Discharge Plan, Pathophysiology, Illustrated Surgical Management (Research Paper Sample)

Discharge Plan
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Introduction
In this paper, pathophysiology of hip fracture will be outlined and the discharge plan related to clinical manifestations, etiology, risk factors, diagnostic findings and medical or surgical management will be illustrated. One is said to have a hip fracture when he or she happens to break the upper quarter of the femur bone. The degree to which the bone breaks depends on the force involved in the accident. An injury to acetabulum or the socket is not considered a hip fracture (Lowth, 2014).
Discharge Plan
Commonly, hip fractures happen when one falls with the hip directly facing the ground or any other rough surface of impact. It can also occur if the hip is hit directly by a heavy object. Other medical condition such as osteoporosis can make the hip more vulnerable to the fractures. . If this disease is severe, a simple twist of the leg by standing on it can cause the fracture to occur. Obesity is one of the conditions that is known to have caused hip fractures. A hip fracture is also caused by malnutrition. An imbalanced diet especially that does not favor the growth of strong bones can cause hip fracture out of minor accidents (Gonnelli, 2014).
Patients with hip fractures experience pain on their upper thigh as well as the groin. The leg of the affected hip may appear shorter than the non injured one (Bhatti, 2015).People suffering from fractured hip may be unable to put weight on the affected leg because of severe pain. Furthermore, the patients would not be able to walk or stand because the fracture can spread, which worsen the pain (Brunner, 2003).
Diagnostic findings
A plain X-ray on both anterior and lateral pelvic x-ray view will show a fracture of the proximal femur. In case of suspected distal extension fracture, femur x-ray is ordered. AP image is taken at different angles of internal rotation example at 15 degrees .MRI pelvis will show the presence of marrow edema and a fracture line. This is the case of intracapsular fracture; there will be evidence of cortex disruption, primary compressive and tensile trabecular lines when compared with the normal hip (Epocrate, 2018).CT pelvis will demonstrate fracture of proximal femur. Extravascular fracture pattern relies on the balance and comminution of medial cortex. The three and four part intertrochanteric fracture with reverse obliquity will be taken to be unstable. Technetium bone scan or CT will demonstrate increased uptake of radioactivity in the region of fracture. This is carried out when plain X-ray results are negative but there are symptoms of a hip injury. MRI is cheaper and very efficient in detecting occult hip fractures. The septic hip will have symptoms of fever and chills. Hip aspiration will reveal frank pus fluid suggestive of infections. This will call for confirmatory laboratory isolation of infecting organisms. The white blood cell count (WBC) will be recommended i.e. (Epocrate, 2018)
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Source: Mayo Foundation for Medical Education and Research.
Medical or surgical management
The type of surgery depends on the location and extent of the fracture. One may have total the hip replacement or have screws or metal rods holding the fractured femur. Surgery should be performed within 24-48hours of patients’ admission, although patient with unstable health condition have to wait until stabilization. The aim of medical management is to ensure bone strength and reduce chances of future fractures. In preoperative stage most of the activities involve prevention of complications such as delirium, pain control and removal of tethers. Postoperative activities include checking excessive bleeding and infections i.e. (Gonnelli, 2014).
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Source: Mayo Foundation for Medical Education and Research
After undergoing surgery, the patients are ready for discharge if they are able to do basic activities such as getting off the bed, walking with crutches from bedroom to the bathroom and can use stairs comfortably. The pain management strategy should also be prescribed to the patient before discharge example; paracentamol 1.0gm should be taken three to four times a day, Oxycidone 2.5gm three times per day (Reiman and Wright, 2012). The patients should be encouraged to adhere to prescribed doses and within marked timeframe especially those intended to prevent development of blood clots i.e. DTV prophylaxis contine should be taken to reduce compression stocking and Venous Thromboembolism (VTE). Patient should be taught on the crucial instructions on how to dress the wound and wound care medication (Dougherty and Liste, 2015). Counseling should be availed as a continuum care which will rekindle the patient’s self-esteem, acceptance and create awareness of expected changes in their life (Hung and Siu, 2012). The case manager should always visit the patient to evaluate the patients’ need for referral and also to ensure that they are getting the best care from the Rehab’ Center.
