IntroductionThe occurrence of falling among old people is increasing (Larson & Eric, 2017; Mascarenhas & Marlon, 2019). Fracture neck of femur is one of the serious health problems that affect patients of advanced age (Iglesias et al., 2017). Morbidity can often be expected following a fractured neck of femur, including immobility and independence (Moon et al., 2011; Fox et al.,2014; Kouli et al., 2017). The suitable treatment of femoral fracture is surgery (Ossendorf et al., 2010). Surgery helps the patient to start a normal life depending on the patient’s underlying condition (Lewis et al., 2019).In this article, the pre-operative management for 84-years-old Mrs. Y who had 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 mild cognitive impairment (Liu-Ambrose et al., 2008) and the use of antihypertensive drugs (Tinetti et al., 2014). Acute pain related to fracture and soft tissue damage as evidenced by the complaint of moderate pain, blood pressure 142/88 and tachycardia (Lord & Woollard, 2011).Risk for disturbed thought process relating to age as evidenced by the stress of trauma, unfamiliar surroundings and medication therapy (Hillier & Barrow, 2014, p. 127).Nursing problem of the highest priorityRisk for fallsPatients’ safety at ward level is fundamental. Falling after a confirmed fracture of the neck of femur may result in more fractures, lacerations, internal bleeding, leading to increase health care utilization or even death (Chou et al., 2019). In the United Kingdom, femoral neck fractures affect up to 75000 elderly people yearly and up to a third of these patients pass away within twelve months (Eaton & Georgette, 2012). All fracture neck of femur injuries should be treated as a “severe” injury on incident reporting and analysis should be carried out in order to reduce the risk of future inpatient injury (Grace & Jennifer, 2019). Falls often delay functional recovery and prolonged length of stay of hospitalization (Morris & O’Riordan, 2017). About 20–30% of falls can be prevented by assessing risks and intervening to reduce these risks (Morris & O’Riordan, 2017). 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 fallsWithin the next eight hours of rendering proper nursing interventions, Mrs. Y will be free from falls and safety will be ensured. Nursing InterventionsRisk for fallsThe prevention of falls is normally considered as an indicator of quality of care (Marques et al., 2015). Medications are an identifiable risk factor that can prevent falls (Watson & Barbara, 2019). Besides, providing therapeutic activities and reality orienting to reduce mild cognitive impairment in hospital falls (Watson & Barbara, 2019). Falls can be prevented by addressing the cause.Use of side railsThe use of side rails in hospital settings are sometimes considered as a restraint or restrictive practice (Heinze et al., 2012; Martin & Mathisen, 2005). Restraints in elderly patients often result in poor outcomes such as functional and psychological decline (Agens, 2010; Bower & McCullough, 2000; Strout, 2010). Studies show that the use of antihypertensive drugs and patients with mild cognitive impairment have the tendency to fall and since Mrs. Y had fractured her neck of femur, therefore the use of side rails is considered as a non-restrictive practice. For Mrs., they are being used as a safety measure to prevent falls. According to the Department for Health and Ageing, Government of South Australia (2015), if a patient is oriented and alert and the patient is very immobile that is bedfast or hoist dependent, the use of side rails are recommended. Nurses must be always present to help dependent patients.Assist in mobilityMany hospitals classify inpatient falls as assisted or unassisted for quality measurement purposes (Staggs et al., 2014). Unassisted falls are more likely than assisted falls to result in injury and should be considered as a target for future prevention efforts (Staggs et al., 2014). According to the Universal Fall Precautions, health care providers must assist patients when moving (Rivera, 2017). Patients suffering from mild cognitive impairment require assistance when mobilizing in bed (Liu-Ambrose et al., 2008). Fractured patients require assistance in mobilizing as well (Myers, 1996). Moreover, they require assistance with nursing care. Besides, Boynton, Kelly and Perez (2014) point out that changing the mindset and embracing the appropriate technology will keep the patients safe from harm. They suggest a mobility assessment tool which helps in safe patient handling and ensures secure activities using high the tech (Boynton et al., 2014).Wearable sensors for fall detectionFall detection and fall prevention are research areas that have been operating for over a decade and they both are fighting to improve people’s lives through the use of pervasive computing (Delahoz & Labrador, 2014). These researches have to overcome many challenges in order to design and implement fall detection and fall prevention. These systems have use wearable sensors. In the health care setting, patient at the risk of falls is provided with a secure wristband to remind healthcare providers to implement fall precaution behaviors. To detect falls, wearable sensors are more reliable. These wearable sensors have been proven to reduce the risk of falling among elderly patients suffering from mild cognitive impairment thus improving care and quality of life (Thapliyal et al., 2017). EvaluationTo conduct evaluation for risk for falls, Mrs. Y should be reassessed using a fall risk assessment tool (Kim et al., 2007) or observation assessment if Mrs. Y shows potential signs of falling from bed. Patients who are at risk of falling or have a history of falling must be assessed completely on admission and that assessment is repeated at agreed and regular intervals (Green et al., 2018). The way Mrs. Y behaves will indicate the proper nursing intervention. A fall risk nursing care plan is then planned to better evaluate the situation. The nurses must observe the behaviors of Mrs. Y as she suffers from mild cognitive impairment. If Mrs. Y is unable to cope with the situation, some cognitive therapy techniques will be developed to orientate the patient. In addition, blood pressure must be monitored as the patient is on antihypertensive drugs. Drugs must be readjusted if the patient shows adverse sign. ConclusionIn this article, an introduction on the fracture neck of femur in the elderly was carried out and the preoperative nursing management of Mrs. Y was discussed. Mrs. Y’s nursing problems were listed in order of priority with the top one nursing prioritized nursing problem explained. The goals for the prioritized nursing problems were initiated using SMART and the nursing interventions for risk for falls were explored. Lastly, the nursing care of Mrs. Y was evaluated.
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