A complete case presentation on hip fracture.

A complete case presentation on hip fracture by maintaining all probable nursing process for all nursing students.

1. Limbs are a very special part of our body and help us every time and every moment. They are
formed with cells, tissues etc, and their blood supply& nerve supply are present. When the
blood& nerve supply are disrupted, they cannot work properly. After that, when individual
faced accident they lose their bony alignment, structure &function, blood circulation and
needed immediate medical and surgical intervention for early recovery and rehabilitation.
I am the 2
nd
year M.Sc. nursing student at the Department of Rehabilitation Nursing
(Academy) of the National Institute for Locomotor Disability, when I was posted at the
R.G.KAR MCH that time I got a client Mrs. Anoyara Bibi, 67 years old with Right neck of
femur fracture was admitted in this hospital for immediate and better management.
Identification data
Name: Anoyara Bibi
Age: 67 years
Sex: Female
Bed no.: T- 23
Date of admission: 20/09/2022
Under doctor: Unit II
Address: c/o Sk. Monsun, vill+p.o- Dhankhali, P.S- Khidirpur, Dist- 24pgs (S)
Religion: Muslim.
Diagnosis: Fracture of Neck Femur (Right)
Chief complaint:
On admission: Pain and tenderness of right hip joint, difficulty in standing on the right leg.
There is swelling and deformity at the right hip joint.
At present: The patient had accidental fall from motor cycle due to RTA on 20/09/2022 and
sustained injury to his right hip joint resulting in pain tenderness, swelling and deformity. He
also has difficulty in standing on his right leg.
Past medical history: She was suffered type Diabetic mellitus from 11 years.
Surgical history:
Past surgical history: nothing significant.
Present surgical history: ORIF right hip on 22/09/22

2. Family history:
NAME RELATION AGE/SEX HEALTH STATUS
Sk. Monsun Husband 72years/M Healthy
Sk. Farid Son 45 years/M Healthy

Socio economic history:
Water supply:
Drinking water- deep tube well.
House hold water: deep tube well.
Ventilation: well ventilated.
Sanitation: sanitary system present.
Housing condition: pacca house.
Monthly income: 8000/-

Physical examination:
CENTRAL NERVOUS SYSTEM
 Emotional state
(Anxious/calm/angry/cooperative/fearful/restless/Withdrawn)

Cooperative
 Level of consciousness
(Alert/Drowsy /Confused/Semiconscious/Comatose)

Alert
Oriented to
Time:

Present
Place: Present
Person: Present
 Speech
(Relevant/Irrelevant/Slurred/Aphasia)
Relevant
Any Hemiplegia/paraplegia/Quadriplegia NA
 Coordination and Reflexes
(Assessment for GCS score)
15/15
 Pupillary Reaction
Equal/Unequal/Reactive/Nonreactive
Equal
HEAD
(Shape/Size)
Normal
SCALP
(Clean/Dandruff/Pediculi)
Clean
FACE
(Symmetry /Asymmetry/Any congenital abnormality)
Symmetry
SINUSES Frontal Normal

3. Maxillary Normal
Ethmoid Normal
Sphenoid Normal
EYES
 Vision
(Normal/Any abnormality)

Normal
 Conjunctiva
(Normal/Purulent/Redness)
Normal
 Sclera
(Normal/Pallor/Icterus)
Pallor
Any Abnormality
(Itching /Lacrimation/Discharge)

Not applicable
EAR
 Hearing
(Normal/Any problem)

Normal
 Condition
(Clean/discharge)

Clean
NOSE
 Sense of smell
(Good/Weak)
Good
 Septum
(Normal/Deviate)
Normal
 Nasal polyp
(present/Absent)
Absent
 Any Discharge
(present/Absent)
Absent
MOUTH
 General condition
(Clean/Sores/Halitosis)
Clean
 Teeth
(Clean/Stent/Plaque/Loose/Caries/Denture)
Clean
 Tongue
(Clean/Coated)
Clean
 Gum
(Healthy /Bleeding)
Healthy
 Lip
(Normal/Dry /Any abnormality)
Dry
 Gag Reflex
(Present/Absent)
Present
 Oral Ulcer
(Present/Absent)
Absent
NECK
 Range of motion
(Flexion/Extension/Hyperextension/Lateral extension)
All range of motion
present
 Thyroid
(Normal/Enlarged)
Normal
 Lymph Node
(Normal/Palpable)
Normal

