Found on the Floor at 6:15 a.m.
At 6:15 a.m. you are the only aide on your hall when you find Mrs. Nadia Petrov, 78, on the floor beside her bed. Her right leg is turned outward and appears shorter than the left. She is alert, pale, and diaphoretic, and says, "My hip-don't touch it." She takes warfarin and is on fall precautions with the bed in the low position. Her call light lies on the floor across the room. She keeps saying she wants to get up and use the bathroom. You are alone; the nurse is at the far end of the building, and the roommate is awake and asking what happened.
1. List your first actions in order, and state what you must not do.
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Order of actions:
- Do not move her. Leave her where she is and tell her not to try to get up. Any lift or straightening of that leg could turn a fracture into a worse injury or cause bleeding.
- Stay with her and call for help from where you are-use the wall call light, the phone, or call loudly down the hall. Do not leave her alone to go find the nurse; if you truly must leave to get help, that is a last resort and you summon someone first.
- Check responsiveness and breathing. Speak to her, note orientation, skin color, and whether she is breathing normally. If she were unresponsive and not breathing, the emergency response and CPR would come first.
- Keep her still and warm-light blanket, pillow under the head only if it doesn't move the hip, calm explanation of what is happening and that help is coming.
- Make the area safe while you wait: cover her, get the call light to her hand if it does not require moving her, and keep the roommate calm.
- Give the nurse a clear report when she arrives: what you found, the position of the leg, her complaints, and the time.
- Vital signs and neuro checks as the nurse directs-alertness, pulse, respirations, and later checking for signs of bleeding.
Must not: lift her, pull her by the arms, "straighten" the leg, sit her up, put her back to bed, give anything by mouth, or leave her alone without summoning help.
2. Which findings point to a hip fracture, and why does her warfarin matter?
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Findings:
- External rotation of the leg - the limb turns outward because the broken bone no longer holds its normal alignment.
- Apparent shortening - the muscle pulls the broken end of the femur upward, so the leg measures shorter.
- Severe pain localized to the hip, worse with any movement - she is guarding and telling you not to touch it.
- Pale, diaphoretic, and a fall - signs of pain and possible internal bleeding.
Why warfarin matters: warfarin thins the blood. Bleeding into the hip, thigh, or pelvis can be significant, and a head strike during the fall could cause bleeding inside the skull with few early signs. That is why you watch for changes in alertness, new confusion, unusual drowsiness, a dropping pulse or rising pulse, pallor, and swelling or bruising-and why you report any of these immediately. It also matters because she may need blood work and treatment decisions quickly; the nurse needs to know she is anticoagulated.
3. She keeps insisting she wants to get up and use the bathroom. How do you manage that, and what do you document afterward?
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Managing the insistence: do not argue or use force, but do not give in. Get to eye level, use her name, and be brief and calm: "Mrs. Petrov, I can't let you stand right now-your hip may be hurt. I'm staying right here with you and the nurse is on her way."
Offer what you can: a bedpan or urinal brought to her (if the nurse agrees she can be moved enough-otherwise she waits), a warm blanket, repositioning of the arms, cool cloth, reassuring touch, and a promise that someone stays with her. Repeated explanations work better than one long one; expect to repeat every couple of minutes. If she tries to stand, protect her by keeping your hands ready and calling for help-not by wrestling her down.
Documentation:
- Time you found her and exactly how she was lying, and what she said.
- Which leg, and exactly what the leg looked like-"right leg externally rotated, appeared shortened"-not a diagnosis.
- Skin color, sweating, level of alertness, complaints of pain and where.
- What you did: stayed with her, called for help, did not move her, kept her warm, who you told and when.
Not on the chart: opinions, guesses about blame, or "resident fell because she was careless." The fall itself usually goes on a separate incident report; the chart gets the facts and the care given. Report any change, worsening pain, or drowsiness to the nurse at once.