Case study - Hip fracture: Nursing

Nurse Kenji works on an orthopedic unit and is caring for Sharon, a 74-year-old female with a history of osteoporosis who was recently admitted for a left hip fracture requiring an open reduction and internal fixation, or ORIF. After settling Sharon in her room, Nurse Kenji goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Sharon’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.  

First, Nurse Kenji recognizes important cues, including Sharon’s vital signs, which are temperature 98.6 F or 37 C, heart rate 90 beats per minute, respirations 19 breaths per minute, and blood pressure 123/88 mmHg. During the bedside report, Nurse Kenji learned that Sharon declined repositioning during the night shift. Upon assessment, he notes that her hip appears mildly swollen and her surgical dressing is clean and dry. Nurse Kenji also notes that Sharon’s left foot is warm with intact sensation, 2+ palpable pulses, and she can wiggle her toes.  

Nurse Kenji asks Sharon about her comfort.  

Nurse Kenji: I see that you stayed in the same position throughout the night. Could you tell me your current pain level? 

Sharon: I don’t have any pain right now, but I don’t want to move because I know it'll hurt my hip. 

Nurse Kenji: I understand. Have you considered taking the prescribed medications to manage your pain? 

Sharon: I really don’t like pain medicine because I’m worried about becoming addicted. 

Next, Nurse Kenji analyzes these cues. He reviews the electronic health record, or EHR, and notes that Sharon is scheduled to begin physical therapy today. He also notes that Sharon is prescribed ice packs to reduce hip swelling, as well as oxycodone and acetaminophen every four hours as needed for pain management but hasn’t taken any medication since early yesterday evening. Nurse Kenji realizes that Sharon’s fear of pain is limiting her mobility. 

With the information he's gathered, Nurse Kenji develops a priority hypothesis of impaired mobility.