What are the basic orders for a patient admitted for hip fracture repair?

Basic Orders for Hip Fracture Repair Admission

The basic orders for a patient being admitted for hip fracture repair should include analgesia with regular paracetamol and peripheral nerve blocks, DVT prophylaxis with low-molecular-weight heparin, supplemental oxygen for at least 24 hours postoperatively, early mobilization planning, and careful fluid management. 1

Pre-operative Orders

Pain Management

• Order peripheral nerve block (femoral or fascia iliaca) to be performed in the Emergency Department 1
  • Ultrasound-guided placement recommended for accuracy
  • Consider repeat block pre-operatively if >6 hours since initial block
• Regular paracetamol 1g every 6 hours 1, 2
• Avoid routine opioids if possible (especially in elderly with renal dysfunction)
• Avoid NSAIDs in elderly patients or those with renal dysfunction 3

Fluid Management

• Pre-operative fluid therapy should be prescribed routinely 1
• Consider cardiac output-guided fluid administration to reduce hospital stay 1
• Early oral fluid intake should be encouraged when possible 1

DVT Prophylaxis

• Low-molecular-weight heparin (preferred) 1, 4
• Start on admission and continue through perioperative period
• Consider mechanical prophylaxis (compression stockings) as adjunct

Oxygen Therapy

• Order supplemental oxygen for at least 24 hours postoperatively 1
• Monitor oxygen saturation regularly

Nutrition

• Nutritional assessment and supplementation as needed (60% of hip fracture patients are malnourished on admission) 1
• Consider dietetic consultation for patients with poor nutritional status

Post-operative Orders

Pain Management

• Continue regular paracetamol administration 1, 2
• Consider scheduled IV acetaminophen which has been shown to reduce length of stay, pain scores, and narcotic usage 2
• Peripheral nerve blocks can be repeated postoperatively if needed 1
• Pain evaluation should be included as part of routine nursing observations 1

Fluid Balance

• Remove urinary catheters as soon as possible to reduce UTI risk 1
• Monitor fluid balance carefully
• Encourage oral fluid intake rather than routine IV fluids 1

Mobilization and Rehabilitation

• Early mobilization orders (key part of management) 1
• Physical therapy consultation for day 1 post-op
• Occupational therapy assessment for activities of daily living

Monitoring

• Regular vital signs monitoring
• Assess for postoperative cognitive dysfunction/acute confusional state (common in 25% of patients) 1
• Monitor for complications: chest infection, myocardial ischemia, UTI 1

Special Considerations

Bone Cement Implantation Syndrome Prevention

• If cemented prosthesis planned, order increased oxygen concentration at time of cementation
• Ensure adequate intravascular volume before cement insertion 1
• Consider additional hemodynamic monitoring in high-risk patients 1

Delirium Prevention

• Avoid medications that may worsen confusion (e.g., cyclizine) 1
• Maintain proper hydration, nutrition, and electrolyte balance
• Use haloperidol or lorazepam only for short-term symptom control if necessary 1

Common Pitfalls to Avoid

1. Inadequate pain control leading to delayed mobilization
2. Overuse of opioids causing delirium and constipation
3. Prolonged catheterization increasing UTI risk
4. Delayed mobilization increasing risk of complications
5. Inadequate nutrition delaying healing and recovery
6. Failure to recognize and treat delirium promptly

By implementing these evidence-based orders, you can help minimize morbidity and mortality while promoting early recovery and return to pre-fracture functional status for patients undergoing hip fracture repair.