Question

Mrs. Lydia Martin, an 88-year-old widow, lives alone in her single-story home. She prides herself in being fully independent. During the middle of the night, Mrs. Martin fell in her home while walking to the bathroom. She was unable to get up, so she crawled to the telephone and dialed 911. She was transported to the emergency department and underwent diagnostic tests including hip and femur x-ray and computerized tomography, which confirmed a left femoral neck fracture. Her past medical history reveals anxiety, osteoporosis, arthritis, and cataracts.

Mrs. Martin underwent an open reduction internal fixation (ORIF) surgical procedure. Following surgery, she had a compression dressing with ice to the left hip, a Foley catheter, antiembolism stockings, a sequential compression device, and an order to use the incentive spirometer every hour while awake. Her medications included hydrocodone bitartrate 7.5 mg/acetaminophen 750 mg (Vicodin ES) 2 tabs q4h prn pain po and enoxaparin (Lovenox) 40 mg daily subcutaneously.

On post-op day 1, the physical therapist began to work with Mrs. Martin; the goal of the session was to get her out of bed to a chair. During the attempted transfer, Mrs. Martin's surgical site was painful and her Foley catheter was pulled, causing pelvic pain. She screamed in pain and refused to continue the process. Mrs. Martin was anxious and fearful of pain; she also became worried that she would never walk again and would end up in a nursing home. She was unwilling to move and declined physical therapy the next 3 days. Mrs. Martin became constipated and lost her appetite. She also developed a stage 2 pressure ulcer over her sacrum. Eventually, on post-op day 4 Mrs. Martin agreed to work with the physical therapist. By this time she experienced significant weakness and fatigue and was unable to move independently. Mrs. Martin was later transferred to a rehabilitation center to continue regaining her mobility.

Case Analysis

This case exemplifies the concept of mobility in many ways. Mrs. Martin's age and injury were significant risk factors for a fall and hip fracture. Following surgery, she was immobile for several days because of pain and experienced several consequences of immobility, including constipation, loss of appetite, poor nutrition, and impaired skin integrity. Mrs. Martin's fear of not being able to return home is substantiated in the literature; it is estimated that up to 25% of older adults who lived independently before a hip fracture spend up to 1 year in a nursing facility to recover and 20% die within 1 year.

Question #1

Which category of immobility is the basis of Mrs. Martin’s problem?

Question #2

If you were Mrs. Martin’s nurse, what are some other potential consequences of immobility for which you would need to be alert?

Answer 1

Answer 1

She is in orthopedic immobility after undergoing an open reduction internal fixation surgery for her hip fracture which is the basis of the problem.

Answer 2

The other potential complications which can be expected in this case are

• A very high chance renal system alteration like retention of urine, infection because of it .This will lead to urinary incontinence after the Foley's catheter is removed for the patient because of poor control of bladder muscles and formation of stones in the kidneys
• Risk for musculoskeletal problems like weakness,contracture, aggravation of osteoporosis due to lack of proper intake which can affect the bone functions to heal
• Respiratory infections are very common due to immobility causing pneumonia in post operative oldage patient
• Loss of mental strength or poor coping mechanism due to prolonged immobility
• Cardiovascular issues like hypotension especially orthostatic hypotension