Initial Discussion Post: An 87 year old female is admitted to the hospital with a diagnosis of a hip fracture secondary to a fall in her home. What clinical manifestations would you expect to see when assessing this patient? What would be three nursing management considerations for this patient pre-operatively? What would be three nursing management considerations post-surgical repair?  What would your neurovascular assessment of the lower extremity include? Are there any positioning considerations, if so what are they?


Hip fractures are a common injury among older adults, particularly in the elderly population. They often result from falls and can have significant consequences for their overall health and mobility. When assessing an 87-year-old female with a hip fracture, several clinical manifestations are expected, and nursing management considerations need to be taken into account both pre-operatively and post-surgical repair. Additionally, a neurovascular assessment of the lower extremity is crucial in guiding nursing care, and there are specific positioning considerations in managing patients with hip fractures.

Clinical Manifestations

When assessing a patient with a hip fracture, there are several clinical manifestations that would be typically observed. These include pain, swelling, bruising, deformity, inability to bear weight, and limited range of motion in the affected hip joint. The patient may also present with an externally rotated and shortened leg on the affected side. These clinical manifestations are indicative of the injury and can guide the nursing management plan in providing appropriate care.

Pre-operative Nursing Management Considerations

Prior to the surgical repair of a hip fracture, there are specific nursing management considerations that healthcare providers should address. The first consideration is pain management. Pain assessment should be performed regularly using appropriate pain scales, and analgesic medications should be provided as prescribed. The primary goal is to control the patient’s pain effectively to improve comfort and facilitate mobility.

The second consideration is maintaining patient safety. Hip fractures can lead to an increased risk of falls and subsequent injuries. Therefore, the nursing staff should ensure the patient’s environment is free from hazards and utilize assistive devices, such as bed alarms or bed rails, to prevent falls. Additionally, regular assessment of the patient’s mental status and cognitive function is important to identify any potential confusion or disorientation that may affect their safety.

The third consideration is nutritional management. Older adults commonly experience decreased appetite and unintentional weight loss. Adequate nutrition is essential for wound healing and recovery post-surgery. The nursing staff should assess the patient’s nutritional status, provide the necessary dietary modifications, and consider consultation with a registered dietitian if needed. This collaborative effort can optimize the patient’s nutritional intake and support healing.

Post-surgical Repair Nursing Management Considerations

After surgical repair of a hip fracture, nursing management considerations are focused on promoting healing, preventing complications, and facilitating the patient’s functional recovery. The first consideration is pain management. Adequate pain control is crucial to enhance patient comfort and facilitate participation in rehabilitation activities. Regular pain assessments and administration of analgesic medications as prescribed should continue post-surgery.

The second consideration is mobilization and rehabilitation. Early mobilization is essential to prevent complications such as pneumonia, deep vein thrombosis, and pressure ulcers. The nursing staff should collaborate with the physical therapist to develop a tailored rehabilitation plan, incorporating both passive and active exercises to improve range of motion and restore functional status.

Lastly, monitoring for complications is a crucial consideration. Complications that can arise after hip surgery include infection, deep vein thrombosis, pulmonary embolism, and pressure ulcers. The nursing staff should closely monitor the patient for signs and symptoms of these complications, such as fever, increased redness or drainage at the surgical site, calf pain, shortness of breath, or new skin breakdown. Prompt recognition and intervention are necessary to prevent further deterioration.

Neurovascular Assessment of the Lower Extremity

A comprehensive neurovascular assessment of the lower extremity is important in evaluating the perfusion and nerve function post-surgery. It includes assessing the color, temperature, capillary refill, pulse strength, and sensation in the affected leg. Comparing these findings with the unaffected leg can help identify any deviations or abnormalities, such as decreased or absent pulses, coolness, or altered sensation, which may indicate compromised circulation or nerve injury. Any abnormalities should be reported immediately to the healthcare provider for further evaluation and intervention.

Positioning Considerations

Proper positioning is crucial in managing patients with hip fractures to prevent complications and facilitate healing. The patient should be positioned in a supine or semi-Fowler’s position with the affected leg slightly abducted. This positioning helps maintain proper alignment and prevents excessive adduction or internal rotation, which can lead to dislocation or other complications. Pillows or specialized wedges can be used to support the affected leg and reduce the risk of pressure ulcers or contractures.


In conclusion, assessing an 87-year-old female with a hip fracture involves identifying specific clinical manifestations and implementing appropriate nursing management considerations pre-operatively and post-surgical repair. A neurovascular assessment of the lower extremity plays a vital role in evaluating perfusion and nerve function. Proper positioning considerations need to be taken into account to prevent complications and facilitate the patient’s recovery. By addressing these aspects of care, healthcare providers can effectively manage patients with hip fractures and promote optimal outcomes.

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