4. RESPIRATORY SYSTEM
 Chest Movement
(Unilateral/Bilateral/Absent)
Bilateral
 Respiratory Pattern
(Normal/Dyspnea/Orthopnea/Paroxysmal/Nocturnal dyspnea)
Normal
 Air Entry
(Bilaterally Equal/Diminished-specify R /L lung)
Bilaterally Equal
 Breath Sound
(Normal/Rales/Ronchi/Wheeze)
Normal
 Shape of the chest
(normal/Any abnormality)
Normal
 Oxygen on Flow lit/min Not present
 Cough
(Present/Absent)
Slightly present
 Chest Drains
(Left Plural/Right Plural/Mediastinal)
Not present
 Fluid column functioning
(Present/Absent)
Not applicable
CARDIOVASCULAR SYSTEM
 Heart Rate
(Normal/ Tachyarrhythmia/Bradycardia)
Normal(70beats/min)
 Heart Sound
S1
S2
S3
Murmur (Systolic/Diastolic/Any other click sound)

Present
Present
Not Present
Not Present
 Chest Pain
(Present/Absent)
Absent
 Neck Vain Distension
(Present/Absent)
Absent
 Peripheral Pulses
(Present/Feeble/Absent)
Radial Present
Brachial Present
Popliteal Present
Post tibial Present
Dorsalis pedis Present
 Pacemaker
(Permanent/Temporary/Pacing wire)
Not present
GASTRO-IN TESTINAL SYSTEM
 Peristalsis
(Present / Absent /Diminished)


Present
 Nausea
(Present /Absent)
Present
 Nutritional Route
(Oral / Tube feeding /Parenteral)
Oral
 NPM
(Yes / No)
No
 Abdominal Distension
(Present /Absent) AG in cms

Absent

5.  Vomiting
(Present /Absent) Specify no of times

Absent
 Bowel Opened
(Yes / No)

Yes
 Constipation
(Present /Absent)

Absent
 Diarrhoea
(Present /Absent)

Absent
 Malena
(Present /Absent)

Absent
GENITO-URINARY SYSTEM
 Pattern of Void
(Voids freely / Catheter)

Voids freely
 Urine Colour
(Normal / Straw / Dark / Yellowish )
Normal
 Sediment
(Present /Absent)

Absent
 Any Abnormality
(Retention / Incontinence/Not Applicable)

Not Applicable
EXTREMETITES (UPPER EXTREMETY)
 Joint Movement
(Freely movable / Restricted)

Freely movable
 Tremor
(Present /Absent)

Absent
 Shape of nail
(Normal / Clubbing/ Spoon Shape)

Normal
 Colour of finger
(Normal /Cyanosed)

Normal
 Strength of Extremity
(Equal / Unequal)

Equal
EXTREMETITES (LOWER EXTREMETY)
 Pitting Oedema
(Present /Absent)

Absent
 Varicose Vein
(Present /Absent)
Absent
BACK
 Spinal Curvature
(Normal / Scoliosis/ Kyphosis)

Normal
 Back Skin
(Intact / Breakdown / Rash / Blister / Infection)

Intact
NUTRITIONAL STATUS
 Appetite
(Good / Fair / Poor)

Poor due to surgery
 Dietary Pattern
(Veg/ Non Veg)
Non-Veg
MOBILISATION
(Ambulant / Bed to Chair or toilet/ Bed-ridden)

Bed-ridden
SPECIAL DEVICES USED

6. (Spectacle / Walker / Crutches / Hearing aids) Not used
SLEEP
(Adequate / Disturbed)
Disturbed
INVASIVE LINE
Site:
Condition:
Present
Lt hand
Patent
INCISIONAL WOUND Healthy
 Oozing
(Absent / Sanguineous / Sero-Sanguineous / Serous)
Not present
 Gaping Not present
 Dressing Present

