Hip fracture in an older adult: before and after surgery
The classic finding is a leg that is shortened and externally rotated, with pain in the groin or thigh and an inability to bear weight. In a fracture without displacement the leg can look normal and the client may still walk; a persistent inability to bear weight after a fall deserves an image even when the examination is reassuring. Before surgery: analgesia is the priority and is given rather than withheld. Untreated pain in this population causes delirium, immobility and pneumonia. Regional blocks are increasingly used and are effective. Surgery early rather than late improves survival, so anything the nurse can do to keep the client ready matters: fasting managed without prolonged dehydration, anticoagulation clarified, the workup completed. After surgery, the outcome is decided by four things: mobilization on the first day, pain controlled well enough to allow it, prevention of delirium, and prevention of thromboembolism. Watch for delirium at every shift with a validated tool. It is the most common complication and the most often missed, and it is not an expected part of getting older. Do not forget the reason for the fall. A hip that is repaired without the fall being investigated is a client who returns with the other hip.