results aren’t in reach during discharge. Moreover, there should be the
need for the community resources that the patient will use including home health care, adult day
care, meals on wheels the need for physical therapy, occupational therapy speech therapy (Black
et al., 2010). Above all, a nurse should educate the patient about diagnosis in the entire care
continuum and review with him what to do if a condition erupts.

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REFERENCES
Avenell, A., & Handoll, H. H. (2010). Nutritional supplementation for hip fracture aftercare in
older people. Cochrane Database Syst Rev, 1.
Black, D. M., Kelly, M. P., Genant, H. K., Palermo, L., Eastell, R., Bucci-Rechtweg, C., ... & de
Papp, A. (2010). Bisphosphonates and fractures of the subtrochanteric or diaphyseal
femur. New England Journal of Medicine, 362(19), 1761-1771.
Ha, Y. C., Cho, M. R., Park, K. H., Kim, S. Y., & Koo, K. H. (2010). Is surgery necessary for
femoral insufficiency fractures after long-term bisphosphonate therapy?. Clinical
Orthopaedics and Related Research®, 468(12), 3393-3398.
Nosbusch, J. M., Weiss, M. E., & Bobay, K. L. (2011). An integrated review of the literature on
challenges confronting the acute care staff nurse in discharge planning. Journal of
clinical nursing, 20(5‐6), 754-774.
Rhudy, L. M., Holland, D. E., & Bowles, K. H. (2010). Illuminating hospital discharge planning:
staff nurse decision making. Applied Nursing Research, 23(4), 198-206.
Schilcher, J., Michaëlsson, K., & Aspenberg, P. (2011). Bisphosphonate use and atypical
fractures of the femoral shaft. New England Journal of Medicine, 364(18), 1728-1737.

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Shepperd, S., Lannin, N. A., Clemson, L. M., McCluskey, A., Cameron, I. D., & Barras, S. L.
(2013). Discharge planning from hospital to home. Cochrane Database Syst Rev, 1(1).
Sugi, M. T., Davidovitch, R., Montero, N., Nobel, T., & Egol, K. A. (2012). Treatment of lower-
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