RESUMEN
Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.
RESUMEN
Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.
RESUMEN
Urinary retention is a common complication of bedridden patients in traumatic orthopedics. The severe condition can even cause permanent bladder injury and renal failure, which brings great pain and psychological pressure to patients and seriously hinders their rehabilitation. The traditional Chinese medicine appropriate technologies have the characteristics of safety, effectiveness, low cost, simplicity and easy learning and achieve good clinical effects in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopaedics, including Chinese herbal medicine, acupuncture and moxibustion, massage, etc. The authors summarize the research progress in appropriate technologies of traditional Chinese medicine in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopedics from aspects of action principles, operation methods and effects of acupuncture points, moxibustion therapy, manipulation therapy, external treatment of traditional Chinese medicine and acupoint injection, so as to provide a reference for further nursing research and clinical application.
RESUMEN
Objective@#To investigate the effect of leading health education path on the clinical nursing of patients with atlantoaxial fracture.@*Methods@#A retrospective case control study was conducted to analyze 38 patients with atlantoaxial fractures admitted to our hospital from January 2017 to February 2018. There were 31 males and 7 females, aged 21-65 years [(49.6±12.5)years]. In the control group, there were 15 males and four females, aged 25-63 years [(48.6±15.3)years]. All patients underwent posterior atlantoaxial pedicle screw fixation. Among the patients in control group, there were eight with atlas fracture, four with axial fracture, and seven with atlantoaxial fracture, of which there were five patients of grade C and 14 of grade D according to the American Spinal Injury Association (ASIA) score. There were 16 males and three females, aged 21-62 years [(51.2±12.3)years] in the study group which adopted the leading health education path to provide patients step by step with knowledge of atlantoaxial fracture. In the study group, there were seven patients with atlas fracture, six with axial fracture, and six with atlantoaxial fracture, of which there were seven patients of grade C and 12 patients of grade D based on ASIA. The visual analogue score (VAS) at 1 week and 1 month after operation, Japanese Orthopedic Association (JOA) score at 1 and 6 months after operation, related knowledge mastery, nursing satisfaction, complication incidence, and ASIA grading improvement were compared between the two groups.@*Results@#The VAS was (2.1±1.3)points at one week after operation and (1.1±0.6)points at one month after operation in the study group, lower than those of control group [(3.4±2.4)points and (2.1±1.2)points] (P<0.05). The JOA score of the study group was (15.9±1.5)points, higher than that of the control group [(14.7±1.3)points] (P<0.05). The scores of knowledge mastery including basic knowledge, appropriate medication, complications prevention and functional exercise were (23.2±2.4)points, (24.1±1.7)points, (21.5±3.1)points and (22.8±1.6)points respectively in the study group, all of which were higher than those of control group [(14.4±3.1)points, (12.9±2.1)points, (15.4±4.3)points and (13.4±3.5)points] (P<0.05). The satisfaction with nursing in the study group was also higher than that of the control group (P<0.05). In the study group, one patient (5%) had pulmonary infection, and in the control group nine patients (47%) had complications including two with lower extremity vein embolism, four with urinary tract infection, two with pulmonary infection, and one with pressure injury (P<0.05). In the study group, there was one patient of grade C, five of grade D and 13 of Grade E according to ASIA; in the control group, there were two of grade C, six of grade D and 11 of Grade E (P>0.05).@*Conclusion@#The leading health education path for patients with atlantoaxial fracture to adopt staged treatment guidance is conducive to relieving pain and improving cervical function, reducing the incidence of complications, and deepening the mastery of relevant knowledge.
RESUMEN
Objective To investigate the effect of leading health education path on the clinical nursing of patients with atlantoaxial fracture.Methods A retrospective case control study was conducted to analyze 38 patients with atlantoaxial fractures admitted to our hospital from January 2017 to February 2018.There were 31 males and 7 females,aged 21-65 years [(49.6 ± 12.5) years].In the control group,there were 15 males and four females,aged 25-63 years [(48.6 ± 15.3) years].All patients underwent posterior atlantoaxial pedicle screw fixation.Among the patients in control group,there were eight with atlas fracture,four with axial fracture,and seven with atlantoaxial fracture,of which there were five patients of grade C and 14 of grade D according to the American Spinal Injury Association (ASIA)score.There were 16 males and three females,aged 21-62 years [(51.2 ± 12.3) years] in the study group which adopted the leading health education path to provide patients step by step with knowledge of atlantoaxial fracture.In the study group,there were seven patients with atlas fracture,six with axial fracture,and six with atlantoaxial fracture,of which there were seven patients of grade C and 12 patients of grade D based on ASIA.The visual analogue score (VAS) at 1 week and 1 month after operation,Japanese Orthopedic Association (JOA) score at 1 and 6 months after operation,related knowledge mastery,nursing satisfaction,complication incidence,and ASIA grading improvement were compared between the two groups.Results The VAS was (2.1 ± 1.3) points at one week after operation and (1.1 ± 0.6) points at one month after operation in the study group,lower than those of control group [(3.4 ± 2.4) points and (2.1 ± 1.2) points] (P ＜ 0.05).The JOA score of the study group was (15.9 ±1.5) points,higher than that of the control group [(14.7 ± 1.3) points] (P ＜ 0.05).The scores of knowledge mastery including basic knowledge,appropriate medication,complications prevention and functional exercise were (23.2 ± 2.4) points,(24.1 ± 1.7) points,(21.5 ± 3.1) points and (22.8 ±1.6) points respectively in the study group,all of which were higher than those of control group [(14.4 ±3.1)points,(12.9 ±2.1)points,(15.4 ±4.3) points and (13.4 ±3.5)points] (P＜0.05).The satisfaction with nursing in the study group was also higher than that of the control group (P ＜ 0.05).In the study group,one patient (5％) had pulmonary infection,and in the control group nine patients (47％) had complications including two with lower extremity vein embolism,four with urinary tract infection,two with pulmonary infection,and one with pressure injury (P ＜ 0.05).In the study group,there was one patient of grade C,five of grade D and 13 of Grade E according to ASIA;in the control group,there were two of grade C,six of grade D and 11 of Grade E (P ＞ 0.05).Conclusion The leading health education path for patients with atlantoaxial fracture to adopt staged treatment guidance is conducive to relieving pain and improving cervical function,reducing the incidence of complications,and deepening the mastery of relevant knowledge.