Clinical Manifestation and Nursing Care Challenges of Neurogenic Bowel Disorder in Closed-Intertrochanteric Fracture Dextra an a 58-Year-Old Female with T2dm And Atelectasis-Tuberculosis: a Case Report

Rina Anggraeni, Tuti Pahria, Chandra Isabella Hostanida Purba

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ABSTRACT

 

Intertrochanteric fractures, characterized by breaks in the proximal femur outside the joint capsule, present significant rehabilitation challenges, especially in older adult with comorbidities. These fractures disrupt the attachment points for major muscles and can lead to complications if not promptly and effectively treated. This case report explores the complex clinical scenario of a 58-year-old female patient with a history of Type 2 diabetes mellitus (T2DM) and tuberculosis, who suffered a closed intertrochanteric fracture dextra. The complications were exacerbated by neurogenic bowel disorder (NBD) due to prolonged immobility. The patient presented to the emergency department with severe hip pain following a fall at home, where she had been bedridden for two weeks. During this time, she developed a grade 2 decubitus ulcer. Despite her painful condition, initial treatment was delayed, leading to severe complications. A subsequent chest X-ray revealed infiltration along with atelectasis of the left superior lobe and left pleural effusion indicative of exacerbated pulmonary tuberculosis. Diagnostic imaging also identified an obstructive ileus. Immediate surgical intervention was indicated to manage the fracture. In addition to surgical care, the patient required specialized nursing care to address her acute and chronic medical needs, including blood glucose monitoring and management of her pulmonary condition. Prior to her surgery, Swadesh massage therapy was employed, resulting in minor relief indicated by the passage of a small amount of hard, mucous-like feces. Effective management of closed intertrochanteric fractures in patients with significant comorbidities requires a multidisciplinary approach. Early surgical intervention, combined with tailored nursing care and continuous monitoring of associated complications, is crucial for restoring functionality and preventing further health deterioration.

 

Keywords: Intertrochanteric Fracture, Neurogenic Bowel Disorder, Type 2 Diabetes Mellitus, Pulmonary Tuberculosis, Multidisciplinary Care.


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Alhani, F., Asghari-Jafarabadi, M., Norouzadeh, R., Rahimi-Bashar, F., Vahedian-Azimi, A., Jamialahmadi, T., & Sahebkar, A. (2022). The effect of family-centered empowerment model on the quality of life of adults with chronic diseases: An updated systematic review and meta-analysis. Journal of affective disorders, 316, 140–147. https://doi.org/10.1016/j.jad.2022.07.066

Alsaywid, B. S., & Abdulhaq, N. M. (2019). Guideline On Writing A Case Report. Urology Annals, 11(2), 126–131. Https://Doi.Org/10.4103/Ua. Ua_177_18

Attum, B., & Pilson, H. (2023). Intertrochanteric Femur Fracture. In StatPearls. StatPearls Publishing.

Carretta, E., Bochicchio, V., Rucci, P., Fabbri, G., Laus, M., & Fantini, M. P. (2011). Hip fracture: effectiveness of early surgery to prevent 30-day mortality. International orthopaedics, 35(3), 419–424. https://doi.org/10.1007/s00264-010-1004-x

Chen, P., Hallock, K. K., Mulvey, C. L., Berg, A. S., & Cherian, V. T. (2018). The Effect of Elevated A1C on Immediate Postoperative Complications: A Prospective Observational Study. Clinical diabetes : a publication of the American Diabetes Association, 36(2), 128–132. https://doi.org/10.2337/cd17-0081

Chiari, P., Forni, C., Guberti, M., Gazineo, D., Ronzoni, S., & D'Alessandro, F. (2017). Predictive Factors for Pressure Ulcers in an Older Adult Population Hospitalized for Hip Fractures: A Prognostic Cohort Study. PloS one, 12(1), e0169909. https://doi.org/10.1371/journal.pone.0169909

