Introduction

A femoral neck fracture is a hip fracture in which the neck of the thigh bone (femur) is partially or completely
broken. Femoral neck fractures may occur as a result of a fall or motor vehicle accident, or they may occur
spontaneously because of a disease process such as osteoporosis. Stress fractures can result from repetitive
mechanical stress or structural defects in the bone that make it weak or brittle. Femoral neck fractures in the
elderly may occur spontaneously or following low-velocity trauma; in young adults, femoral neck fracture usually
is caused by high-velocity trauma. Conditions that predispose to femoral neck fracture include diabetes,
osteoporosis (particularly in postmenopausal women), softening of the bones (osteomalacia), cancer that has
metastasized to the bone,rheumatoid arthritis, neurological disease, previous hip
fracture,hyperparathyroidism associated with severe renal disease and maternal history of hip fracture.

A complete fracture is described as the femoral neck no longer being intact. A displaced fracture of the femoral
neck, usually caused by trauma, refers to a condition where the bone has been moved out of its original position
resulting in the two adjoining bone fragments failing to line up. Another potential scenario for a displaced fracture
is a femoral neck bone fragment having rotated about its axis. If a stress fracture goes unrecognized, it can
progress to a complete fracture and displace.

Fractures of the femoral neck are divided into four types according to the Garden system, which describes
fractures according to their degree of completeness and displacement. Garden Type I fracture is incomplete or
twisted (valgus impacted); Type II is complete but not displaced; Type III is complete and partially displaced; and
Type IV is complete and totally displaced. Type I fractures are considered stable, while the other classes of
fractures are considered unstable. An impacted fracture, in which the surfaces are crushed together, must be
distinguished from a nondisplaced fracture. A nondisplaced fracture has no impaction and no inherent instability.

Distance runners and ballet dancers are at particular risk for developing a stress or incomplete fracture of the
femoral neck, as are the elderly. Other risk factors for femoral neck fracture include low body weight,
prior radiation treatment (irradiation), sedentary lifestyle, impaired vision and poor balance that results in falls,
and previous hip fracture. Athletic training errors, such as a sudden increase in the quantity or intensity of training
or the introduction of a new activity, also are risk factors.

Objectives

General Objectives

The study aims to widen our nursing skills and knowledge by understanding and gathered
information through proper execution of nursing process pertaining to our case Abdominal Aortic
Aneurysm.

Specific Objectives

After the case study and presentation we will be able to:

• Understand the process by which Abdominal Aortic Aneurysm develops.
• Determine the various risk factors that contribute to the development of Abdominal Aortic
Aneurysm.
• Be able to give clinical significance of various laboratory and diagnostic exam.
• Be able to formulate and implement appropriate nursing care plan.
• Be able to determine what drugs are used on treating Abdominal Aortic Aneurysm along with its
responsibilities.
 • Be able to put into practice and impart essential health teachings for achievement of patient’s
optimal health.
• Be able to evaluate if the goals, plan of care and objectives were met.

Patient’s Data

Name: Isabel Emano Bagang

Sex: Female
Age: 73 y/o
Birthday: October 24, 1937
Address: Sitio Kumunoy, Brgy. Bagong Silangan, Quezon City
Nationality: Filipino
Religion: Roman Catholic
Status: Widow
Admitting Diagnosis: Fracture Femoral Neck Left
Date of Admission: April 1, 2011
Time of Admission: 6:00 am
Nursing Health History

Chief Complaint: “Pain because of fall”

History of Present Illness:

Few days prior o admission, while sweeping in her backyard, the patient fell hitting her
left hip and left lower extremity. The patient can no longer walk due to pain. Her son brings her
on bed inside their house. The patient complaint pain on her left hip. On the next day, she wasn’t
able to walk and she still felt the pain that is why they decided to bring the patient to East
Avenue Medical Center.

Past Health History:

The client recalled his childhood diseases such as measles, mumps and chickenpox. He
has the following immunizations such as BCG, Hepa B, and DPT and OPV as compulsory
during his childhood. Also, he had no known allergies.

On year 2006, the patient was vomit blood that is why she was admitted on the same
institution and stayed for 1 week. Prior to that, she felt pain on her abdomen. She is also
hypertensive but she doesn’t have maintenance.

Family History of Illness:

They had a history of hypertension. Her uncle and mother are hypertensive.

