Joint Replacement Center Johnson City

 

 

The Joint Replacement Center at
Johnson City Medical Center
Hip Fracture - Hospital Care


Hip Fracture Treatment

 Hospital Care
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 Preventing Future Falls  Preventing Potential Complications
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More Information About Hip Fractures

Treatment will depend on the location and the severity of the fracture. The severity of the fracture depends upon the intensity of the injury-causing event and the strength of the bone.

To relieve pain from the fracture, we use the most effective medications available and strive for early surgical treatment. Almost all hip and femur fractures in the elderly require surgery.

Hospital Care

The Coach's Role

Having a support system in place after surgery is important. We recommend that you identify someone who will be available before and after your surgery to assist you in the process. We will be referring to this person as your "coach" or "VIP" (Very Important Partner). Your coach can be a spouse, family member neighbor or close friend. The role of a coach is to:

 

  • Help build the patient's confidence by offering him/her encouragement and support.
  • Encourage the patient to participate in the full therapy process. Remember, all patients progress at different rates.
  • Encourage patients to follow instructions given to them by their physician, nurse, therapist or other caregiver.
  • Participate in the educational process. Fractures can be life-altering events for both the patient and his/her family.
  • Attend therapy sessions when possible with the patient. Therapy is offered twice daily starting the day after surgery.
  • Communicate with case management the unique discharge needs of the patient (this may include a walker, commode or additional caregivers).

What to Expect During Your Stay

Day of Admission

After a fall, patients either come through the Emergency Department or are admitted directly from a nursing facility or assisted living facility. As part of the admission process, you will be evaluated by an orthopedic surgeon and a hospital-based physician or primary care doctor to help you prepare for surgery to repair the broken bone. A health history will be obtained, including getting an accurate home medication list. An X-ray of your chest and affected bone will be taken, and blood samples will be collected. A Foley catheter will be inserted to drain the bladder, and intravenous fluids will be started.

One of the program's primary goals is effective pain management. Before surgery, your pain will be managed with medicine followed by early surgical treatment. Most patients who are admitted to the program are evaluated by a physician and prepared for surgery to repair the fracture within 24-36 hours of admission.

Day of Surgery

Prior to surgery, you will not be able to eat or drink. You will be on bed rest until after surgery. At the appropriate time, you will be escorted to the surgery holding area for one hour, where you will see the anesthesiologist. Surgery will take approximately one and a half hours. Following surgery, you will be taken to a recovery area where you will remain for one to two hours. During this time, pain control will be established, your vital signs will be monitored and an X-ray will be taken of your repaired hip fracture. Total time in surgery is four to five hours.

The surgeon will talk with your family or "coach" when your surgery is completed to let them know how the surgery went. You will return to your room, where a nurse will care for you. Most of the discomfort occurs the first 24 hours following surgery. During this time, you will be receiving pain medication through your IV. You will probably remain in bed the first day.

 

Day 1 After Surgery

 

  • Vital signs will be taken every eight hours and as needed.
  • A blood thinner and compression sleeves will continue to be used.
  • Blood work will be done.
  • Breathing exercises will continue.
  • Most patients can resume their regular diet.
  • Pain will be regularly assessed using a pain scale.
  • Physical and occupational therapists will continue treatment. Mobility levels will continue to be advanced as tolerated.
  • Most patients will be up in a bedside chair for most of the day and will begin to walk using an assistive device such as a walker (when weight bearing is permitted).
  • The medical physician, orthopedic surgeon and case manager will continue to make daily rounds.
  • Rehabilitation options will be discussed and a placement plan will be developed to best suit your needs.
  • In some cases, you may discharge home today if you are doing well and are moving safely with assistance from your coach.

