llefebvre01-
what is a hip fracture?
break in upper quarter of femur bone
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what does type of surgery for hip fracture depend on?
bone quality, affected soft tissue, level of fracture
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what is most common cause of fractures in elderly?
falls
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what are most common fractures?
hip, femur, pelvic, tibia/fibula, anke, wrist/arm, vertebral
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what are fall risks?
osteoporosis
falls
poor vision
decreased or limited mobility
home environment
gait
dizzy
postural hypertension
psychotropic meds
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what is osteoporosis?
a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes.
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where do fractures most often occur? what time of year?
at home
summer - they go out more
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what is the hip fracture trajectory for someone admitted from home?
admitted from home -> pre op -> health assessment, social support -> post op
IF patient alert -> return home/discharged to rehab
IF post op delirium -> monitor 2-3 days -> resolves -> return home/discharged to rehab
IF post op delirium -> monitor 2-3 days -> unresolved -> geriatric + social work consult -> send pre-vis to CLSC signalling complex discharge -> disposition meeting -> LTC
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what is the hip fracture trajectory for someone admitted from CHSLD?
admitted -> pre op -> transferred back once stable
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what is pre-op care of hip fracture patient?
overall health/past medical history
cognitive status
risk for surgery
pain
risk for delirium
social situation
skin integument
nutrition
discharge planning
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when is it best to do surgery?
within 24-48 hrs
incidence of post op complications increases the longer the wait time
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what are 4 ways to do surgery on hip fracture?
intramedullary nail
cannulated screws
compression screws
hemiarthroplasty
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what is post-op care of hip fracture patient?
LOS (length of stay)
ABC
cognitive status
pain
incision
comorbidities
skin integument
elimination
VTE prevention
nutrition
fall prevention
post-op delirium
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what is post op delirium?
acute state of confusion characterized by inattention, abnormal levels of consciousness, thought disorganization
commonly affects elderly following surgery
caused by direct physical consequence of a medical condition which has caused change to their normal homeostasis + bodily function
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what is difference between delirium and dementia?
very similar
delirium is reversible condition
dementia takes longer to develop + is degenerative disease process
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what are signs and symptoms of delirium?
reduced awareness of environment
decreased ability to focus
easily distracted
not oriented in time place person
changes in memory
language disturbance
disorientation
hallucinations
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what are delirium triggers?
fluid/electrolyte imbalances
dehydration
hypercarbia
acid-base disturbance
meds
unrelieved pain
blood loss
decreased CO
heart failure
MI
unfamiliar surroundings
emergency surgery
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how to manage delirium?
need to identify cause of delirium and treat it
state of confusion can be an early indicator of underlying problem
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what are delirium strategies?
assess fall risk
not restrain, explore other options
close monitoring
keep patient close
assess environment
orient time and place
uninterrupted night sleep
med management
involve family
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what are delirium outcomes?
varies
usually resolves within 2 days
⅓ patients will have symptoms until discharge
50% will continue to show signs 1 month after surgery
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what are roles in discharge planning?
PT: assess mobility, motor + gait function, potential for rehab
OT: assess functional status, ability to return home, home evaluation
social worker: assess social support, patient ability to cope mentally + physically
discharge nurse: coordinate discharge destination
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what are outcomes of hip fractures?
affects mostly women
¼ die in first year
25-75% do not regain previous level of autonomy + cannot return home
many need relocation into LTC
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how to prevent hip fractures?
vit K + calcium
regular bone density screening
home safety evaluation
regular exercise
walking aids