Emmanuel A. (2019). Neurogenic bowel dysfunction. F1000Research, 8, F1000 Faculty Rev-1800. https://doi.org/10.12688/f1000research.20529.1

Galivanche, A. R., Kebaish, K. J., Adrados, M., Ottesen, T. D., Varthi, A. G., Rubin, L. E., & Grauer, J. N. (2020). Postoperative Pressure Ulcers After Geriatric Hip Fracture Surgery Are Predicted by Defined Preoperative Comorbidities and Postoperative Complications. The Journal of the American Academy of Orthopaedic Surgeons, 28(8), 342–351. https://doi.org/10.5435/JAAOS-D-19-00104

Hamasaki H. (2023). The Effects of Mindfulness on Glycemic Control in People with Diabetes: An Overview of Systematic Reviews and Meta-Analyses. Medicines (Basel, Switzerland), 10(9), 53. https://doi.org/10.3390/medicines10090053

Leer-Salvesen, S., Engesæter, L. B., Dybvik, E., Furnes, O., Kristensen, T. B., & Gjertsen, J. E. (2019). Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register. The bone & joint journal, 101-B(9), 1129–1137. https://doi.org/10.1302/0301-620X.101B9.BJJ-2019-0295.R1

Merloz P. (2018). Optimization of perioperative management of proximal femoral fracture in the elderly. Orthopaedics & traumatology, surgery & research : OTSR, 104(1S), S25–S30. https://doi.org/10.1016/j.otsr.2017.04.020

Molitoris, K. H., Balu, A. R., Huang, M., & Baht, G. S. (2024). The impact of age and sex on the inflammatory response during bone fracture healing. JBMR Plus, 8(5), ziae023. https://doi.org/10.1093/jbmrpl/ziae023

Rayman G, Akpan A, Cowie M, et al. Managing patients with comorbidities: future models of care. Future Healthc J. 2022;9(2):101-105. doi:10.7861/fhj.2022-0029

Rozenfeld, M., Bodas, M., Shani, M., Radomislensky, I., Murad, H., Comaneshter, D., Israeli, A., & Peleg, K. (2021). National study: Most elderly patients benefit from earlier hip fracture surgery despite co-morbidity. Injury, 52(4), 905–909. https://doi.org/10.1016/j.injury.2020.10.060

Ståhl, A., & Westerdahl, E. (2020). Physiotherapy to prevent hospital-acquired pneumonia in patients undergoing hip fracture surgery. European Respiratory Journal, 56(suppl 64), 1268. https://doi.org/10.1183/13993003.congress-2020.1268

Yao, W., Sun, X., Tang, W., Wang, W., Lv, Q., & Ding, W. (2024). Risk factors for hospital-acquired pneumonia in hip fracture patients: A systematic review and meta-analysis. Medicine, 103(10), e35773. https://doi.org/10.1097/MD.0000000000035773

Yu, Y., & Zheng, P. (2022). Determination of risk factors of postoperative pneumonia in elderly patients with hip fracture: What can we do?. PloS one, 17(8), e0273350. https://doi.org/10.1371/journal.pone.0273350

Zhao, K., Zhang, J., Li, J., Guo, J., Meng, H., Zhu, Y., Zhang, Y., & Hou, Z. (2020). In-Hospital Postoperative Pneumonia Following Geriatric Intertrochanteric Fracture Surgery: Incidence and Risk Factors. Clinical interventions in aging, 15, 1599–1609. https://doi.org/10.2147/CIA.S268118

Ziegler, C. M., Wagner, F., Alleborn, K., Geith, T., Holzapfel, B. M., & Heimkes, B. (2024). Muscle forces acting on the greater trochanter lead to a dorsal warping of the apophyseal growth plate. Journal of anatomy, 244(1), 63–74. https://doi.org/10.1111/joa.13944




DOI: https://doi.org/10.33024/mahesa.v6i2.20428

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