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Hip Fracture and Postoperative Nursing Notes

Immediate assessment after a fall

  • In the scenario discussed, when a patient has fallen, the first priority is assessment before attempting to move the legs. Do not move the legs if hip fracture is suspected;
    call 911 according to protocol.
  • Look for signs that suggest a hip fracture: the patient fell and there may be pre-existing joint issues (arthritis) that could contribute to symptoms; elderly may not report events clearly; ask what they were doing prior to the fall and whether they heard any sounds (e.g., bone rubbing) prior to losing balance.
  • Note that joints can be worn due to aging and arthritis, which may contribute to symptoms around the hip.
  • Before moving, gather information about the incident and perform a careful assessment to determine the need for immobilization and urgent transport.

Postfall hospital management and general principles

  • Hip fracture management often involves surgical repair, and in some cases traction or bone grafting may be used.
  • Be aware of potential leg shortening or deformity after fracture; surgeons may use traction to lengthen/align the bone, but this can result in the leg healing shorter if not corrected.
  • If the patient has a lot of blood loss, there may be consideration of blood transfusion (note the transcript mentions “oral blood transfusion,” which is not standard terminology; in practice this would be a blood transfusion and/or iron supplementation as prescribed).
  • Nursing care includes addressing pain, mobilization, and preventing complications such as pressure injuries and blood clots.

Cold/Hot pack orders and nursing cautions

  • Any order for cold or hot packs must specify the exact parameters:
    • duration and intensity of the therapy (how long to leave it on or off),
    • number of days the therapy should be used,
    • how long the pack stays on the skin (on time) and how long it is off between cycles (off time),
    • and how many times per day the therapy should be applied.
  • If orders are incomplete, there is a risk of skin damage from too long exposure or insufficient blood flow management.
  • Use the prescribed protocol to avoid skin damage from cold/heat therapy, which can affect underlying vessels and tissue.

Nutrition, healing, and pressure injury prevention

  • After hip fracture, nutrition is important for bone healing, especially in older adults, who heal more slowly.
  • Emphasize adequate intake to support bone repair and overall recovery; malnutrition can hinder healing and increase infection risk.
  • Encourage turning and repositioning to prevent pressure ulcers and promote circulation, particularly during recovery and if immobilized.
  • Adequate protein, calcium, vitamin D, and overall calories support bone healing; assess appetite and nutritional needs.

Blood loss, drainage, and wound management

  • Postoperative patients may have surgical drains to remove blood and fluid from the operative site.
  • The drainage system typically includes a drain line connected to a collection container; the nurse may monitor drainage amount and character.
  • The drain setup often involves a suction mechanism to assist drainage; containers and connectors may require careful handling (e.g., ensuring connections are secure and the cup is accessible for emptying).
  • The wound drainage system helps prevent accumulation of blood and fluid, which could impede healing.

Limb assessment, measurement, and edema control

  • Calf and leg measurements may be performed to monitor edema and to guide treatment; measurements vary by whether the fracture is above the hip or at the knee.
  • Follow the manufacturer’s guidelines or protocol on measurement technique and sizing (e.g., for devices such as stockings or wraps) to ensure proper fit.
  • Elastic stockings (compression devices) help prevent edema and blood clots by promoting venous return; improper fit (too loose or too tight) can undermine effectiveness and cause complications such as swelling or restricted blood flow.
  • If stockings are too tight, they can impede circulation; if too loose, they won’t prevent edema or clots.

Traction, prosthesis care, and mobility

  • In some cases, traction may be used to gradually align the bone and prevent further shortening until healing occurs.
  • Postoperative hip care requires keeping the hip straight during certain stages; bending the hip too soon may risk compromising the prosthesis or traction.
  • When removing or adjusting devices, teach the patient how to bend carefully only when appropriate and to slide the leg into position safely.
  • Early mobilization is encouraged to prevent complications of bed rest (e.g., pneumonia, DVT, muscle atrophy) and to promote circulation; encourage ambulation as tolerated.

Activities of daily living (ADLs) and assistive positioning

  • Assist patients from the unaffected or stronger side when helping with transfers or ADLs, because the affected leg may be unable to bear weight or may be restricted.
  • Avoid forcing weight or pressure on the affected leg to prevent injury or pain.
  • Monitor for numbness or neuropathic symptoms around the hip area, as nerves pass through that region and could be affected by injury or surgery.
  • Address numbness or tingling promptly as they may indicate nerve involvement or complications.

Pain management and patient education

  • Do not ignore pain: if pain begins, initiate pain control measures rather than hoping it will dissipate.
  • If pain is left unmanaged, it can worsen and hinder recovery.
  • Educate the patient to take prescribed pain medications as needed to maintain comfort and enable participation in rehabilitation.

Implications, safety considerations, and practical guidance

  • The patient’s recovery depends on careful assessment, adherence to orders (e.g., cold/hot therapy duration), and timely mobilization.
  • Improper handling or lack of adherence to protocols can lead to complications such as skin damage, delayed healing, edema, blood clots, or prosthesis issues.
  • Maintain clear communication with the healthcare team (nurses, physicians, therapists) to ensure orders are complete and followed.

Quick reference reminders (practical nurses and students)

  • Do not move the legs if hip fracture is suspected; immobilize and call for urgent transport.
  • When managing drains: know the setup, how to measure drainage, and how to empty/record values.
  • Check stockings for fit and skin condition; ensure proper application to prevent edema and DVT.
  • Always document signs, patient reports, and care interventions to guide ongoing treatment and prevent complications.

4 ext{ hours} on and 4 ext{ hours} off scheduling (example format for on/off cycles in therapy orders)
n{ ext{days}} days for a therapy course f{ ext{per day}} times per day for application

  • Note: Use exact values from the patient’s orders when available; the transcript examples illustrate the types of details required for therapy orders.