Question

An 87 year old female is admitted to the hospital with a diagnosis of a hip fracture secondary to a fall in her home.

What would be three nursing management considerations post-surgical repair?  
What would your peripheral neurovascular assessment of the lower extremity include?

Are there any positioning considerations, if so what are they?

Answer 1

As a surgery, the primary objectives will be the management of pain, prevention of infection and other postoperative complication such as deep vein thrombosis, pressure ulcer etc. We need to consider the age of the patient also for proper care and management. we should mobilize the patient as early as possible to prevent complications such as deep vein thrombosis. It is important to prevent delirium by proper pain management as well as prevention of urinary tract infection by catheterization.

Neurovascular assessment includes assessment of pain and sensation. It will be alarming if the patient experiences tingling, numbness or loss of sensation on their affected lower extremity. Capillary refilling must be assessed to make sure proper blood flow to the extremities. We should always make sure that both extremities are in same color and temperature. Also, need to check for normal peripheral pulsation on the affected extremity and presence of any swelling. If swelling presents, need to elevate the lower extremity.

Need to mobilize as early as possible after surgery to prevent further complications. But we need to take care of the position while sleeping or resting. Do not stress the surgery site while sleeping. It is important to avoid turning or cross the operated thigh. Always use pillows or cushin to support affected extremity. The sleeping position must be comfortable for the affecte hip.