CASE STUDY OF HIP FRACTURE

Stella Carbolito is a 74 years old, Italian America with a history of osteoporosis. She
is a widow and lives alone in two-story row home. Mrs. Carbolito is retired and depends on a
pension check and social security for her income. She takes pride in making all her own food
from scratch. While walking to the market one day, Mrs. Carbolito falls and fracturees her
left hip. She is transported by ambulance to the nearest hospital emergency department.
I. Assessment
During the initial assessment at the ED, abnormal findings are that Mrs. Carbolitos
left leg is shorter than her right leg and is externally rotated. Distal pulses are present and
bilaterally strong; both legs are warm. Mrs. Carbolito complains of severe pain but states that
no numbness or burning is present. She is abble to wiggle the toes on her left leg and has full
mevement of her roght leg. Initial vital signs are as follows: T 98.0
o
F (36.6
o
C), P 11, R 18,
BP 120/58. Diagnostic test include CBC, blood chemistry, and X-ray studies of the left hip
and pelvis. The CBC reveals a hemoglobin of 11.0 g/dl and a normal WBC count. Blood
chemistry findings are within normal limits. The X-ray reveals a fracture of the left femoral
neck. Mrs. Carbolito is admitted to the hospital with an order for 10 lb of straight leg traction.
An open reduction and internal fixation (ORIF) is planned for the following day.
II. Diagnosis:
Damage to the integrity of the skin / skin tissue associated with the installation of traction.
Objective:
The client expressed discomfort disappear, show behavioral techniques to prevent damage to
the skin / facilitate healing as indicated, according achieve wound healing time.
Criteria Results:
Expressing discomfort disappear, showing behaviors / techniques to prevent skin damage /
healing as indicated facilitates wound healing and achieve the appropriate time.



III. Interventions / Rationale:
1) Maintain a comfortable bed (dry, clean, fast looms, under the elbow pads, heel).
Rationale:
Reduces the risk of damage / skin abrasion wider.
2) Massage skin particularly bony areas and areas distal splint / cast.
Rationale:
Increases peripheral circulation and improve skin and muscle enervation of the
relatively constant pressure on immobilization.
3) Protect skin and casts in the perineal area.
Rationale:
Prevent skin and tissue integrity impaired due to fecal contamination.
4) Observe the state of the skin, suppression of the cast / splint on the skin, insertion
traction.
Rationale:
Assess client's developmental problems.
IV. Evaluation
Three days after surgery, Mrs. Carbolito, could get out of bed and sit in a chair. She
said there was a decrease in pain and can demonstrate and perform isometric flexion and
extension movements. She was able to mention the purpose of traction and surgery. She said
the need heparin to prevent deep-vein thrombosis. Mrs. Carbolito planned to go home
tomorrow and that will take care of his family. Will hold a community nurse visits, and has
suggested that there Mrs. Carbolitos home has a bed, a set of toilet seat, pedestal sits on his
chair and cane to a walker.