Specifičnosti sestrinske skrbi kod bolesnika s prijelomom vrata bedrene kosti

Pertrohanterna fraktura je prijelom bedrene kosti u proksimalnom dijelu, u pertrohanternoj regiji kod kojih prijelomna pukotina uvijek križa zamišljenu spojnicu između dva trohantera. Čine 15% svih prijeloma lokomotornog sustava, a najčešći su kod starije populacije kod koje su prisutne osteoporotične promjene, te nastaju i pod djelovanjem malih sila. Pertrohanterni se prijelomi mogu podijeliti anatomski na subtrohanterne i intertrohanterne, a po tipu prijeloma na stabilne i nestabilne. Liječenje je uglavnom operativno osim u slučaju relativnih ili apsolutnih kontaindikacija za operativni zahvat kada se pribjegava konzervativnim metodama- imobilizaciji ekstenzijom, privremenom ( do zahvata ) ili trajnom. S obzirom na dob bolesnika i komorbiditete u prijeoperacijskom periodu vrši se temeljita priprema i kondicioniranje bolesnika, te daje adekvatna profilaksa za moguće komplikacije. Metode operativnog zahvata ovise o tipu prijeloma, najčešće DHS ( Dynamic Hip Screw ) vijkom ili Gamma čavlom. U ranom poslijeoperacijskom periodu intervencije medicinske sestre su vezane uz praćenje vitalnih funkcija i operativnog područja, a u kasnijem periodu pažnja se posvećuje sprećavanju mogućih komplikacija, praćenju psiho-emotivnih promjena i stanja svijesti ( zdravstvena njega sadrži i neke gerontološke značajke ), a isto tako i što ranijoj mobilizaciji u okviru dozvoljenog pri čemu značajnu ulogu ima fizioterapeut. S obzirom da bolesnik po otpustu nastavlja rehabilitaciju i ovisan je o pomoći, kroz cijelo vrijeme boravka na odjelu se vrši edukacija bolesnika i obitelji, odnosno skrbnika. Ponekad je taj segment problematičan zbog izostanka resursa podrške te je nužno inkorporirati i socijalne službe, a bolesnik se smješta u ustanove specijalizirane za kronične bolesti.Pertrochanteric fracture is a thigh bone fracture in the proximal part of the bone, in the pertrochanteric region, where the fracture line always crosses the imagined junction between the two trochanters. Pertrochanteric fractures make up 15% of all locomotor system fractures, and most commonly occur among the older population with osteoporotic changes, thus such fractures are caused even by a small force. In anatomical terms, pertrochanteric fractures can be divided into subtrochanteric and intertrochanteric, while in terms of the fracture type they can be classified as stable or unstable fractures. The treatment is usually surgical unless there are relative or absolute surgery contraindications, which requires application of conservative methods – immobilization through extension, either temporary (before the surgery) or permanent one. Depending on patient's age and comorbidities, the pre-surgical period includes a detailed preparation and conditioning of the patient as well as giving an adequate prophylaxis for possible complications. Surgical methods depend on the type of the fracture, and usually include a DHS (Dynamic Hip Screw) or a Gamma nail. In the early post-surgical period nursing interventions relate to the follow-up of the vital functions and the surgical region, while the later period includes prevention of possible complications, the follow-up of psychological and emotional changes and of the state of consciousness (medical care contains some of the gerontological features as well). In addition, nursing interventions include as early mobilization as possible and as permitted, whereupon the physiotherapist has a significant role. Since the patient after the discharge from the hospital continues with the rehabilitation and depends on others, both patient and her/his family (guardians) are educated through the entire period spent in hospital. This may be problematic sometimes bearing in mind the lack of support resources, therefore it is necessary to engage social services as well, while the patient is put in chronic disease institutions