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

ByJamez

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:

  1. Define neck of the femur fracture and list the clinical manifestations of hip fracture.
  2. List the possible risk factors of hip fracture for Mona.
  3. Describe hemiarthroplasty.
  4. Discuss the post-operative care for Mona.
  5. Plan a health education and discharge plan for Mona.

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