Hip fracture nursing care plan

A hip fracture nursing care plan is a structured document setting out the assessments, NANDA diagnoses, interventions and expected outcomes after a broken hip. Hip fractures are most common in older adults. The first 72 hours after surgery and the first weeks of mobilization carry the highest risk of complications.

This guide walks through the assessment, diagnoses and interventions a nurse needs, with a shift-by-shift checkpoint schedule and a fully worked care plan entry. It links to a free downloadable template you can adapt for each patient.

Key takeaways

A hip fracture nursing care plan links each assessment finding to a NANDA-I diagnosis, a measurable goal, an intervention and a review point.

Acute pain, impaired physical mobility, risk for falls and risk for infection anchor most plans, with acute confusion and constipation close behind.

Neurovascular checks, venous thromboembolism (VTE) prophylaxis, delirium screening and getting the patient up the day after surgery are the priority postoperative interventions.

Hip precautions depend on the surgical approach, so the plan should copy the surgeon’s own orders rather than a generic list.

Digital forms in practice software such as Pabau keep the plan in one record that each shift updates and the next shift can trust.

Hip fracture nursing care plan: What it covers

A hip fracture nursing care plan is a written framework that connects what the nurse observes with what the nurse does about it. Each entry names a nursing diagnosis from NANDA International (NANDA-I) and the related factors that support it. It then sets out the interventions chosen and the outcomes the team expects to see.

Most plans follow the same five columns:

• Assessment data: The findings that point to the problem, such as a pain score or a skin check.
• Nursing diagnosis: The NANDA-I label, written with its related factors and defining characteristics.
• Goal: A measurable outcome with a time frame, such as walking 10 meters with a frame by day three.
• Interventions: The nursing actions that move the patient toward the goal.
• Evaluation: Whether the goal was met, and what changes if it was not.

The diagram below follows one acute pain entry from the worked example through all five columns.

Multidisciplinary teams use the plan to coordinate orthopedic surgeons, physical therapists, pharmacists and discharge coordinators. Regulators such as The Joint Commission expect care planning to be consistent and traceable. A shared plan supports both patient safety and audit readiness.

Hip fracture clinical context for nurses

Hip fractures are usually classed by location: Femoral neck, intertrochanteric and subtrochanteric. The fracture type decides the operation, and the operation decides much of the nursing plan.

Timing matters as much as technique. The NICE hip fracture guideline (CG124) recommends surgery on the day of admission or the day after. The American Academy of Orthopaedic Surgeons (AAOS) guideline supports surgery within 24 to 48 hours.

Elderly patients make up most cases, and they often carry comorbidities that raise the risk of delirium, pulmonary complications and falls. Planning starts at admission and continues through rehabilitation.

Nursing assessment on admission

Begin with a baseline the team can compare against later. Record pain, neurovascular status, skin integrity, nutrition, cognition and fall risk at admission.

• Neurovascular checks: Assess the affected limb for the 5 Ps (pain, pallor, paresthesia, pulselessness, paralysis) at regular intervals.
• Pain scoring: Use a validated numerical or behavioral scale and document the time of each reading.
• Skin integrity: Record existing pressure areas and use a screening aid such as the Braden scale as one input, not a final verdict.
• Nutritional status: Note intake, weight changes and any dietary restrictions.
• Cognitive baseline: Document orientation so later changes are easier to spot.
• Fall risk: Apply a locally approved tool such as the Morse Fall Scale.
• Elimination: Record bladder and bowel habits, any catheter, and the date of the last bowel movement.

A full nursing skin assessment at admission gives you a reference point for every pressure area check that follows. The same applies to the cognitive baseline. Without it, new confusion after surgery is hard to tell apart from a long-standing memory problem.

NANDA nursing diagnoses for hip fracture

NANDA-I diagnoses give the care plan a common language. The four below appear most often in hip fracture plans, and each should be linked to measurable goals.