Pain Scale Score (On a scale of 0-10):6
Introduction:
Injuries to the hip are one of the most catastrophic events in the life of both the patient and
the treating orthopaedic surgeons. Being the biggest weight bearing joint of the body there
may be lots of complications. Great clinical effort is required to put the house in order as far
as hip joint is concerned.
Definition:
Neck of femur fracture is the breach in the continuity of the bone in the region between head
of femur and the upper (greater) trochanter, due to stress on the region which is more than the
amount of stress that the region of the bone can bear.
Anatomy and physiology:

7. The femur is the largest hammiest bone of the body. The head is almost spherical and fits
into the acetabulum of the hip bone to form the hip joint. The neck extends outwards and
slightly downwards from the head to the shaft and most of it is within the capsule of the hip
joint. The posterior surface of the lower thirds forms a flat triangular are called the popliteal
surface. The distal extremity has two articular condyles which with the tibia and patella form
the knee joint. The blood supply of this bone is by femoral artery and drainage by femoral
vein and nerve supply is by femoral nerve, latent cutaneous nerve of thigh, obdurate nerve.
Classification:
According to book
Board classification

 Intracapsular -from sub capital area to the middle of the neck;

8.  Extracapsular-from base of the neck to the per trochanteric region.
Garden’s classification:
This is the most accepted classification and is based on the pattern of fracture line and the
displacement of the fracture:


 Incomplete fracture.

9.  Complete fracture but undisplaced.

 Complete fracture with partial displacement.

 Complete fracture with total displacement.
Different classification for the fracture neck of femur:

10.  Impacted fractures.
 Undisplaced fractures.
 Displaced fractures.
Causatively in addition to fractures resulting from trauma without other complicating
conditions, there are
 Stress fractures.
 Pathological fractures.
 Post irradiation fractures
In my patient:
Traumatic undisplaced fracture,
Aetiology:
According to Book

In my patient.

1. Spontaneous (pathogenic):-

 Due to cancer: the bone there is weakness of the
bone due to which slightest of stress to the region
can cause fracture of the region.

 Due to infection: -bone material decreases due to
erosion of the bone and slight stress on the region
causes fracture of the bone of that region which
can be due to turning and twisting or near jerks of
the region.

 Osteoporosis: due to osteoporosis the bone
become spongy and weak as a result of which
slightest stress exerted on the region can cause
fracture of the region.

2. Accidental:
 RTA
 Fall for height.

3. Physical Assaults:
 Crushing force: if due to any reason a heavy
object falls on the region of the bone (neck of
femur) the bone get crust and there is fracture.

 Sudden twisting motions: - if due to region
example accidental or physical assault. The bone
of the region of neck of femur. Gets twisted that
can result to fracture of neck of the femur.
Road Traffic accident

11.  Bending force:-if due to any region example
accidental or physical assault. The bone of the
region of neck of femur gets bent that can result to
fracture of neck of the femur.
 Shearing force:-if due to any region if there is pull
or shearing force on the region of the neck of
femur which is more than the region can bear.
Then there occurs a fracture in that region.
Pathophysiology:
According to book In my Patient

Due to aetiology factors

Stress on a bone exceeds the ability of the
bone to absorb it

Disruption in the continuity of bone

Disruption of muscle and blood vessels
attached to the end of the bone

Soft tissue damage

Bleeding and haematoma forms in medullary
canal and surrounding bone tissue and
fractured site
The patients had a RTA and sustained injury
to his right hip resulting in fracture of the
neck of right femur

Swelling and tenderness of right hip joint

X-ray of right hip joint revels fracture neck
of femur and hematoma formation

Clinical Manifestations:
According to book In my patient

 Localized pain
 Discomfort
irritation,
restlessness
 Localized swelling
 Tenderness
 Weakness and
lethargy
 Loss of function

12.  Continuous pain occurs due to muscle spasm and direct
tissue trauma.
 Pain becomes severe with the movement of fractured
bone
 Discomfort, irritability and restlessness



