I am a CNA at a nursing home. I haven't been a CNA long, less than 6 months.
We have a resident who is 101 years old. She fell out of bed last week and complained consistantly of leg, knee pain. We continued to tell the nurses and they tried to get the resident to be more specific about the pain, but the resident has dementia and usually can't even tell us her name.
Yesterday she finally went for an x-ray. It wasn't read till today after noon. It was discovered she has a fractured hip.
My questions are...is that the normal procedure before determining whether to x-ray?... She was still treated the same ie regular transfer and walking orders. Even this morning I was unaware of her possible fracture and two of us had her standing and were tugging her pants up! Also we have received no change in how to treat her except that she doesn't have to walk to the diningroom. She is still two person transfer.
They are not going to do surgery and they have offered her tylenol as pain medication.
I am shocked and horrified thinking it seems like not enough care is taken both before and now after this incident.
Is it truely not that big of deal and minimally painful that she can continue her regular care plan minus the walking to the diningroom?
All you nurses out there please respond!
Oct 20, '01
No, this is NOT the way this patient should have been treated!!
She should have been examined immediately by her nurse to check for injury, especially for the possibility of a fracture, and the MD notified right away, with emphasis given to the patient's c/o pain -regardless of whether or not she could be specific about the site of her pain. At her advance age, it would be a wonder if she HADN'T sustained a fracture! I can't think of a single one of my doctors who would not have ordered x-rays immediately, and been very upset that it took 24 hours to get the results.
I am not surprised that there will be no surgery. At her age, chances are that she would not survive surgery, and at her advanced age, the fracture may not heal regardless of whether surgery were performed. I am surprised, though, that she wasn't even placed on fracture precautions, with staff being taught ways to care for her without causing further injury or increased pain. She most definitely does not need to lie on the affected side, or to put weight on that leg. And the hip needs to be kept as immobile as possible.
It IS possible that tylenol could relieve her pain. We all have different pain thresholds. But she should be monitored closely for signs that her pain is NOT being relieved.
Thank you for your concern about your patient. I'm glad that you didn't just report her problem and forget it. Many would have. Her recovery may depend on what you observe and report about changes in her condition, so please continue to watch her closely, and handle very gently.
Oct 21, '01
I'm so sorry that you experienced this Vicki30CNA. this is absolutely unacceptable behavior, on the part of the nurse and physician of this facility. When an elderly person has a fall, Fractures are one of the first things that hit your mind, and in my expeience also first in the physician,s mind. Full exam and x-rays should have been ordered immediately. This borders on neglect and abuse. Another thing i wonder about, was this patient on fall precautions? She is going to need delicate care from now on, considering no surgery and good pain management. Anything could have happened from this including throwing a blood clot,leading to..... I'll close now because i'm mad
Oct 25, '01
Vicki, bravo to you for being a patient advocate
One thing has always stuck in my head from CNA training, if a person acts like they are in pain, they are & if a hip fracture is a possibility check to see if one leg is shorter than the other or if the leg turns in or out.
And don't ever be afraid to go higher if you feel it is in the pt's best interest.
Your 101yr old is a poor candidate for surgery, but she deserves some kind of efforts for her pain to be relieved.
Oct 26, '01
Isn't it amazing what we do to the pts that can't articulate their pain? In the NICU, with babies, we give them tylenol post-op. They cry, of course, but all babies cry so tylenol is all they get. Seems to be similar with older adults with dementia. Terrible isn't it?
Nov 10, '01
I hope that NOW she is on fall precautions. Come on now, don't laugh...We had a resident who fell and fx his hip. Two days later, he climbed OOB and fx'd the other one. Said that he was going for a smoke! Now we put any fall risk in a low bed and they roll off the bed and onto a mat. Then we scoop them up with the lift and put them back into bed. After doing this about 3 or 4 times, we put them in a geri chair and bring them out to the nurses station where we can monitor them very closely. This seems to work out well. And as far as pain medication, they usually only get tylenol unless their pain isn't releived, then the Dr will prescribe tylenol #3 or percocet.
Nov 12, '01
This is for Vicki!
Hooray for you. This incident is negligence; and of course,
in this day, bedrails are a restraint! Though most older folks
will go right over 'em. Keep up the good work!
Nov 22, '01
In my experience, bed rails just give the patient further to fall!
Dec 14, '01
Absolutely NOT normal procedure to assess and treat after a fall in this manner!!! And good for you for caring so much about your patients -- you are the kind of CNA we need more of!!!! We recently had a nurse put a resident back to bed after a fall in the middle of the night, and she charted no injuries notes. The am nurse came on and noted obvious rotation of one leg and sent her immediately for x-rays. It was fractured and she had surgery. We just had an inservice done by PT on the proper way to assess for fractures in the hip -- in someone who is oriented and someone who is not -- and the proper way to treat, transfer, etc if a fracture is suspected. Even though surgery isn't going to be done on this lady, she should be on fall precautions (at our facility we use the low bed and we also use bed alarms) and also should be on a positioning program I would think -- leg rolls to keep the hip in alignment etc.
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