IntroductionFalls among elderly is the leading cause of accidents and the third leading cause of death (Falcão et al., 2019; Mascarenhas et al., 2019) while fractured neck of femur remains the second leading cause of hospital admission in older patients (Moon et al., 2011). Femoral fracture in the elderly is known to be highly morbid and few studies have reported on conditions associated with increasing mortality and morbidity rate (Iglesias et al., 2017; Morrissey et al., 2017). The best treatment for fracture neck of femur is surgery. Surgery will help the patients to increase independence and mobility (Lehtonen et al., 2018). In this article, the pre-operative management of Mrs. Y aged 84 years old who fractured her right neck of femur shall be discussed.Actual or potential nursing problem statements in order of priorityRisk for falls related to impaired mobility as evidenced by age of 65 and above, mild cognitive impairment and use of antihypertensive drugs.Impaired skin integrity of the right forehead related to laceration from fall as evidenced by a dressing on the right forehead and eight stitches.Acute pain related to physical injury and fracture of neck of femur as evidenced by complaint of moderate pain (Eaton, 2012).Nursing problem of highest priorityRisk for fallsOlder women have a higher incidence of falls compared with older men (Liu-Ambrose et al., 2008). Recurrent falls are more prevalent in elderly with mild cognitive impairment (Borges et al., 2015). Falling from bed after a fracture neck of femur can result in more tissue damages and severe injuries. Unfortunately, death can follow. These falls are often unassisted. Moreover, older persons sustaining a hip fracture suffer long-lasting limitations in mobility, activities of daily living, self-care, participation, and quality of life (Benzinger et al., 2019). This also increases cost of the hospitals (Green et al., 2018).Patient-centric goalThe nursing care goal for Mrs. Y was formulated to be specific, measurable, achievable and realistic and have a time-frame (SMART criteria).Risk for fallsFor the next eight hours of nursing interventions pre-operatively, Mrs. Y will not experience falls and safety will be assured.Nursing InterventionsRisk for fallsIdeally, health care providers want to prevent falls from happening, but once an older person falls or has a fracture then they are at increased risk of subsequent falls and fractures (Health and Safety Commission New Zealand, 2019). The best nursing interventions will be developed by addressing the cause of the problems to ensure safety and prevent falling (Jones et al., 2016).Cognitive therapyThe presence of mild cognitive impairment in older patients increases their risk of fall (Lipardo & Tsang, 2018). Cognitive therapy helps patients with mild cognitive impairment maintain and improve their thinking, well-being and general functioning (Bahar-Fuchs et al., 2019). Antihypertensive medications helps in cognitive decline (Kane et al., 2017). However, cognitive therapy has proven to function well when drugs are administered simultaneously (Lipardo & Tsang, 2018). At ward level cognitive therapy shows some beneficial effects on cognitive functions such as attention, orientation, perception, language and memory (Lipardo & Tsang, 2018). Nurses must engage patient in physical activity, mental stimulation and social interaction for successful cognitive aging approach (Vitale at al., 2014). In other words nurses must introduce patients to the ward, engage patients to patients interactions, develop therapeutic communication skills towards the patients and provide a calm and peaceful environment for patients to sleep in order to reduce the risk of fall.Side railsSide rails are being used as a safety measure at ward level to prevent fall. Patients with mild cognitive impairment are known to climb over the side rails when the nurse was out of the room thus resulting in falls (Silvestri, 2011) . Research shows that patient suffering from mild cognitive impairment and who is on antihypertensive drugs in hospital need to lower their beds to the lowest position and do not use side rails to prevent injury while falling off the bed. However, for Mrs. Y side rails are being used as the patient has fractured her neck of femur beside being a cognitive impaired and hypertensive patient. The patient is very immobile and cannot voluntarily get out of bed so the use of bed rails are highly recommended (Mullette & Zulkowski, 2004). Moreover, In this developing world, the use of high technology cannot be ignored.Bed alarmTechnology is improving standards and quality care in nursing. It is of great advantage in the health sector. Nursing technologies are rapidly changing patients’ care around the world. The use of bed alarm is of great help to the health care providers. Bed alarm is a system used to reduce fall at hospitals by alerting health care providers when at-risk patients try to leave their bed without assistance (Shorr et al., 2012). Since Mrs. Y suffers from mild cognitive impairment and is on antihypertensive drugs the bed alarm is considered the best option to prevent falls. The bed alarms system are used and have proven to be a well-defined fall prevention program and it is cost effective to the problem of falls (Shorr et al., 2012). However, nurses must be very quick to attend patients when the alarm is on to prevent any danger from happening.EvaluationTo conduct evaluation for risk for falls, Mrs. Y should be assessed using a risk for fall assessment tool such as “FRAT-UP” (Cattelani et al., 2015) or the latter should be observed if she shows risk for falling out of bed. Therefore, it is important to investigate the different risk factors for falls in older people with Mild Cognitive Impairment to establish specific planning for prevention of falls (Ansai et al., 2019).ConclusionTo conclude, in this article an introduction about fracture of femur was briefly explained. The preoperative management of Mrs. Y was discussed and the nursing problems were listed in order of priority. One nursing problem of the highest priority was chosen and elaborated. The goals for the prioritized nursing problems were carried out using the SMART criteria and the nursing intervention for risk for falls were discussed. Lastly, an evaluation for the nursing care was achieved.
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