 Localized swelling and discolouration of skin
 Tenderness over fracture site
 Weakness and lethargy
 Loss of function occurs at fractured extremity
 Numbness present due to nerve damage



 Limb shortening occurs during fracture of long bones as
overlapping fragments





 Oedema and ecchymosis as a result of trauma and

13. bleeding in to the adjacent tissues



 Hypovolemic shock occurs due to blood loss or with
other associated injuries

Investigations:
According to book In my patient

1. History taking
 About the cause of fracture
 Site where the pain is present
 Whether there is any loss of sensation
or not at the fracture site
2. Physical examination
Checking all the vital signs
Examine the site of fracture for redness,
swelling, tenderness etc.
Assess the pain score
3. X-ray studies
X-ray is taken in anterior, posterior and
lateral view prior to reduction and after
reduction and periodically during the healing
process
4. CT scan: CT scan also done to
confirm the diagnosis. It is non-
invasive diagnosis imaging procedure
that uses a combination of X-rays and
computer technology to produce
horizontal or axial images of the
body. A CT scan shows images of
different part of the body, muscle and
organs.
5. Blood biochemistry, CBC and
coagulation studies, serology, blood
grouping are done.

1. History is collected.
2. Physical examination.
3. X-ray shows fracture of neck of right
femur
4. Blood test-
 TC-6500
 Hb-10.5 gm/dl
 BT-2 min 30 sec
 CT-3 min 30 sec
 PT-12 sec
 Control-11 sec
 INR-1.10 sec
 Blood group-A+
 Serology-Nonreactive
 Na+-131mmol/l
 K+-4.3mmol/l
 R.B.C-4.38mil/ul

14. Medical Management:
According to book

In my patient
 Narcotics and analgesics are
administered to relief pain.
 Antibiotics are administered to
prevent infection
 anticoagulants are administered to
prevent deep vein thrombosis
 Stool softeners may be administered
to relieve constipation
 high protein diet ,calcium
supplementation etc. are given to
promote healing
 Bed rest initially
 Inj cefoperazone+sulbactum 1.5 gm
IV BD
 Inj Metrogyl 100 ml IV TDS
 Tab Limcee 500 mg 1 tab BD
 Inj T.T 0.5 ml IM stat

Surgical management:
According to book In my patient

1. Reduction: -



2. This is the preferred method of treatment in adults
and ORIF is chosen for those fractures which can
be made stable by closed and open reduction. The
choice of internal fixation with implants at
different levels of fracture is between interlocking
nail, Zeckel’s nail, gamma nail



 Closed reductions: in most instances, closed
The patient required open
reduction.
The procedure done-ORIF right
leg under general anaesthesia

15. reduction is accomplished by bringing the
fragment into apposition through manipulation
and manual traction



 Open reduction:-some fracture requires open
reduction through a surgical approach Open
reduction and internal fixation done, while,
metallic device like pin, screws, and plates. These
device hold the bone fragments in position until
solid bone healing occur. These devices can be
attached to side of bone. After general or spinal
anaesthesia, the hip fractures are reduced under
X-ray visualization using an image intensifier. A
stable fracture is usually fixed nails, a nail and
plate combination, multiple pins, compression
screw devices. Adequate reduction is important
for fracture healing. The better is reduction the
better the healing is.
3. Hemiarthroplasty(replacement of the head of the
femur with a prosthesis)



This surgery involves replacing the fractured head
of the femur with a metal or ceramic ball. A metal
stem is attached to the shaft of the bone to add
stability. After Hemiarthroplasty surgery the
surrounding muscles and tissues fully heal
between 6 weeks to 3months. During this period
the joint is weaker and become dislocated more
easily than usual.

16. 4. Total HIP replacement:




A total hip replacement (total hip arthroplasty)
consists of metal femoral component topped by a
spherical ball fitted into a plastic acetabula socket.