Social and Lifestyle Data:

 According to the patient she doesn’t smoke or even drinks alcoholic beverages. The
patient eats three to four meals per day, she eats anything available but pork adobo was her
favorite viand. She doesn’t complaint difficulties sleeping, she slept 9-10 hours per day he sleep
at 9pm. She took a bath every day. She eliminates and urinates regularly. She is a full time
housewife when she was at home she watch TV and do a house hold task. She always swept
their backyard regularly and that is one of her exercise.

Anatomy and Physiology

The femoral aspect of the hip is made

up of the femoral head with its articular cartilage and the femoral neck, which connects the head to the
shaft in the region of the lesser and greater trochanters. The synovial membrane incorporates the entire
femoral head and the anterior neck, but only the proximal half of the posterior neck. The shape and size
of the femoral neck vary widely.

Crock standardized the nomenclature of the vessels around the base of the femoral neck. The blood
supply to the proximal end of the femur is divided into 3 major groups. The first is the extracapsular
arterial ring located at the base of the femoral neck. The second is the ascending cervical branches of
the arterial ring on the surface of the femoral neck. The third is the arteries of the ligamentum teres.

A large branch of the medial femoral circumflex artery forms the extracapsular arterial ring posteriorly
and anteriorly by a branch from the lateral femoral circumflex artery (see images shown below). The
ascending cervical branches ascend on the surface on the femoral neck anteriorly along the
intertrochanteric line. Posteriorly, the cervical branches run under the synovial reflection toward the rim
of the articular cartilage, which demarcates the femoral neck from its head. The lateral vessels are the
most vulnerable to injury in femoral neck fractures.
 Posterior view of the extraosseous blood supply to the femoral

head. Anterior view of the extraosseous blood supply to the femoral head.
A second ring of vessels is formed as the ascending cervical vessels approach the articular margin of
the femoral head. From this second ring of vessels, the epiphyseal arteries are formed. The lateral
epiphyseal arterial group supplies the lateral weight-bearing portion of the femoral head. The
epiphyseal vessels are joined by the inferior metaphyseal vessels and vessels from the ligamentum
teres.

Femoral neck fractures frequently disrupt the blood supply to the femoral head (see images below).
The superior retinacular and lateral epiphyseal vessels are the most important sources of this blood
supply. Widely displaced intracapsular hip fractures tear the synovium and the surrounding vessels.
The progressive disruption of the blood supply can lead to serious clinical conditions and complications,
including osteonecrosis and nonunion.
 Posterior view of the extraosseous blood supply to the femoral head.

Anterior view of the extraosseous blood supply to the femoral head.

http://emedicine.medscape.com/article/86659-overview#a0106

http://education.yahoo.com/reference/gray/subjects/subject/59

http://www.health-writings.com/femoral-neck-fracture-pathophysiology/

Pathophysiology
 CLINICAL CHEMISTRY

Date: 04-14-11

Time: 15:08:41
RESULT NORMAL VALUES INTERPRETATION/ANALYSIS
Sodium 127 135-148
Potassium 4.5 2.60-5.20 NORMAL

Laboratory Exam

COAGULATION REPORT

Date: 4-14-11
COMPONENTS RESULT NORMAL VALUES INTERPRETATION/ANALYSIS
Prothrombin Time

PT 13.4 11.0-14.0

% activity 120

INR 0.90
Control 11.7
Activated Partial
Thromboplastin time

APTT
23.5 26-31
Control
26.0

RESULT NORMAL VALUES INTERPRETATION/ANALYSIS

BUN 6.0 20.5-61

Creatinine 52 53.00-115.00

Sodium 144 135-148

Potassium 3.0 3.60-5.20

Chloride 108.5 100-108

RESULT NORMAL INTERPRETATION/ANALYSIS

VALUES
COMPONENT

WBC Count 10.8 5.10

Hemoglobin 116 120-140

Hematocrit 0.35 0.38-0.48 NORMAL

DIFFERENTIAL
COUNT

Neutrophil
0.82 0.45-0.65
Lymphocyte
Monocyte 0.09 0.25-0.50
Eosinophils 0.05 0.02-0.06 NORMAL

0.04 0.02-0.04 NORMAL

Platelet count

MCV 435 150-450 NORMAL

MCH 89.7 80-100 NORMAL
MCHC 29.0 27-31 NORMAL
RDW 323 320-360 NORMAL

13.5 11.6-14.6 NORMAL

Nursing Care Plan