Day 2 After Surgery

  • Vital signs will be taken every four to eight hours after surgery to monitor blood pressure, pulse, temperature and respiratory rate.
  • A blood thinner and compression sleeves will be used to decrease the risk of blood clots.
  • Blood work will be done to monitor blood levels after surgery.
  • Continue to use the incentive spirometer and breathing exercises to decrease the risk of pneumonia.
  • Your diet will be advanced as tolerated to minimize nausea and vomiting.
  • The Foley catheter will be removed to prevent the risk of a urinary tract infection and to promote mobility.
  • Pain will be frequently assessed using a pain scale.
  • Physical therapists will evaluate and treat you using individualized plans. Your mobility will be advanced as tolerated to increase your functional independence.
  • A goal is to get up from the bed and move to a bedside chair to promote mobility and decrease risk of pneumonia.
  • A physician will work with you and your family to determine rehabilitation needs after discharge from the hospital.
  • A case manager will assist in planning hospital discharge and ordering any medical equipment that may be needed.

 

Day 3 After Surgery

  • Vital signs will be taken every eight hours and as needed.
  • A blood thinner and compression sleeves will continue to be used.
  • Breathing exercises will continue.
  • Pain will be regularly assessed using a pain scale.
  • Physical therapy will continue. Mobility levels will continue to be advanced as tolerated.
  • The medical physician, orthopedic surgeon and case manager will continue to make daily rounds.
  • Rehabilitation options will be discussed and a placement plan will be developed to best suit your needs.
  • Final rehabilitation and discharge plans will be implemented.

Physical and Occupational Therapy

 

Discharge planning starts within 24 hours of admission. Physical therapy evaluates the patient on post-op day one and makes recommendations per performance for inpatient rehab, skilled nursing home, home health services or outpatient physical therapy. Case management and social work follow and make arrangements based on decision of patient, family or POA.

Occupational Therapy

Your occupational therapist will see you upon the request of your physician. Once evaluated by your OT, you and your OT will establish specific goals based on your specific needs. You will start mobilizing early with a focus on your ability to perform self-care needs independently such as dressing, bathing and toileting. Your OT may recommend specific adaptive equipment to assist you in your self-care to help you regain your highest level of independence. Adaptive equipment suggestions may include a bedside commode, shower seat, sock aid, reacher, long-handled sponge or extended shoe horn.

 

Discharge Process

Discharge Options for Fractured Hips

  • Inpatient rehab
  • Skilled nursing facility
  • Home health care
  • Outpatient rehab

Inpatient Rehab

  • Physical therapy recommendations
  • All insurances will allow inpatient rehab if acceptable except United Healthcare (formally John Deere). This also includes AARP since it is owned by United Healthcare.

Skilled Nursing Facility

  • Patients who come from a nursing home will return back to that facility if they are agreeable and if it has a skilled unit. If not, a skilled facility of patient and family's choice will be pursued.

Home Health Care

  • Patients who wish to return home, have strong family support and qualify for Home Health will receive physical therapy visits three times a week.
  • After a few weeks of home health, one can transition to outpatient therapy if applicable.
  • Outpatient Rehab
  • Arranged at discharge to the facility of choice.

 

Assisted Living

  • Patients who reside in an assisted living facility cannot return until they are able to ambulate independently.

DMEs

  • Patients will need a rolling walker and a 3-in-1-bedside commode. These items are covered by insurance.
  • Insurance will not cover any items for the bathroom, for example, commode extender, shower chair, transfer bench.

Summary

  • Discharge planning starts within 24 hours of admission.
  • Physical therapy evaluates post-op day one and makes recommendations per performance for inpatient rehab, skilled nursing home, home heath services or outpatient physical therapy.
  • Case management and social work follow and make arrangements based on decision of patient, family or POA.

You will start physical therapy the first day after surgery and participate in physical therapy daily. Early and daily mobilization after a fracture, either to a chair or to a standing position, is essential to begin recovering following your surgery. You will have physical therapy two times a day. You may also receive occupational therapy.

  
Please feel free to contact us if you have any questions (423)431-6937