Precautions:
 Do only very light work. No bending, twisting or crossing the legs at the hip joint, or
at the ankles.
 Do not force movements at the hip.
 Do not bead forward or to either side to reach objects on the floor.
 Do not sit on low seats.
 Avoid standing for long periods of time.
 Avoid driving and gardening for 3months.
Nursing care after Operation:
In ICU-
 Connect all the monitors and scrupulously record the readings.
 Keep the foot end elevated for at least 24 hrs,
 Administer IV fluids, antibiotics, and other injectable as per instructions.
 Inspect the dressing for any soaking.
 Check the drain for proper connection and drainage.
 Catheterise the patient with a Foley’s catheter and record the urine output on a regular
basis.
 Strictly record the input output chart.
 Check the pulse BP every 2 to 4 hrs,

17. In Ward-
The patient is shifted out of the ICU after 24 hrs.
 Wheel the patient out of the ICU either on A STRETCHER OR A WHEEL CHAIR.
 Remove the drain after 24-48 hrs.
 Change the postoperative dressing after 3 days. Inspect and clean the wound.
 Give sponge bath the patient every day.
 Suture removal needs to be done usually on the 12
th
or 14
th
day.
Treatment algorithm for femoral neck fracture
Physiological age

Functional status Treatment
<65

Community ambulatory ORIF
65-75

Community ambulatory ORIF
>75

Community ambulatory Hemiarthroplasty

18. NURSING Care plan: Day 1-21.09.2022 (Applied Roy’s Adaptation Theory)

Assessment
of
behaviour
Assessment of
stimuli
Nursing
diagnosis
Goal Implementation Evaluation
Ineffective
sense and
protection
in physical-
physiologic
al mode
(pain,
swelling at
fracture
site.)
Focal stimuli
Neck femur
after motor
cycle accidents



Impaired
skin integrity
related to
fragility of
the skin
immobilizati
on.



Long-term
objective:
Fracture area
will be
totally
healed.
Skin will
remain intact
with no
ulcerations.
Short-term
objective:
Pain,
swelling
decreases.
No signs of
infection
over the
wound
within 5
days.
Presence of
healthy
granular
tissues in the
wound site
within 5
days.



1.Maintain the
wound area clean
and dry.
2.Maintain sterile
technique while
providing cares to
the wound to
prevent infection.
3.Do wound
dressing with
betadine solution
which promote
healing and
growth of new
tissue.
4.Check for signs
and symptoms of
infection or also
delay in healing.
5.Administer the
antibiotics
prescribed and
vit-C
supplementation
to enhance the
healing process.


Short term goal: Met
1.Wound size decreased’
2.WBC count became
normal gradually.
Long term goal:
partially met
1.Skin moderately intact
with no ulcerations.
2.Continue plan re-
evaluate goal and
interventions.
3.Unmet-Complete
healing
of operated area not
achieved’
4.Continue plan re-
evaluate goal and
intervention.

19. Assessment
of
Behaviour
Assessment
of Stimuli
Nursing
Diagnosis
Goal Implementation Evaluation
Impaired
activity in
physical-
physiological
mode


Focal
stimuli:
During the
hospital
stay great
and the
right leg
was ORIF’
But the
surgical
wound
turned is
not healed
and became
pain and
oedema,
swelling.


Impaired
physical
mobility
related to
ORIF of
the right
hip and
presence
of
unhealed
wound.


Long
term
objective:
Patient
will attain
maximum
possible
physical
mobility
within 4
months.
Short
term
objective:
1.surgical
wound
dressing
is done.
2.Passive
and ROM
is done.
3.She will
be self-
motivated
in
activities.



Assess the level of restriction of his
movement
Encourage to do active and
passive exercises to all the
extremities to Improve his muscle
tone and strength.
Make the client to do the range of
motion exercises to lower
extremities which will strengthen
his muscle.
Rub the upper and lower
extremities which help to improve
his circulation.
Provide articles near to the him and
encourage to do activities within
limits which promote feeling of
well-being to him.
Provide positive reinforcement for
even a small improvement to
increase the frequency of the
desired activity.
Pain relief measures should be
taken before doing the activities
and initiated as pain can hinder
with the activity.


Short-term
goal: Met:
She try to
carry out daily
living
activities
correctly.

He is also
motivated self
in doing minor
exercise.

Partially Met:
he is now
walking with
minimum
support.
Long-term
goal: Unmet:
He is not
achieved
maximum
possible
physical
mobility.

