Chapter 31: Care of the Adult with a Musculoskeletal Condition

Mrs Sally Thompson is 87 years old and has been admitted with a fractured right neck of femur. Sally lives alone and has a history of osteoporosis. She fell whilst out shopping and was brought to A&E by ambulance. On arrival Sally is in severe pain and her right leg is shortened and externally rotated.

Question

  • Describe the care Sally would need during her admission.

Answer

Sally would need to follow an evidence-based care pathway specifically for fractured neck of femur:

  • Initial assessment including ABCDE, vital signs, details of event, past medical history, medications, allergies, skin integrity, nutrition, hydration, elimination and home situation.
  • Consider other injuries, collapse vs fall
  • Pain assessment and management
  • Investigations: hip x-ray, chest x-ray, ECG, blood tests
  • IV fluids
  • Early involvement of MDT
  • Early surgical intervention (on the day of or day after admission)
  • Effective post-operative care is focused on two main aims:
    • The prevention and recognition of complications
    • Supporting the patient in regaining mobility through rehabilitation
  • Early discharge planning.