Nursing care plan ncp fractured hip internal fixation or prosthesis insertion

Fractured Hip with Internal Fixation or Prosthesis Insertion

A fractured hip is the term used to describe a fracture of the proximal end of the femur. Hip fractures are classified according to the specific location of the fracture. A common classification system divides hip fractures into three types: femoral neck fractures (also referred to as intracapsular fractures), intertrochanteric fractures, and subtrochanteric fractures (the latter two types are sometimes referred to as extracapsular fractures).

A fractured hip is one of the most common orthopedic injuries in the elderly because of the increased incidence of osteoporosis and falls in the elderly population. Although a fractured hip can be treated by traction, the preferred treatment is surgery because it allows earlier mobility. Surgery involves insertion of a femoral head prosthesis or reduction and internal fixation of the fracture with an intramedullary fixation device, cannulated screws, or a dynamic compression hip screw with a plate assembly. Internal fixation with preservation of the femoral head is the preferred treatment for hip fractures, but the femoral head and neck can be replaced with a prosthetic device (e.g., Austin Moore prosthesis) if an intracapsular fracture has occurred and factors are present that increase the risk for avascular necrosis and/or nonunion. Ideally, surgery is performed within 12-24 hours after the injury, especially if the client has a displaced femoral neck. During the preoperative period, traction is usually applied to stabilize and reduce the fracture and reduce muscle spasms and pain.

Preoperative
Fear/Anxiety
Acute pain: hip
Risk for peripheral neurovascular dysfunction: fractured extremity

Postoperative
Risk for peripheral neurovascular dysfunction: operative extremity
Acute pain: hip
Impaired physical mobility
Risk for infection
Risk for falls
Potential complications
hypovolemic shock
dislocation of prosthesis or internal fixation device
thromboembolism
fat embolism syndrome (FES)
avascular necrosis
delayed healing of the fractured bone
Grieving
Deficient knowledge, Ineffective therapeutic regimen management, or Ineffective health maintenance

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