Continue plan
re-evaluate
goal and
interventions

20. Assessment
of Behaviour
Assessment
of Stimuli
Nursing
Diagnosis
Goal Implementation Evaluation
Alteration in
Physical self
in Self-
concept mode
(She is very
nervous about
changes in
surgical out-
come) Change
in Role
performance
mode. (She
was the only
house
working
member in his
family. So, his
role shift is
not
compensating)
Contextual
stimuli:
She is
known case
diabetes
mellitus for
past 11
years and
on
treatment
with insulin
for 9 years.
Residual
stimuli:
She has no
special
knowledge
in health-
related
matters










Anxiety
related to
hospital
admission
and
unknown
outcome of
the disease
and
financial
constraints.




Long-term
objective: The
patient will
remain free from
anxiety.
Short-term
objective:
1.Demonstrating|
effective coping
in the treatment
2. Being able to
take rest and
sleep
3.Asking less
questions


1.Allow and
encourage him
and family to ask
questions,
2.Allow him and
his family to
verbalize their
anxiety.
3. Provide
comfortable and
quiet
environment for
the patient and
family.
Short-term goal:
Met: Demonstrated
effective coping
with treatment. She
is able to rest and
sleep quietly.
Long-term goal:
Unmet: She is not
totally remained
free from anxiety
due to financial
constraints.
Continue plan re-
evaluate goal and
interventions.

21. Nursing management:
DIAGNOSIS GOAL PLANNING INTERVENTION EVALUATION
1. Acute pain
related to
tissue trauma,
disruption of
skin integrity,
oedema as
evidenced by
reluctance
to move,
guarding of
affected area,
pain scale score,
facial grimacin
Patient will
experience
less pain.

a) To assess
general
condition
b) To assess
pain score
c) Comfortable
positioning
to be given
d) To provide
analgesics
a) Assessed general
condition
b) Pain score
assessed.
c) Comfortable
positioning
given.
d) Provided
analgesics
Pain was reduced
than before.

2. Bleeding (blood
loss) related to
right leg’s
fracture, surgery
(ORIF)
as evidenced by
observation.
Patient will
experience
less blood
loss.

a) To assess
the cause of
bleeding

b) To change
the dressing
c) To assess
the amount
of blood
loss

a) Assessed the
cause & source
of bleeding.
b) Changed the
dressing.
c) Assessed amount
of bleeding
Patient is
haemodynamically
stable, &
experience less
blood loss.

3. Impaired physic
al
mobility related
to pain, stiffness
&surgical proce
dure as
evidenced by
limited joint
movement,
inability to
ambulating.
Patient will
able to
participate
in daily life
activities.

a) To assess
condition of
wound
b) To assess
the
neuromuscu
lar status at
least every
2 hours
interval at
least for
first 48
hours.
c) To assist to
do ROM
exercises.
a) Assessed
condition of
wound
b) Assessed the
neuromuscular
status at least
every 2 hours
interval at least
for first 48 hours.



c) Assisted to ROM
exercises
Patient participate
in daily activities
with assistance
4. Self-care deficit
related to
fracture neck of
femur, stiffness
surgical
procedure as
evidenced by
Patients
will able do
his ADLs
with
assistance.
a) To assess
the level of
performing
activities of
daily living
b) To assist in
performing
a) Assessed the
level of
performing
activities of daily
living
b) Assisted in
performing
Patient performed
all ADLs with the
help of assistance

22. limited joint
movement,
inability to
ambulating.
ADLs
c) To assist in
changing
position
d) To assist in
doing range
of motion
exercises
ADLs
c) Assisted in
changing
position
d) Assisted in doing
range of motion
exercises
5. Altered sleeping
pattern related
to pain, anxiety
& hospitalizatio
n as evidenced
by
verbalization.
Patient will
experience
sound sleep
a) To assess
general
condition
b) To assess
pain score.
c) To give
comfortable
Position,
d) To provide
analgesics
a) Assessed
general
condition
b) Pain score
assessed.
c) Comfortable
positioning
given.
d) Provided
analgesics
Patient slept well
than before
6. Anxiety related
to disease
condition as
evidenced by
facial
expression,
communication

























