THE SK ELE TAL SYST E M

Client Profile Mrs. Damerae is a 77-year-old woman who was transported to the emergency
department following a fall onto her right hip on a snowy morning. “I just wanted
to check the mail. I was making my way down my front walk slowly. I had my good
boots on. But there must have been ice under the snow and I slipped. It all hap-
pened so fast. I was up. I was down. And here I am.”

Case Study Physical exam reveals that Mrs. Damerae’s right leg is shorter than her left leg and
her right leg is externally rotated. There is bruising of her right hip. An X-ray con-
firms that Mrs. Damerae has an extracapsular fracture of the trochanter region of
her right hip. Mrs. Damerae will have an open reduction of the fracture and inter-
nal fixation (ORIF) surgery the next morning.

Questions
1. Prior to surgery, the health care provider
chooses to place Mrs. Damerae’s right leg in Buck’s
extension (traction). Why is this intervention
prescribed prior to surgery?
2. A trochanter roll is another option for
Mrs. Damerae. What is a trochanter roll and how
would it be useful?
3. How might Mrs. Damerae’s age affect her
hospitalization and recovery?
4. Briefly discuss how Mrs. Damerae’s past medical
history played a role in her injury.
5. Mrs. Damerae’s surgeon informs her of the
potential complications of hip surgery. Identify at
least three complications the surgeon will address.
6. Prioritize five nursing diagnoses appropriate for
Mrs. Damerae following surgery.
7. Explain how the nurse should move
Mrs. Damerae in order to position her safely on
her side to wash her back.
8. The nurse applies graduated compression
stockings (TEDs) and sequential compression
devices (SCDs) as prescribed. What is the rationale
for these interventions?
9. Mrs. Damerae asks for assistance to the
bathroom. The nurse checks to see that the
appropriate equipment is available in the bathroom
before assisting the client to ambulate. What is the
nurse looking for in the bathroom?
10. Mrs. Damerae is assisted back to bed. She asks
that the head of her bed be raised so she can read.
How high should the head of the bed be raised and
why?
11. Mrs. Damerae is seated in a reclining chair.
What reminders will the nurse give Mrs. Damerae
regarding positioning while sitting and why is
positioning so important?
12. Identify the indications of a possible hip
dislocation that the nurse should watch for.
13. If the nurse notices any of the above signs,
discuss the appropriate action for the nurse to take.
14. Alendronate sodium is prescribed for
Mrs. Damerae. What is the rationale for the use of
alendronate sodium? Discuss the client education
regarding proper administration to maximize the
benefits of alendronate sodium and adverse effects.
15. Following discharge from a rehabilitation
unit, a visiting nurse will provide follow-up care for
Mrs. Damerae. On the first home visit, the nurse
conducts a home safety assessment. Identify at least
five components of a safe home environment.