Nursing Case Study: Patient with Neck of Femur Fracture - Care Plan

This nursing assignment presents a case study of an 84-year-old woman, Mrs. Y, admitted with a neck of femur fracture following a fall. The assignment applies the clinical reasoning cycle to prioritize nursing care for the next eight hours. The student nurse assesses subjective and objective cues, identifying nursing problems like pain, hypertension, and a history of congestive heart failure. The assignment establishes SMART goals for pain reduction, hypertension management, and hypercholesterolemia improvement, outlining interventions such as pain killers, mindfulness therapy, beta-blockers, diuretics, and dietary modifications. The evaluation focuses on monitoring pain levels, blood pressure, and cholesterol levels. The reflection highlights the student's learning experience, emphasizing the importance of effective interventions and patient empowerment in nursing practice. References to relevant literature are included to support the case study analysis.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Authors note:

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Part B: clinical reasoning cycle:
Considering the patient situation:
The case study represents the neck of femur fracture of Mrs. Y, 84 years woman who
was living alone and her husband recently passed away. He was admitted to the ward because of
fall at home earlier. Her neighbour found her lying on the floor early in the morning when she
went to visit her.
Collect cues and information:
Considering subjective cues, it was observed that the patient had a history of
hypercholesterolemia, hypertension and congestive cardiac failure. Considering objective
assessment, it was observed that in the right hip of patient, right arm and face had bruise. She
had a dressing and eight stitches were present. Her blood pressure was 142/88, indicating high
blood pressures and her blood glucose level was 5.6 mmol/L, indicating close to pre-diabetes.
Her weight was 75 kg. The heart rate of the patient was 110 and no urine output was observed
after admission.
Process of the information:
From the case study, several nursing problems were identified. Considering the first
nursing problem, the patient may experience pain due to bruises because of fall as well as due to
8 stitches. The patient may experience deep wound which results in laceration as she was
dressed with eight stitches. Consequently, she might experience pain. Li (2016), highlighted that
patient may experience sudden fall when they have symptoms of dementia as observed in this

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case study. The patient became a little forgetful which can be early symptom of dementia. It can
be said that the blood glucose level can be close to the blood glucose of pre-diabetic patients. In
this case, it can be said that patient may be close to hypoglycaemia and at a high risk of
developing dementia which facilitated sudden fall and patient experienced bruises, stitches, and
pain (Wheatley et al., 2017).
In this case, it can be observed that the patient have a history of hypertension. In healthy
individuals, normal blood pressure is 180/120. In the case of a patient, the blood pressure was
142/88, indicating high blood pressures. Rangel-Huerta et al. (2016) suggested that while high
blood pressure has no specific symptoms, it can be observed in patients who are overweight. In
this current context, the patient was overweight as her weight was 75 kg.
The patient had a history of congestive heart failure because of hypercholesterolemia.
The Hypercholesterolemia can be observed due to high blood pressure as arteries are blocked to
facilitate the normal blood flow (Pop, de Boer & Stalenhoef, 2016). The heart rate of the patient
was also high. Consequently patient experienced congestive heart failure.
Identification of issues or problem:
There is three nursing problem statement that has been identified. The first nursing
problem statement is the sudden fall and associated pain. Consequently, the patient experienced
neck of femur fracture and due to laceration which addressed through eight stitches. The second
problem is hypertension which was observed in the patients due to overweight. The third
nursing problem statement is a history of congestive heart failure because of
hypercholesterolemia.
.

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In this case, the first and highest nursing priority would be pain as upon assessment
it was observed that the patient had a sudden fall which results in bruises in the right arm, right
hip, and face. The patient may experience pain due to bruises as well as due to 8 stitches.
Tosounidis et al. (2015), suggested that patient usually experience pain femur fracture which
not only because of bruises but because of the deep wound present in the body. In this case, out
of all nursing priorities, pain can be chosen as the prime nursing priorities that are required to
manage within the next eight hours.
Established goals:
As a nurse first SMART Goal would be reduced pain in patient with the assistance of
pain killer and mindfulness therapy within the next 8 hours.
The second SMART goal would be the management of hypertension within the next
eight hours with the assistance of diuretics and beta-blockers
The third SMART goal would be the improvement of Hypercholesterolemia within next
1 week with the assistance of modification of diet and medication.
Take action:
As observed in this case, the patient had experienced pain due to fracture, bruises
because of sudden fall. In this case, the patient would be provided with pain killers with the
assistance of the general practitioner. Tosounidis et al. (2015), pain killers are analgesic drugs
which act on the central nervous system to reduce the feeling of pain. On the other hand, Veehof
et al. (2016), mindfulness therapy involves breathing method, guided imagery to relax the body

