Nursing Care Plan – 8 Fracture Nursing Care Plan (NCP)

A fracture (sometimes abbreviated FRX or Fx, Fx, or #) is a discontinuity or break in a bone. There are more than 150 fracture classifications (see this Wikipedia entry). Five major ones are as follow:

1. Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).
2. Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.
3. Closed: The fracture does not extend through the skin.
4. Open: Bone fragments extend through the muscle and skin, which is potentially infected.
5. Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.

Nursing Priorities

1. Prevent further bone/tissue injury.
2. Alleviate pain.
3. Prevent complications.
4. Provide information about condition/prognosis and treatment needs.

Discharge Goals

1. Fracture stabilized.
2. Pain controlled.
3. Complications prevented/minimized.
4. Condition, prognosis, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.

Diagnostic Studies for Fracture

1. X-ray examinations: Determines location and extent of fractures/trauma, may reveal preexisting and yet undiagnosed fracture(s).
2. Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI) scans: Visualizes fractures, bleeding, and soft-tissue damage; differentiates between stress/trauma fractures and bone neoplasms.
3. Arteriograms: May be done when occult vascular damage is suspected.
4. Complete blood count (CBC): Hematocrit (Hct) may be increased (hemoconcentration) or decreased (signifying hemorrhage at the fracture site or at distant organs in multiple trauma). Increased white blood cell (WBC) count is a normal stress response after trauma.
5. Urine creatinine (Cr) clearance: Muscle trauma increases load of Cr for renal clearance.
6. Coagulation profile: Alterations may occur because of blood loss, multiple transfusions, or liver injury.

Additional Diagnoses

1. Trauma, risk for—loss of skeletal integrity, weakness, balancing difficulties, reduced muscle coordination, lack of safety precautions, history of previous trauma.
2. Mobility, impaired physical—neuromuscular skeletal impairment; pain/discomfort, restrictive therapies (limb immobilization); psychological immobility.
3. Self-Care deficit—musculoskeletal impairment, decreased strength/endurance, pain.
4. Infection, risk for—inadequate primary defenses: broken skin, traumatized tissues; environmental exposure; invasive procedures, skeletal traction.

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