2013 Monthly Trauma Edu Brief

Transcription

1 2013 Monthly Trauma Edu Brief Care of the Hip Fx Patient Kelly Simon BSN, RN Pete Benolken MSN, RN, CEN, CPEN, PHN Click here to progress to the next slide.

2 Target Audience This lesson is intended for all RN's at UMC that care for Trauma Patients. Contacts Kelly Simon, Pete Benolken, Estimated Duration and Viewing Instructions The expected time to complete this learning activity is 10 minutes. If you are unable to complete during scheduled work time it may be completed outside of work with prior approval from your supervisor. Any overtime must be approved.

3 On completion of this lesson, learners should be able to: 1. Recognize the enormity of falls as a health problem in the older population 2. Identify common complications in hip fracture patients 3. Explain the need for complication prevention in hip fracture patients, stating nursing cares that aide in complication reduction

4 Not only will this education allow RN s to provide care to patients who are experiencing trauma, but it will also allow them to do this in a timely and cost-effective manner.

5 Prevalence of Falls in the Older Population Among older adults, falls are the leading cause of both fatal and nonfatal injuries 1/3 older adults (aged 65 or older) fall each year, but less than half talk to their healthcare providers about it (2010) 2.3 million nonfatal fall injuries among older adults were treated in emergency departments & more than 662,000 of these patients were hospitalized (2010) the direct medical costs of falls, adjusted for inflation, was $30 billion [Ref:

6 Prevalence of Falls in the Older Population After age 75, falls are the most common mechanism of injury Every year about 50% of people older than 80 yrs of age will fall and require medical treatment

7 How Falls Impact the Older Population Older adults do not die as a direct consequence of their injuries due to a fall but as a result of the secondary complications (i.e. pneumonia, clots, infection) 1/3 to half of older adult patients hospitalized after a fall do not survive another year (TNCC p 233)

8 FA L L S Femoral neck fractures are common after a fall in the older population

9 N U R S I N G T H I N G S T O T H I N K A B O U T Pain Control Utilize both narcotic and non-narcotic medications, stepwise approach: long acting and short acting, IV meds for breakthrough, transition to all PO meds as soon as able Utilize non-pharmocologic measures as well, such as ice, positioning, verbal reassurance

10 N U R S I N G T H I N G S T O T H I N K A B O U T Activity Orders Per MD team Early mobilization is best, even if from bed to chair only Utilize Physical and Occupational Therapy experts

11 T H E S U R G I C A L APPROAC H Posterior vs Anterior Surgical approaches Anterior is usually less invasive Most minimal incision The surgeon moves the muscles aside rather than cutting through them.

12 T H E S U R G I C A L APPROAC H Posterior Hip Precautions as ordered by MD Ideals like: No flexion past 90 degrees No internal rotation past neutral No adduction past midline DO: use elevated toilet seat, chair in shower, keep hip in neutral straight position when sitting, walking or lying

13 N U R S I N G T H I N G S T O T H I N K A B O U T Possible Complications to Prevent: Pneumonia, fat embolism, nerve or vascular injury, bone union issues, soft tissue damage There is benefit in early surgery intervention for these patients to decrease the chance of a prolonged hospital stay and complications thereof

14 N U R S I N G C A R E S W H A T C A N W E D O Pneumonia Prevention: pulmonary toilet: Cough deep breath, get patient up and out of bed, up to chair Incentive Spirometer use and Acapella use (remind patients to do during commercials for instance when in bed) Utilize your Respiratory Therapy colleagues

15 N U R S I N G T H I N G S T O T H I N K A B O U T To Reduce catheter acquired infections: Foley Catheter: follow your hospital s policy FV System Wide Guideline HERE DC as soon as able Promote mobility as soon as able

16 N U R S I N G T H I N G S T O T H I N K A B O U T Anxiety and Depression can easily occur with these patients, but creative nursing care and awareness of this can go far Delirium is a common complication in older adults after hip fx with rates between 10 & 65% (2013, Tsang)

17 N U R S I N G T H I N G S T O T H I N K A B O U T Delirium risk factors: (2013, Tsang) Cognitive impairment Constipation, Alcohol abuse, Visual/hearing impairment, untreated or undertreated pain, malnutrition, hypoxia, poly-pharmacy, UTI, immobility, use of Foley catheter

18 C O M P L I C AT I O N S A R E A P R O B L E M Dr. Dy et all created a multidisiciplinary collaborative model care: the Medical Ortho Trauma Service (MOTS) 306 pts w/hip fx s were studied Complications decreased in the MOTS cohort Conclusion: a multidisciplinary collaborative model decreases complications and may influence hospital readmission rates (2012) Dy et al MOTS J of Orthop Trauma 26,6

19 W H AT C A N W E D O? Prevention Matter of Balance Class LINK MN Classes Class aides to increase strength + activity, encourages assertiveness, provides opportunity to learn from others Education: leading hazards are loose rugs and slippery or uneven surfaces, many falls are associated with a position change, getting up from chair or bed

20 TA K E AWAY S U M M A RY Falls are a problem for older adults. Femoral neck (hip) fractures are a common result of falls for older patients. There are special nursing considerations and common complications for patients with femoral neck fractures. Nurses mitigate complications and assist with fall prevention in this patient population (Click Here for more info).

21 R E F E R E N C E S (2012) Dy et al. The medical Orthopaedic Trauma Service: An innovative multidisiplinary team model that decreases in-hospital complications in patients with hip fractures TNCC 6 th Edition, Emergency Nurses Assoc (2013) Tsang, L. Nurse Prediction prevention and management on post-op delirium in geriatric patients with hip fracture: the development of a protocol to guide care CDC: (2011) Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Elsevier, St Louis MO; Chapter 63

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