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and reduce the pain. Hypertension can reduce with the help of beta-blockers and diuretics. Prins
et al. (2015), highlighted that beta-blockers are used to lower the heart rate and blood pressure.
On the other hand, Roush and Sica (2016), suggested that diuretics are used for increasing urine
production which will eliminate excess salt and water. It will facilities urine production and
reduce high blood pressure. Hypercholesterolemia can be improved with the modification of
diets such as a high proportion of vegetables, dietary fibre, fruits and low in fats results which
will further in a modest decrease in total cholesterol (Widmer et al., 2015).
After management of three nursing priorities, it is crucial to involve patients in the
surgery with the assistance of physicians in order to improve the quality of life.
Evaluation:
The reduction of pain would be required to monitor to evaluate the effectiveness
outcome. The pain is required to monitor with the assistance of a pain assessment tool. In this
tool, a set of the questionnaire can be used to determine the pain status of the patient after
providing interventions (Fillingim et al., 2016). The effective outcome for pain management
would be less tearfulness of the patient and pain score would be zero. The reduction of
hypertension can be evaluated by monitoring the blood pressure level of the patient. The blood
pressure can be measured by sphygmomanometer where the possible outcome would be normal
blood pressure 120/80 (Lai, 2019). The hypercholesterolemia is required to monitor in order to
gather the data regarding hyperglycaemia where normal cholesterol level would be 200
milligrams per decilitre (mg/dL).
Reflection:

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The case study explored neck of femur fracture of the patient who admitted in the
hospital and recently had bruises, stitches due to sudden fall early in the morning. Before, while I
was aware of the surgery for addressing the neck of femur fracture in patient, I was unaware of
the interventions of three crucial nursing priorities within 8 hours of the admission. Hence, this
further affected my nursing practice as a registered nurse since I failed to empower patients,
empathize them. However, while I was gathering the information through, I gather an
understanding of effective intervention for the pain management of the patient who is
experiencing the neck of femur fracture. I gathered an in-depth understanding of the evaluation
method of the effective intervention which will further help me ineffective shared decision
making. Consequently, I will be able to empower patients, boost their self-confidence and
facilitate high self-esteem. The patient will feel empowered and safe and I will able to achieve
high patient satisfaction and outcome. I will further incorporate it in my future practice in order
to improve my future practice and empower patient.

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References:
Bell, D. A., Pang, J., Burrows, S., Bates, T. R., van Bockxmeer, F. M., Hooper, A. J., ... & Watts,
G. F. (2015). Effectiveness of genetic cascade screening for familial
hypercholesterolaemia using a centrally co-ordinated clinical service: an Australian
experience. Atherosclerosis, 239(1), 93-100.
Fillingim, R. B., Loeser, J. D., Baron, R., & Edwards, R. R. (2016). Assessment of chronic pain:
Domains, methods, and mechanisms. The Journal of Pain, 17(9), T10-T20.
Lai, Y. H. (2019). The social network analysis on the behavioral intention to use cloud
sphygmomanometer. Health and Technology, 1-8.
Li, F. (2016). Alzheimer's disease increases the incidence of hospitalization due to fall-related
bone fracture in elderly Chinese. International Journal of Gerontology, 10(4), 227-231.
Pop, G. A., de Boer, M. J., & Stalenhoef, A. F. (2016). Reducing cardiac after-load by lowering
blood viscosity in patients with familial hypercholesterolemia–A pilot study. Possible
mechanism for occurrence of anemia in chronic heart failure patients?. Cor et
Vasa, 58(4), e374-e378.
Prins, K. W., Neill, J. M., Tyler, J. O., Eckman, P. M., & Duval, S. (2015). Effects of beta-
blocker withdrawal in acute decompensated heart failure: a systematic review and meta-
analysis. JACC: Heart Failure, 3(8), 647-653.
Rangel-Huerta, O. D., Aguilera, C. M., Martin, M. V., Soto, M. J., Rico, M. C., Vallejo, F., ... &
Mesa, M. D. (2015). Normal or high polyphenol concentration in orange juice affects

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antioxidant activity, blood pressure, and body weight in obese or overweight adults. The
journal of nutrition, 145(8), 1808-1816.
Roush, G. C., & Sica, D. A. (2016). Diuretics for hypertension: a review and update. American
journal of hypertension, 29(10), 1130-1137.
Tosounidis, T. H., Sheikh, H., Stone, M. H., & Giannoudis, P. V. (2015). Pain relief management
following proximal femoral fractures: Options, issues and controversies. Injury, 46, S52-
S58.
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance-
and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic
review. Cognitive behaviour therapy, 45(1), 5-31.
Wheatley, A., Bamford, C., Boyles, M., Shaw, C., & Allan, L. M. (2017). Mapping existing care
pathways for people with dementia with fall-related injuries. Alzheimer's & Dementia:
The Journal of the Alzheimer's Association, 13(7), P1173-P1174.
Widmer, R. J., Allison, T. G., Lerman, L. O., & Lerman, A. (2015). Digital health intervention as
an adjunct to cardiac rehabilitation reduces cardiovascular risk factors and
rehospitalizations. Journal of cardiovascular translational research, 8(5), 283-292.

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Appendix B:
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S6 neck of femur fracture
AND ( intervention or
treatment or therapy )
Limiters - Full Text;
Published Date:
20150101-20191231;
English Language
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Boolean/Phrase
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S5 neck of femur fracture
AND ( intervention or
Limiters - Full Text;
Published Date:
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treatment or therapy ) 20150101-20191231
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Boolean/Phrase
S4 neck of femur fracture
AND ( intervention or
treatment or therapy )
Limiters - Full Text;
Published Date:
20150101-20181231
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S3 neck of femur fracture
AND ( intervention or
treatment or therapy )
Limiters - Full Text
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S2 neck of femur fracture
AND ( intervention or
treatment or therapy )
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S1 neck of femur
fracture
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View Results (307)