Acute pain is usually the first diagnosis to address, because it limits the movement that every other goal depends on. Impaired mobility follows closely, and the two should be reviewed together at each shift. For wound checks and dressing goals, the risk for infection plan goes into more detail.

Risk for impaired skin integrity

Immobility and age both raise pressure injury risk. Plans should set a repositioning schedule and specify any pressure-relieving equipment. Record the screening score as one input among several clinical observations.

Risk for acute confusion

Delirium is common after hip fracture surgery and often starts within the first few days. Pain, infection, dehydration, urinary retention and new medicines can all trigger it. Screen at set intervals, and treat a sudden change in attention as urgent.

Constipation and urinary retention

Opioids, bed rest and reduced fluid intake slow the bowel. Retention is also common once a catheter comes out. Record each void and each bowel movement, because both problems can drive pain and delirium. The constipation nursing care plan sets out bowel goals and interventions in full.

Other diagnoses to add when they apply

Not every patient needs the same plan. Add these diagnoses when the assessment supports them:

Each of these has its own detailed plan. The DVT nursing care plan and the imbalanced nutrition care plan show how to write the goals and interventions in full.

Nursing interventions for hip fracture: Perioperative and postoperative care

Interventions change across the surgical pathway. Preoperative work focuses on pain control, fasting status and baseline observations. Postoperative work focuses on circulation, breathing, clot prevention and early mobilization.

• Monitor neurovascular status of the operated limb per the ward protocol.
• Follow the prescribed VTE prophylaxis regimen and document administration.
• Encourage deep breathing and coughing to reduce pulmonary complications.
• Reassess pain after each intervention and record the response.
• Escalate any new confusion, reduced urine output or fever to the medical team.

Dosages, anticoagulant choices and weight-bearing status are set by the surgical and medical team for each patient. The care plan should reference those orders rather than restate them as universal rules.

Hip precautions after arthroplasty

Hip precautions protect a replaced hip from dislocating while the soft tissues heal. They depend on the surgical approach, and many surgeons now relax or skip them. Copy the surgeon’s orders into the plan word for word.

Early mobilization

Getting the patient up early is one of the most effective interventions in the plan. NICE recommends a physical therapy assessment and mobilization on the day after surgery, unless there is a medical or surgical reason to wait. After that, the patient should mobilize at least once a day.

Give prescribed analgesia ahead of each session so pain does not cut it short. Record what the patient managed, such as sitting out, standing or steps with a frame. That record lets the next shift build on it.

The first 72 hours: A checkpoint schedule

Each phase of the first 72 hours has its own priorities. The schedule below maps them to the admission, surgery and early recovery phases, alongside what to write down. Frequencies still follow your ward protocol.

The “what to document” column is what makes handover work. When the plan records the time and result of each check, the next nurse can compare readings and spot a trend.

A worked example of one care plan entry

Here is one completed entry for acute pain, for an illustrative patient. She is 82 and had an intertrochanteric fracture fixed with an intramedullary nail. Use it as a model for the other diagnoses.

Notice that the goal names a number, an activity and a deadline. With all three in place, the evaluation becomes a yes-or-no answer.

Special considerations for elderly hip fracture patients

Older patients are at higher risk of postoperative delirium. Screening with the Confusion Assessment Method (CAM) is widely used in clinical practice. Teams should confirm which tool their local policy requires before stating it as mandatory.

• Delirium screening: Repeat the chosen tool at set intervals and after any medication change.
• Polypharmacy review: Flag sedating or anticholinergic medicines to the prescriber.
• Nutrition support: Involve the dietitian where intake is poor.
• Orthogeriatric input: Request a review from the orthogeriatric team when cognition or mobility declines.
• Bone health: Prompt an osteoporosis assessment, because one fragility fracture raises the risk of the next.
• Falls history: Record how the fall happened so the falls prevention plan targets the cause.

