PRE-OPERATIVE DELIRIUM IN A PATIENT WITH HIP FRACTURE: A CASE REPORT

Objective: delirium, defined as changes in baseline mental functions characterized by rapidly developing fluctuations of consciousness, attention and perception, is a common problem in elderly patients with hip fracture. the aim of this paper is to delineate the nursing care and outcomes within the treatment process of a patient having preoperative delirium during hospitalization in orthopedics and traumatology service due to hip fracture. case: ninety years old, female patient was proposed to emergency room by her relatives after falling at home. after the examination patient, diagnosed to have right femur intertrochanteric fracture, was admitted to the orthopedics and traumatology service, and skin traction with two kilogram weight was applied prior to surgery. on the preoperative second day of hospitalization, the patient developed unsuitable thinking process behaviours and conversations, tried to get out of the bed and throw the bed linens at night. responsible practitioner nurse considered the patient to have delirium symptoms and informed the physician. the patient was diagnosed to have delirium after psychiatry consultation. practitioner nurse planned, implemented and assessed the nursing care of patient with diagnosis of acute confusion, deterioration in mental process, self-care deficit syndrome. discussion and conclusion: delirium, that is especially common in elderly patients after hip fracture surgery, was recognized by the practitioner nurse preoperatively and required measures were taken in place. therefore nursing care was planned, applied and evaluated by the same practitioner nurse. interventions include providing quiet and relaxing environment by hospitalization of patient and companion in a separate room instead of ward, enhancing safety measures, initiation of required medication after psychiatric consultation, encouraging patient to participate in daily life activities as much as possible, briefing caregivers on care of patients with delirium. delirium can be under control by recognizing and interpreting the symptoms, providing physiological and psychosocial support, establishing effective communication, adjusting environmental factors and proper medication, and this period can become acceptable for both patients and relatives. thus, it is recommended for nurses to enhance their knowledge on delirium and geriatric patient care by in-service training programs.