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.