HS2261/HS2232 Adult Nursing: Hip Fracture Case Study and Care Plan
Case Scenario:
Mona, aged 65, slipped and fell at home. She is unable to bear weight on the left lower limb. She reports severe pain localized to the left hip. Radiographic imaging confirmed a fractured left femoral neck, and she is scheduled for a left hemiarthroplasty.
Physical Examination:
General appearance: Alert, conscious, appears distressed due to pain
Extremities: Both lower limbs warmth to touch. Distal pulses present and strong over bilateral lower limbs.
Musculoskeletal: Mild swelling, tenderness, and ecchymosis noted over the left hip region. Severely restricted and painful passive range of motion of the left hip, especially in internal rotation. Height: 159cm
Weight: 90kg
Vital Signs:
Temperature:37.7°C
Pulse Rate: 92 beats/ min
Respiratory Rate:23 breaths/min
Blood Pressure: 154/93 mmHg
SpO₂: 96% on room air
Pain Score: 8/10
Past medical history: Osteoporosis, Diabetes, and Hyperlipidaemia
Past surgical history: Nil
Social History: Mona is a widowed with no children and is staying alone.
Current Medication:
| P.O Arcoxia 90 mg OM | P.O Lovastatin 20 mg ON |
| P.O Omeprazole 20 mg BD | P.O Calcium Carbonate 625 mg ON |
| P.O Metformin 250 mg BD | P.O. Colecalciferol 1,000-unit OM -3 times per week |
| Laboratory Results: | |||
| FBC | Reference Range | Biochemistry | Reference Range |
| WBC: 8.2 x 109/L | 4.0 – 10.0 x 109/L | Sodium: 138 mmol/L | 135-145 mmol/L |
| RBC: 3.0 x 1012/L | 3.6 – 4.9 x 1012/L | Potassium: 4.2 mmol/L | 3.5 – 5.1 mmol/L |
| HB: 10.5 g/dL | 11.5 – 15.0 g/dL | Chloride: 97 mmol/L | 95-110 mmol/L |
| PLT: 250 x 109/L | 150 – 400 x 109/L | Urea: 6.5 mmol/L | 2.8 – 7.6 mmol/L |
| Other results | Reference Range | Creatinine: 95 µmol/L | 50 – 90 µmol/L |
| HbA1c: 7.8% | < 6.4% | Venous glucose: 5.0 mmol/L | 4.0 – 7.0 mmol/L |
| Albumin: 38 g/L | 40 – 51 g/L | Calcium: 2.0 mmol/L | 2.2 – 2.7 mmol/L |
| Vit D: 18 ng/mL | ≥ 30 ng/mL | Phosphate: 1.45 mmol/L | 1.12 – 1.45 mmol/L |
Questions:
- Define neck of the femur fracture and list the clinical manifestations of hip fracture.
- List the possible risk factors of hip fracture for Mona.
- Describe hemiarthroplasty.
- Discuss the post-operative care for Mona.
- Plan a health education and discharge plan for Mona.