Patient will
experience
less anxiety
a) To assess
anxiety
level of
patient.
b) To assess
reason of
anxiety,
c) To assess
knowledge
level of
patient &
family
regarding
disease,
treatment &
homecare.
d) To clarify
all doubts
of patient.
e) To explain
disease
process,
treatment &
home care.
f) To explain
dietary
modificatio
n & need of
changes
a) Assessed
anxiety level of
patient.

b) Assessed reason
of anxiety.
c) Assessed
knowledge level
of patient &
family
regarding
disease,
treatment &
homecare.
d) Clarified all
doubts of
patient.
e) Explained
disease process,
treatment &
home care.
f) Explained
dietary
modification &
need of changes
Anxiety reduced &
patient & family
member gain
knowledge about
treatment&
homecare of
fracture & ORIF

23. 7. Risk for
peripheral
neurovascular
dysfunction
related to
vascular
insufficiency &
nerve
compression
Patient will
demonstrate
no
neurovascul
ar
dysfunction
a) To assess
peripheral
neurovascula
r function of
the affect
part
b) To assess the
skin colour,
integrity,
capillary
refill,
temperature
of the
injured part.
c) To support
the affected
body part.

d) To prevent
wound
infection
a) Assessed
peripheral
neurovascular
function of the
affect part

b) Assessed the
skin colour,
integrity,
capillary refill,
temperature of
the injured part.
c) Support given
the affected
body part.
d) To prevent
wound infection
Risk of peripheral
neurovascular
dysfunction
reduced
8. High risk for
infection related
to surgical
incision
Patient
will show
no signs of
infection
a) To assessed
signs of
infection.
b) To checked
body
temperature.
c) To check IV
cannula site
& patency
d) To maintain
aseptic
technique
a) Assessed signs
of infection.
b) Checked body
temperature.

c) Checked IV
cannula site &
patency
d) Maintained
aseptic technique
Patient maintained
personal hygiene
with assistance

. Complications:
According to book

In my patient
 Shock: Hypovolemic shocks occur due to
haemorrhage and from loss of extracellular
fluid into the damage tissue.

 Infection.

24.  Thrombolytic complication: -deep vein
thrombosis and pulmonary embolism can
develop in patient who are immobile due to
prolonged rest and decreased mobility
because of trauma,





 Infection:-open fracture and internal
 fixation have more risk of infection pain,
redness ,tenderness, swelling, warmness are
main symptoms of infection.


Day to day progress note:
Day Vital Signs Pain score Vomiting Oral feeding

1
st
Day Stable 3-4 No Normal diet
2
nd
Day Stable 1-2 No Normal diet
3
rd
Day Stable 0 No Normal diet

Conclusion:
A fracture of the bone is very painful. It may cause varies complications. But through surgery
or rehabilitation the correction of the fractured bone can be done properly. And after surgery,
an effective and proper rehabilitation can give a patient a better and new life.

25. BIBLIOGRAORY:

1. Pearson Alan. Vaughan Barbara. Nursing Models for Practice. 3rd ed.
Butterworth Publishers; 2005.p 161-178

2. Lewis MS, Heitkemper M M, Dirksen RS. Medical surgical nursing. 6h ed.
Canada: Mosby; 2004

3. Black JM. Medical surgical nursing. 7h ed. New Delhi: Elsevier; 2005

4. Johnson YJ. Brunner and Siddhartha's textbook of medical surgical nursing.
11 ed.

5. New Delhi: Lippincott William and Wilkins; 2008. King's theory and nursing
process.-nursinglabs.com/Imogene-m-king-theory-of-goal attainment.

26. CASE study
ON A PATIENT WITH
Neck femur fracture
ROY’SADAPTATION
THEORY

Submitted to Submitted by
Mrs. S. Srimani Dipali Shee
Lecturer cum ANS 2
nd
year M.Sc Nursing student
CON, NILD. Kolkata Session (2020-2022)
CON, NILD. Kolkata
Date-