I. Key points of care
1.Femoral neck fractures are mostly seen in elderly people, who are slow in sensation and reaction, have low living ability, and many of them have other diseases combined. Therefore, nursing staff should first observe carefully, understand the condition, give timely and appropriate treatment and care, and at the same time, strengthen basic care to prevent complications such as pneumonia, urinary tract infection and decubitus ulcer.
2.After internal fixation, the correct position should keep the affected limb in abducted neutral position, strictly prohibit lateral lying, inversion, external rotation of the affected limb, sitting cross-legged to prevent nail displacement.
II. Nursing problems and nursing measures
Nursing problem 1: After fracture revision, the patient is required to be in passive position for a long time or the elderly patient has poor tolerance and cannot maintain the correct position.
Nursing measures.
(1) Explain the importance of maintaining the correct position and the adverse consequences of non-correct position to obtain active cooperation from the patient.
(2) The patient should keep the affected limb in abducted neutral position, avoid lying on the side, cross-legged, inward and outward rotation, to prevent the nail from shifting, resulting in adverse consequences.
(3) Elderly patients because of the thin subcutaneous fat, long time in the same position in bed inevitably discomfort, so should keep the bed clean and flat, dry, hard bed mattress should be thicker, often massage the pressure parts, and at the same time can help the patient appropriate semi-sitting position, avoid too long to reduce discomfort.
(4) Elevate the affected limb to facilitate swelling and pain relief.
(5) Wear thong shoes if necessary and put a pillow between the legs to prevent external rotation and inversion of the affected limb.
Nursing problem 2: Poor understanding of the purpose of functional exercise or poor physical fitness of elderly patients, lazy activities cause poor initiative of functional exercise
Nursing measures.
(1) Explain the purpose and significance of functional exercise to the patient, and cooperate with treatment and nursing.
(2) Supervise and guide the patient to master the correct functional exercise method. For example, isometric contraction of the quadriceps muscle and voluntary movement of the ankle and toe joints. Functional exercise should be done gradually and according to the patient’s ability, so as not to feel fatigue.
(3) When the patient gets out of bed, he/she should be instructed to use the crutches correctly and keep the affected limb in abduction without weight bearing.
Nursing problem 3: Femoral head replacement has the possibility of dislocation
Nursing measures.
(1) Understand the patient’s surgical route and joint type in order to provide good postoperative care and avoid joint dislocation.
(2) Keep the affected limb in a neutral abduction position after surgery and wear anti-external rotation shoes if necessary to prevent dislocation caused by external rotation.
(3) The hip joint and the affected limb should be held up when moving the patient. Keep the affected limb in a horizontal position to prevent inversion and flexion of the hip to avoid hip dislocation.
(4) Encourage the patient to take early functional exercise in bed and make him master the correct functional exercise method, avoiding premature straight leg raising activities.
(5) In case of hip dislocation, absolute bed rest and braking should be applied to prevent vascular and nerve injury, and then treated as appropriate.
3.Discharge instruction
1. Ask the patient to eat more high-protein and nutritious food. Such as meat, eggs, animal offal, soy products, etc.
2. When getting out of bed for functional exercise, it is better to have family members around for protection to avoid falling and causing two fractures.
3.For six months, it is prohibited to lie on the side or sit cross-legged to prevent internal and external rotation of the affected limb, which may cause adverse consequences.
4.Check regularly.