Comprehensive Care of a 93-Year-Old Patient with an Intertrochanteric Femur Fracture in the Emergency Department

QUESTION

A 93-year-old patient presented to the emergency department after an unwitnessed fall. The patient came from her memory care unit with an unwitnessed fall. The patient was unsure if she hit her head. Having pain to the left hip denies any other pain. exam without any concerning findings other than left hip pain and some shortening of the left leg. X-ray received with communicated  intertrochanteric left femur fracture.

past medical history dementia, dyslipidemia, shingles, appendectomy

Rhythm strip 630, interpreted by : Normal sinus rhythm at a rate of 65. Inervals:PR 186, QRS 74, QTC 474,

Medication : Fentanyl citrate , ondansetron HCI

Labs: chloride high, BUN high, Creatinine high, GFR low , glucose high

1. narrate a two-page narrative note about the patient at the emergency room treatment and recovery process

2.

Priority 1 Nursing diadnosis

Nursing Diagnosis:

nursing intervention 1

nursing intervention 2

nursing intervention 3

nursing intervention 4

short term goal

long term goals

Priority 2Nursing diadnosis

Nursing Diagnosis:

nursing intervention 1

nursing intervention 2

nursing intervention 3

nursing intervention 4

short term goal

long term goals

Priority 3Nursing diadnosis

Nursing Diagnosis:

nursing intervention 1

nursing intervention 2

nursing intervention 3

nursing intervention 4

short term goal

long term goals

ANSWER

Comprehensive Care of a 93-Year-Old Patient with an Intertrochanteric Femur Fracture in the Emergency Department

Narrative Note

Upon arrival at the emergency department, the 93-year-old patient was brought in after experiencing an unwitnessed fall at her memory care unit. The patient was alert and oriented but complained of left hip pain and some shortening of the left leg. Her past medical history included dementia, dyslipidemia, shingles, and an appendectomy. A rhythm strip showed a normal sinus rhythm at a rate of 65, and the patient was on fentanyl citrate and ondansetron HCI for pain and nausea, respectively.

Physical examination revealed no concerning findings except for the intertrochanteric left femur fracture. The patient denied any head injury or other pain. An X-ray confirmed the fracture, leading to the decision to initiate treatment immediately.

Treatment and Recovery Process

The patient was promptly evaluated by the orthopedic team, and surgical consultation was obtained. Given her age and comorbidities, the decision was made to proceed with surgical repair of the femur fracture. The patient was provided with pain management through fentanyl citrate, and ondansetron HCI was continued to address any post-operative nausea. Vital signs were closely monitored to ensure stability throughout the preoperative period.

In the operating room, the patient underwent a successful repair of the intertrochanteric femur fracture. Postoperatively, the patient was transferred to the recovery unit, where she was closely monitored for any signs of complications, such as respiratory distress or delirium. Pain management and wound care were continued, and the nursing team ensured the patient’s comfort and safety.

Priority 1 Nursing Diagnosis: Acute Pain related to femur fracture and surgical intervention.

Nursing Interventions

Administer prescribed analgesics regularly and assess pain level using a pain scale.
2. Position the patient comfortably, using pillows for support to alleviate pressure on the affected hip.
Collaborate with the interdisciplinary team to manage pain effectively and adjust medication as needed.
Educate the patient and family about the importance of adhering to the pain management plan.

Short-Term Goal: The patient’s pain will be controlled to a tolerable level (pain score ≤ 4) within 24 hours post-surgery.

Long-Term Goal: The patient will achieve pain relief and manage postoperative discomfort effectively during the recovery period.

Priority 2 Nursing Diagnosis: Impaired Mobility related to the femur fracture and surgical intervention.

Nursing Interventions

Collaborate with physical therapy to create a personalized mobility plan and implement early mobilization.
Utilize assistive devices as needed to support the patient’s mobility and reduce the risk of falls.
Encourage the patient to perform range-of-motion exercises to prevent stiffness and promote healing.
Assess the patient’s mobility regularly and modify the plan based on her progress and limitations.

Short-Term Goal: The patient will achieve safe mobility with assistance (e.g., using a walker) within 48 hours post-surgery.

Long-Term Goal: The patient will regain independence in mobility and perform activities of daily living with minimal assistance during her recovery.

Priority 3 Nursing Diagnosis: Risk for Impaired Skin Integrity related to immobility and surgical intervention.

Nursing Interventions

Conduct regular skin assessments, paying special attention to bony prominences and areas at risk for pressure injuries.
Implement pressure-reducing measures, such as repositioning the patient every two hours, using pressure-relieving surfaces, and applying skin protectants as needed.
Collaborate with the wound care team to monitor and address any signs of skin breakdown promptly.
Educate the patient and family about the importance of proper skin care and prevention of pressure injuries.

Short-Term Goal: The patient will maintain intact skin without any signs of pressure injuries throughout her hospitalization.

Long-Term Goal: The patient will maintain healthy skin integrity and prevent pressure injuries during her recovery and rehabilitation.

Conclusion

The care of a 93-year-old patient with an intertrochanteric femur fracture in the emergency department requires a comprehensive and patient-centered approach. Nursing interventions should focus on pain management, promoting mobility, and preventing complications related to immobility. By addressing the patient’s immediate needs and setting achievable goals for her recovery, the nursing team can facilitate a successful postoperative period and contribute to her overall well-being.