A Forensic Nursing Student Discusses Hip Fracture Surgery

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As I currently instruct an online Forensic Nursing Certification Course, I am often told stories about how my students have experienced different facets of their professional lives. This is one of them:

Hip Fracture Surgery

I live and work in an area where there is a growing population of elderly people. In the community hospital where I work, as an operating room nurse, one of the services that we do the most surgery with is orthopedics.

We do many hip fractures in our operating room, more in the winter than in the summer for obvious reasons. People who experience a hip facture can have many causes for weakened bone. The most prevalent reason is low bone density, one because of the age of the client and as is documented in many books inactivity. When talking with one of the orthopedic surgeons in our hospital he states that inactivity is the main reason for the elderly to have low bone density, related to the long winters we have here. The most common fracture of the hip is the femoral neck fracture that we see.

Doing surgery to repair the fracture requires an open reduction with compressions screws. The most important aspect of surgery that the nurse needs to think about with is blood loss. When ever there is surgery involving the hip, as opposed to the knees where a upper leg tourniquet is used which reduces blood loss, there is usually a large blood loss secondary to cutting in to the bone.

When surgery is performed on the elderly many can not afford to have a large blood loss. When a client has a large loss of blood that delays them post operatively in healing and rehabilitating.

Postoperatively the patient is always put on a blood thinner usually coumadin to prevent blood clots, and if not contraindicated, antiembolotic stockings (Ted’s) and compressions stockings. The major concern for the nurse taking care of the post-op is monitoring the patient for signs and symptoms of deep vein thrombosis which can lead to pulmonary embolus and then death, if not monitored closely.

This is one of the common causes of mortality in clients with hip fractures. The signs and symptoms of pulmonary embolus will depend on the location of the thrombus. The most common signs are chest pain, dyspnea, and tachycardia. It is very important for the nurse to monitor the client for DVT’s.

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