Health Perception and Health Maintenance Pattern
The patient should be taught on the negative effects of substance of abuse such as smoking and alcohol drinking (Doenges and Mur, 2016). The health care providers have to help the patient in quitting these habits. They should also educate the patient how alcohol and cigarette will delay the healing process of the bones and react with the pain killers. The hygiene and cleanliness should also be emphasized to avoid infection of the wound from poor handling and management. Proper therapy administration will also be important to avoid overdose or under-dose which might hinder proper recuperation e.g. blood thinner and pain killers. Osteoporosis check-up should be a must for treatment of weak bones by use of bisphosphates (Bhatti, 2015). Moreover, proper drug disposal should be taught in case of availability of children in the patient’s home. The patient should be advised to continue wearing the compression stocking for 3 weeks as it will reduce probability of blood clot occurrence.
Metabolic Pattern
The pattern of consumption of both fluid and food intake is highly considered in determining the patients’ recovery. The patient should be encouraged to eat balanced diet and nutrients dense food. Carbohydrates will replenish the lost energy and enhance quick recovery. Proteins are important in healing of the wound as they are responsible for body tissues repair (Gordon, M, 2014). High fluids intake should also be high to allow body process to function normally and allow drug dissolution. Supplements such as calcium and vitamin D are also crucial for borne strengthening.
Elimination Pattern
Drugs are eliminated through the bowels, urine, skin and some through tears. This is evidenced by discoloration of stools especially for drugs with bismuth and iron. Urinary tract infections (UTI) should be checked and confirmed after the removal of catheters (Brunner, 2003). It is advisable to ensure bowel is open to reduce effects of fecal compaction and constipation, regular use of laxatives with stool softener is recommended (Reiman and Wright, 2012). Prophylactic antibiotics should be applied to prevent infections. An elevated toilet sit is advisable to avoid excess bending which may be fatal. Slippery floor especially in the bathroom and toilet should be replaced with rough ones and fitted with hand rails to avoid tripping hazards (Hung and Siu, 2012).
Activity and Exercise Pattern
The patient should be encouraged to do exercises with minimal energy requirement regularly but avoid extremes. This will promote blood circulation in the body. Different positioning in bed should be encouraged to prevent pressure sores from occurring (Hung and Siu, 2012).The exercises can also reduce pain on the affected part. The usual time to walk with a crane is 2-4 weeks and 4-6 weeks unassisted. The therapist should help the patient to regain the ability to walk up and down the stairs. When driving, the patient should be able to comfortably operate the brake pedals and crutch. Driving when under anesthesia is prohibited due to dozing out effect. The patient can return to driving after 4-6 weeks i.e. (Dougherty and Liste, 2015).
Sleep and Rest Pattern
The sleeping activities should be well planned. The bed should be designed to allow the patient’s feet to touch the floor without straining. When sleeping, the patient should put a pillow between his legs to avoid crossing of legs. The sleeping position should be able to promote sleep and prevent injury to the patient (FA Davis et al, 2016). The patient should have breaks within his resting periods; he should not sit for more than 45 to avoid fatigue and excess stress on the affected area. The patient should use a comfortable chair with arms for support and should be restricted on leaning forward. Moreover, the patient should always be hand-free as his hands may be of use in balance maintenance.
Self Perception and Self Concept Pattern
The patients view of their condition of being sick or healthy matters a lot in therapy administration. When they change their perception and see themselves as sick, they may develop a defiant character toward the therapy which may result to negative effects on their health. The health care provider should always keep the patients engaged in creative things like visual movies which relieve pain and enhance positive thoughts of the future. (Gordon, M, 2014).
Role and Relationship Patter
It is important to assess that patient’s family structure, relationship at work and even understand their roles on the dependants. Hip fracture patients should resume work duties depending on the...