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Exemplar 13.3: Hip Fractures

Description

The patient that I use in here a decent amount is an elderly, white female with osteoporosis. I have named her Ella. You start out by giving her family instruction about how to prevent hip fractures. When they do not listen to your instruction (as patients and their families will often do), Ella falls and breaks her hip. You give Ella instruction on her potential treatment options, then you provide her pre-op and post-op care and discharge instruction.
Olivia McRitchie
Quiz by Olivia McRitchie, updated more than 1 year ago
Olivia McRitchie
Created by Olivia McRitchie over 6 years ago
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Resource summary

Question 1

Question
Which of the following statements about hip fractures is FALSE?
Answer
  • The 2 types of fractures are intracapsular (at the head or neck of the femur) and extracapsular (within the trochanter region).
  • In addition to the 2 types of fractures, there are also intertrochanteric fractures (between neck and trochanter) and subtrochanteric fractures (immediately below lesser trochanter)
  • In children, hip fractures also include pelvic bones.
  • The most common site for fractures is the subtrochanteric area
  • Fractures to the neck are especially dangerous because the fracture often cuts of blood supply to the head and neck of the femur, causing avascular necrosis (osteonecrosis)
  • Extracapsular hip fractures are less likely to develop avascular necrosis

Question 2

Question
Select the patients that exhibit a risk factor for hip fractures.
Answer
  • An 86 year old male patient who doesn't smoke or drink, exercises fairly regularly, and has a balanced diet.
  • A 65 year old African American female with osteoporosis.
  • A 40 year old Asian male with hyperparathyroidism
  • A 25 year old white female with anorexia nervosa
  • A 45 year old male that's slightly overweight, but otherwise healthy.
  • A 50 year old immobile male that doesn't drink or smoke.

Question 3

Question
You are speaking to the family of an older adult female that has osteoporosis, named Ella. The family knows that osteoporosis places Ella at risk of hip because they've heard "horror stories" from close friends. They don't know what to do to do help Ella, but they want to do something. Select the statements about preventing hip fractures that you can give to the family.
Answer
  • "Talk to a physical therapist about creating a safe exercise plan."
  • "Remove the throw rugs from the floor in her house."
  • "Next time you're getting her medication, ask the pharmacist if her medications can make her dizzy."
  • "Have her drink and eat things like dairy products, fish, and fortified orange juice."
  • "Have her eat more things like peanuts and chicken."

Question 4

Question
Unfortunately, Ella's family did not heed your warnings. Ella has fallen and suffered a hip fracture. Which of the following is NOT a potential complication of a hip fracture? (Look at the quiz description if you need information about Ella).
Answer
  • Deep vein thrombosis
  • Pressure ulcers
  • Urinary tract infection
  • Pneumonia
  • Muscle atrophy
  • Loss of independence for approx 1 year
  • Cellulitis

Question 5

Question
Women are more likely to die from hip fracture complications than men are.
Answer
  • True
  • False

Question 6

Question
You have a moment to talk to Ella about her hip fracture. Ella is very scared (as well as in pain) because she doesn't know what they're going to do to treat her hip fracture. She asks you to explain, to the best of your ability, all of her potential treatment options and what complications she could face. At this point the doctors have taken X-rays, but you do not know the location of the hip fracture yet. Select the statements you can give to Ella. (See quiz description for information about Ella).
Answer
  • "You may have to have surgery to repair the fracture."
  • "If you undergo surgery, we will likely have you on bed rest while you heal."
  • "If you need surgery, you'll either have pins placed to hold the bone together, or you'll have your hip replaced."
  • "If you have your hip replaced, you may need a revision surgery in about 5 years."
  • "Aside from surgery, the only thing we can do is put you in a cast."
  • "We will try to prevent complications by giving you special stockings and having you exercise and participate in respiratory exercises."

Question 7

Question
Which of the following is NOT included in the pre-op assessment of a patient with a fractured hip?
Answer
  • Vital signs (including pain)
  • Looking for shortening and external rotation of injured hip
  • Assessing mobility status.
  • Assessment for hematoma, inflammation, and swelling.
  • Cognitive function
  • The 5 P's of neurovascular assessment
  • An account of the event that caused the fracture.
  • History of disorders that affect strength, mobility, balance, and coordinatio.
  • Assess skin integrity over fractured hip.
  • Oxygenation status

Question 8

Question
You discover that Ella will be undergoing a total hip replacement. Before you have her sign the consent form for the surgery, you want to confirm that she understands what procedure she's getting and what the potential complications from it are. Select the incorrect statement made by the patient. (See quiz description for info about Ella).
Answer
  • "The procedure I'm undergoing in called a hemiarthroplasty."
  • "Both the ball and the socket of my hip are being replaced with a prosthesis."
  • "Dislocation of the prosthesis could occur if I sit in the wrong position."
  • "An infection could develop."
  • "There could be delays with healing."
  • "I may need a revision surgery in 10 years, which carries a greater risk than the original surgery,"

Question 9

Question
Ella is now out of her arthroplasty. There were no complications; she is in a splint for her post-op recovery. Ambulation is not contraindicated. Select all of the appropriate interventions for her post-operative care, (See quiz description for information about Ella).
Answer
  • Tell Ella that crossing her legs are okay, but she cannot lift her knee on her surgery side higher than her hip,
  • Perform passive range of motion exercises on the arms and the non-affected leg.
  • Help Ella ambulate, first around her room for as long as tolerated, then around the unit for as long as tolerated.
  • Assess the visible parts of the leg for redness, warmth, and swelling.
  • Perform respiratory exercises to maintain lung function
  • Talk to Ella and her family about getting Ella around the clock care at home.

Question 10

Question
It's time for Ella to be released from the hospital. They have decided to have her move in to a house within walking distance of them, with a home health care worker (not a nurse, but a CNA) there during the day but not during the night. You have given them discharge instructions, both verbally and on paper, and are now assessing that they understand. Which of the following statements made by the family indicates that more thorough teaching is needed? (See quiz description for info about Ella)
Answer
  • "The only thing she needs to do when she goes to sleep is not lay on the operative side."
  • "We will get a higher toilet seat for mom [Ella]."
  • "We will make sure we follow the weight-bearing restrictions prescribed by the doctor to avoid a potential hip dislocation."
  • "We will be sure we give her 1/2 of a tablet of ibuprofen 800 when she needs it, but we will not give it any less than 4 hours after the previous dose."
  • "We will be sure to give the home health care CNA a copy of these written instructions."
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