NURSING CARE PLAN ON MUSCULOSKELETAL UPDATED VERSION 2023

Presentation: Nursing Care Plan for Musculoskeletal Disorder. 1. Provide a care plan for elderly patient that has been admitted with a medical diagnosis of fractured hip and second day post op for hip arthroplasty. Hip Fracture Hip fractures are an acute and worsening public health problem. They mainly affect elderly people, a population group that is highly vulnerable to disease and accidents, and to falls in particular. Although it has been suggested that osteoporosis is the cause of hip fractures, they mainly occur after a fall has been suffered. The underlying causes of a fall are not related to osteoporosis, although pharmaceutical companies have coined the term “osteoporotic fracture” for hip fractures in the elderly. The diagnosis of a hip fracture is generally made by an X-ray of the hip and femur. An MRI may identify a hip fracture otherwise missed on plain X-ray. If the patient is unable to have an MRI scan because of an associated medical condition, computed tomography (CT) may be obtained instead. Definition of Medical diagnosis: An X-ray usually will confirm that one has a fracture and show exactly where the fracture is on their bone. If the X-ray does not show a fracture but the patient still has hip pain, his or her doctor may order an MRI or bone scan to look for a small hairline fracture. Most hip fractures occur in one of two locations on the long bone that extends from the pelvis to the knee (femur): • The femoral neck. This area is located in the upper portion of your femur, just below the ball part (femoral head) of the ball-and-socket joint. • The intertrochanteric region. This region is a little farther down from the actual hip joint, in the portion of your upper femur that juts outward. Etiology/Pathophysiology: Etiology: Falls from a standing height account for a significant majority of hip fractures in elderly patients. This is associated with the osteopenia or osteoporotic condition of bone. An NIH consensus conference in the US defines osteoporosis as "a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of two main features: bone density and bone quality. Pathophysiology Fracture pathophysiology includes cortical disruption, periosteal damage, and damage to the intramedullary and cancellous architecture. Histomorphometry studies have shown that cortical thinning and some decrease in trabecular bone mass and connectivity can be seen especially in osteoporosis suggesting a lower quality of bone, and thus decreased mechanical strength resulting in fracture. An age-related decline in osteocyte viability has also been observed in experimental studies. An inflammatory response also occurs following fractures of the proximal femur. Common Sign and Symptoms: • Inability to move immediately after a fall • Severe pain in your hip or groin • Inability to put weight on your leg on the side of your injured hip • Stiffness, bruising and swelling in and around your hip area • Shorter leg on the side of your injured hip • Turning outward of your leg on the side of your injured hip A hip fracture can reduce your future independence and sometimes even shorten your life. About half the people who have a hip fracture aren't able to regain their ability to live independently. • If a hip fracture keeps you immobile for a long time, the complications can include: • Blood clots in your legs or lungs • Bedsores • Urinary tract infection • Pneumonia • Further loss of muscle mass, increasing your risk of falls and injury • Additionally, people who've had a hip fracture are at increased risk of weakened bones and further falls — which means a significantly higher risk of having another hip fracture.