Running head: TRAUMATIC HIP FRACTURE

Diana Millan
Traumatic Hip Fracture
Southwestern Oregon Community College
12/05/13

Traumatic Hip Fracture

Eighty-nine year old female was admitted to Baycrest on 11/26/13 for aftercare
following a fracture of her left hip, better known as a left femoral neck fracture. According to the
report from Bay Area Hospital, the patient had been sleeping when she was startled by the sound
of her washing machine. She ran to turn it off, tripped, and fell on her left side. Her fall required
surgery which she initially refused and stated she wanted to die. The doctor was able to convince
her of undergoing surgery, assuring her that the severe pain from the fracture would subside. She
lives alone and denies any tobacco or alcohol use. She believes she has lived a wonderful life
which is now coming to an end and she does not want to go through pain and discomfort
associated with a hip fracture.
Diagnosis at a Cellular Level
Hip fractures are a common injury among older adults. These fractures are classified as
intracapsular or extracapsular which are further divided depending on the location of the fracture.

TRAUMATIC HIP FRACTURE

In this case, it is a femoral neck fracture. A fracture in that area may lead to interruption of blood
supply to the femoral head which may then lead to ischemic or avascular necrosis. This causes
death of the bone tissue, causing pain and limited mobility (Ignatavicius & Workman, 2013).
Fracture healing may be direct, where no callus formation occurs and surgery is used to repair
the bone, or indirect in which there is callus formation leading to remodeling of the bone.
Treatment for this patient involved open reduction surgery. In this procedure, fragments are
aligned and a form of prosthesis is used to maintain the reduction (Huether & McCance, 2012).
Primary and Secondary Diagnosis Interrelations
Osteoporosis is a secondary diagnoses for this patient which may be related to her
recent fracture. Even though it was caused by a fall, osteoporosis increases the risk for femoral
neck fractures (Ignatavicius & Workman, 2013). Week bones from osteoporosis lead to falls in
the older adult which may not occur so easily in a young adult. As mentioned, a hip fracture will
most likely lead to impaired mobility. If the patient is in a lot of pain, she may not want to go
through physical therapy. No exercise, even if it is just walking, may lead to, or increase her
generalized muscle weakness. Aside from having osteoporosis, this patient also has
osteoarthrosis, the deterioration and loss of cartilage in one or more joints (Ignatavicius &
Workman, 2013). Both diseases cause pain and limited mobility, thus adding to the discomfort of
a hip fracture. Though it is unspecified whether or not her osteoarthrosis and osteoporosis is
generalized or localized, it may be related to cervicalgia, a co-morbidity of the patient.
Compression of spinal nerve roots caused by osteoarthritis results in pain, stiffness and muscle
spasms in the extremities (Ignatavicius & Workman, 2013). Also, this patient is anemic which
may be related to a slower healing process of a fracture or generalized weakness and difficulty
walking (Huether & McCance, 2012).
Besides the physical effects of ostearthrosis, osteoporosis, and fractures, there may also
be emotional effect. If someone has constant pain and is limited when it comes to mobility, it

TRAUMATIC HIP FRACTURE

may lead to a sense of hopelessness. This patient lived alone before being admitted to Baycrest.
All of a sudden she is undergoing surgery and living in an unfamiliar place. This may lead to
worsening anxiety or depression. In fact, according to the hospital, the patient stated that she did
not want to live due to the pain and immobility that the patient expected from the fracture.
Medications and Labs
Calcium and vitamin D supplements are being taken to help with the healing of a hip
fracture. Both of these medications may cause constipation along with the decreased intestinal
motility of the older adult. Constipation may not be a problem in this patient considering she is
taking four different medications for constipation.
The patients level of consciousness should be monitored since some of her medications
such as alprazolam, cetirizine HCl, and chlorpheniramine-DM may cause drowsiness and
sedation. Also, medications such as anticonvulsants and antidepressants may cause changes in
mental status or behavior changes. The patient may have suicidal thoughts as a side effect of
those medications and therefore should be monitored continuously. As for the labs, the patients
hematocrit and hemoglobin are low which may be related to a blood loss from the hip fracture,
resulting in a decrease in the number of red blood cells. Another cause may be anemia, also
resulting in a decreased number of red blood cells (Corbett & Banks, 2013).

References

TRAUMATIC HIP FRACTURE

Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (5th ed.). St. Louis,
Mo.: Mosby/Elsevier.
Ignatavicius, D. D., & Workman, M. L. (2013). Medical-surgical nursing: patient-centered
collaborative care (7th ed.). St. Louis, Mo.: Saunders/Elsevier.
Corbett, J. V., & Banks, A. D. (2013). Laboratory tests and diagnostic procedures: With nursing
diagnoses (pp. 183). New Jersey: Pearson.