# An 82-year-old patient with a fractured hip is scheduled for surgery in 2 hours. The patient reports severe pain (8/10) and appears anxious. Which nursing intervention should be the priority?

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> subject: Adult Health

## 문제

An 82-year-old patient with a fractured hip is scheduled for surgery in 2 hours. The patient reports severe pain (8/10) and appears anxious. Which nursing intervention should be the priority?

## 보기

1. Administer prescribed analgesic medication and provide comfort measures **✔ 정답**
2. Encourage deep breathing exercises and early mobilization
3. Apply ice packs to the affected hip area
4. Position the patient in high Fowler's position for comfort

**정답: 1**

## 해설

Pain management is the priority for a patient with severe pain (8/10) and anxiety preoperatively, as uncontrolled pain can lead to complications and interfere with preparation. Other interventions like breathing exercises or positioning are important but secondary to immediate pain relief.

## 심화 해설

Understanding the Priority Setting

An 82-year-old patient with a hip fracture awaiting surgery presents with two interconnected problems: severe pain (8/10) and anxiety. In the NCLEX-RN framework, priority setting requires addressing the most immediate threat to the patient's physiological and psychological stability. Uncontrolled acute pain in an elderly patient is not merely a comfort issue; it triggers a cascade of harmful pathophysiological responses, including sympathetic nervous system activation, which increases heart rate, blood pressure, and myocardial oxygen demand. This is particularly dangerous in older adults who may have compromised cardiac function. Furthermore, the research evidence directly links preoperative psychological distress, including anxiety and fear, to worse postoperative outcomes. A study on preoperative surgical fear found that it is specifically associated with higher postoperative pain intensity and a lower quality of recovery after major joint surgery [3]. Therefore, the most critical and immediate nursing action is to break the pain-anxiety cycle by administering the prescribed analgesic and providing comfort measures.

Why Other Options Are Not the Priority

- **Option 2 (Deep breathing and early mobilization):** While deep breathing is a valuable non-pharmacological intervention for anxiety, it is insufficient as a sole intervention for severe pain rated 8/10. Early mobilization is contraindicated preoperatively for a non-surgically stabilized hip fracture due to the risk of displacement and further injury. Pain must be controlled first to enable any future participation in mobilization.

- **Option 3 (Apply ice packs):** Cold therapy can help reduce local inflammation and provide some analgesia, but it is an adjunctive measure, not the primary intervention for severe, acute pain in this context. Pharmacological management is the priority to achieve rapid and effective pain relief.

- **Option 4 (High Fowler's position):** This position is generally not recommended for a patient with a fractured hip as it can increase pressure and discomfort at the fracture site and does not address the underlying pain or anxiety.

The Critical Link Between Pain, Anxiety, and Surgical Outcomes

The rationale for prioritizing analgesic administration is strongly supported by the interconnected nature of pain and anxiety. A diagnostic model developed for elderly hip fracture patients highlights that trauma-related pain is a significant factor that complicates the diagnosis and screening of preoperative anxiety, which in turn significantly affects treatment prognosis . By effectively managing pain, the nurse simultaneously addresses a primary driver of the patient's anxiety. This integrated approach is crucial because a qualitative study on perioperative mental health interventions confirms that depression and anxiety can worsen surgical outcomes in older adults, underscoring the need for emotional health support that begins with basic comfort and pain control . Furthermore, a retrospective cohort study on older adults with hip fractures demonstrated that effective pain management strategies, such as continuous peripheral nerve blocks, are independently associated with reduced early opioid requirements . While the nurse in this scenario administers a prescribed analgesic, the principle is the same: early and aggressive pain control is a cornerstone of optimal perioperative care. Failing to prioritize pain management would leave the patient in a state of physiological stress, potentially complicating anesthesia induction and the postoperative recovery trajectory.References (research sources)

- [3]Preoperative Surgical Fear and Association with Postoperative Pain and Quality of Recovery After Total Joint Arthroplasty.Research articleGumus K, Çelik GK, Öztürk Ö. (2026) · DOI: 10.3390/jcm15093451

## 임상 시나리오

Preoperative Pain & Anxiety in Hip FracturePrioritizing Analgesia to Break the Pain-Anxiety Cycle
For an elderly patient with a hip fracture and 8/10 pain, the priority is to administer the prescribed analgesic. Uncontrolled pain triggers a sympathetic nervous system response, increasing heart rate and myocardial oxygen demand, which is especially dangerous in older adults.

Addressing pain directly helps reduce anxiety. Preoperative psychological distress is linked to worse postoperative outcomes, including higher pain intensity. Pharmacological intervention is the most effective way to break this pain-anxiety cycle.

CautionDo not rely solely on non-pharmacological methods like deep breathing for severe acute pain. Early mobilization is contraindicated before surgical stabilization. Avoid High Fowler's position, which can increase pressure and pain in the affected hip.

## 핵심 개념

- **Pain-Anxiety Cycle** — A vicious cycle where unrelieved pain increases anxiety, which in turn heightens pain perception, requiring simultaneous management of both symptoms.
- **Sympathetic Nervous System Activation** — The body's 'fight or flight' response to severe pain, causing increased heart rate, blood pressure, and myocardial oxygen demand, which is dangerous for elderly patients.
- **Preoperative Analgesia** — The administration of pain medication before surgery to manage acute pain, reduce physiological stress, and improve postoperative recovery outcomes.
- **Priority Setting (NCLEX-RN)** — A decision-making framework that requires the nurse to address the most immediate physiological or psychological threat to the patient's stability first.
- **Non-Pharmacological Intervention** — Comfort measures such as positioning, ice application, or breathing exercises that are used as adjuncts to, but not replacements for, pharmacological pain relief in severe acute pain.

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