Discharge planning and expected outcomes

Discharge planning starts on admission. The care plan should record the home environment, mobility aids, medication changes, follow-up appointments and physical therapy arrangements. Capture them before the patient leaves the ward.

Patient teaching belongs in the plan with its own goals and evaluation. Before discharge, confirm the patient or caregiver can explain the following:

• Which movements to avoid, if hip precautions apply
• How to take anticoagulant and pain medicines, and for how long
• The signs of wound infection, clots or dislocation that need a call
• How to use the walking aid safely at home

A discharge planning worksheet helps you check equipment, follow-up and caregiver arrangements in one pass.

How to fill out the template

The downloadable template is a practical starting point rather than a finished record. Adapt each section to the patient in front of you and keep the clinical orders in your own record.

1. Complete the baseline assessment and mark any existing skin, cognition or nutrition concerns.
2. Select the NANDA diagnoses that match the patient’s current problems and note the related factors.
3. Write measurable goals and link each to a specific intervention and evaluation point.
4. Review the plan at each shift and update it when the patient’s status changes.
5. Carry the completed plan into discharge planning and share it with the multidisciplinary team.

Who uses the care plan

Ward nurses, orthopedic and geriatric teams, rehabilitation staff and nursing students all use hip fracture care plans. Students benefit from seeing how a diagnosis links to an intervention and an outcome. Post-acute and home care teams use the same plan to pick up where the hospital left off.

Benefits of a standardized care plan

A shared template makes handover faster and reduces the chance that a risk, such as falls or pressure injury, is missed between shifts. It also gives auditors a clear trail of assessment and response.

How Pabau keeps hip fracture care plans current across shifts

A paper care plan goes stale between updates. When it sits in a folder at the bedside, the night shift’s neurovascular check may never reach the day team’s handover. Findings get rewritten from memory, and a slow change is easy to miss.

Pabau, the practice management platform we build for private practices, rebuilds the template’s headings as digital forms for nursing teams. Staff complete each assessment on a tablet at the bedside, and the entry saves straight to the patient’s Client record with a time stamp. The next nurse opens one record and sees the trend.

Orthopedic, rehabilitation and post-acute practices can keep assessments, care plans and discharge notes together. That means less time chasing paperwork and more time with the patient. Every Pabau subscription includes the full feature set.

Keep every shift working from the same care plan

Pabau’s digital forms and Client records keep assessments, care plans and discharge notes in one place. Each update is time-stamped, so the next nurse sees what changed.

Book a demo

Conclusion

A hip fracture care plan earns its keep in the first 72 hours. That is when delirium, clots, pressure injuries and failed mobilization are most likely to start, and when a timed record catches them early. Write every goal with a number, an activity and a deadline.

The template gives you the structure, but the patient sets the content. Copy the surgeon’s orders for weight-bearing and precautions, and drop any diagnosis the assessment does not support. A shorter plan that the team reviews each shift beats a long one nobody updates.

If your team still carries care plans on paper, moving them into one shared record is the change that pays back fastest. Book a demo to see how Pabau keeps assessments, care plans and handover notes in one place for your team.

Continue your research

Caring for a patient on anticoagulant prophylaxis? DVT nursing care plan sets out the clot-prevention checks, leg assessments and teaching that run alongside hip fracture recovery.

Worried about pressure injuries during bed rest? Nursing skin assessment gives you a head-to-toe template for recording pressure areas, wounds and changes between shifts.

Is a fixation site showing signs of deep infection? Osteomyelitis nursing care plan covers the diagnoses and interventions for bone infection after orthopedic surgery.

Is poor appetite slowing your patient’s recovery? Imbalanced nutrition nursing care plan shows how to set intake goals and track weight, meals and dietitian input.

Getting ready to send the patient home? Discharge planning worksheet helps you confirm equipment, follow-up appointments and caregiver teaching before the patient leaves.

Frequently asked questions