A fracture is the medical term used for a broken bone. They occur when the physical force exerted on the bone is stronger than the bone itself. They commonly happen because of car accidents, falls or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Fracture is sometimes abbreviated FRX or Fx, Fx, or #.
Types of Fracture
There are many types of fractures, but the main categories are complete, incomplete, open, closed and pathological. Five major types are as follows:
- Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).
- Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.
- Closed: The fracture does not extend through the skin.
- Open: Bone fragments extend through the muscle and skin, which is potentially infected.
- Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.
Nursing care planning of a patient with a fracture, whether in a cast or in traction, is based upon prevention of complications during healing. By performing an accurate nursing assessment on a regular basis, the nursing staff can manage the patient’s pain and prevent complications. On emergency trauma care basic include triage, assessment and maintaining airway, breathing, and circulation, protecting the cervical spine and assessing the level of consciousness.
Here are eleven (11) nursing care plans (NCP) and nursing diagnosis (NDx) for fracture:
- Risk for Trauma: Falls
- Acute Pain
- Risk for Peripheral Neurovascular Dysfunction
- Risk for Impaired Gas Exchange
- Impaired Physical Mobility
- Impaired Skin Integrity
- Risk for Infection
- Deficient Knowledge
- NEW Risk for Injury
- NEW Self-Care Deficit
- NEW Constipation
- Other Nursing Diagnoses
Risk for Trauma: Falls
Risk for Falls: Increased susceptibility to falling that may cause physical harm.
- Risk for Trauma
Risk factors may include
- Loss of skeletal integrity (fractures)/movement of bone fragments
- Getting up without assistance
- Client will maintain stabilization and alignment of fracture(s).
- Client will display callus formation/beginning union at fracture site as appropriate.
- Client will demonstrate body mechanics that promote stability at the fracture site.
|Maintain bed rest or limb rest as indicated. Provide support of joints above and below fracture site, especially when moving and turning.||Provides stability, reducing the possibility of disturbing alignment and muscle spasms, which enhances healing.|
|Secure a bed board under the mattress or place patient on the orthopedic bed.||A soft or sagging mattress may deform a wet (green) plaster cast, crack a dry cast, or interfere with the pull of traction.|
|Support fracture site with pillows or folded blankets. Maintain a neutral position of affected part with sandbags, splints, trochanter roll, footboard.||Prevents unnecessary movement and disruption of alignment. Proper placement of pillows also can prevent pressure deformities in the drying cast.|
|Use sufficient personnel for turning. Avoid using abduction bar for turning patient with a spica cast.||Hip, body or multiple casts can be extremely heavy and cumbersome. Failure to properly support limbs in casts may cause the cast to break.|
|Observe and evaluate splinted extremity for resolution of edema.||Coaptation splint (Jones-Sugar tong) may be used to provide immobilization of fracture while excessive tissue swelling is present. As edema subsides, readjustment of splint or application of plaster or fiberglass cast may be required for continued alignment of fracture.|
|Maintain position or integrity of traction.||Traction permits pull on the long axis of the fractured bone and overcome muscle tension or shortening to facilitate alignment and union. Skeletal traction (pins, wires, tongs) permits the use of greater weight for traction pull than can be applied to skin tissues.|
|Ascertain that all clamps are functional. Lubricate pulleys and check ropes for fraying. Secure and wrap knots with adhesive tape.||Ensures that traction setup is functioning properly to avoid interruption of fracture approximation.|
|Keep ropes unobstructed with weights hanging free; avoid lifting or releasing weights.||An optimal amount of traction weight is maintained. Note: Ensuring free movement of weights during repositioning of patient avoids sudden excess pull on fracture with associated pain and muscle spasm.|
|Assist with placement of lifts under bed wheels if indicated.||Helps maintain proper patient position and function of traction by providing a counterbalance.|
|Position patient so that appropriate pull is maintained on the long axis of the bone.||Promotes bone alignment and reduces the risk of complications (delayed healing and nonunion).|
|Review restrictions imposed by therapy such as not bending at the waist and sitting up with Buck traction or not turning below the waist with Russell traction.||Maintains integrity of pull of traction.|
|Assess the integrity of the external fixation device.||Hoffman traction provides stabilization and rigid support for fractured bone without the use of ropes, pulleys, or weights, thus allowing for greater patient mobility, comfort and facilitating wound care. Loose or excessively tightened clamps or nuts can alter the compression of the frame, causing misalignment.|
|Review follow-up and serial X-rays.||Provides visual evidence of proper alignment or beginning callus formation and healing process to determine the level of activity and need for changes in or additional therapy.|
|Administer alendronate (Fosamax) as indicated.||Acts as a specific inhibitor of osteoclast-mediated bone resorption, allowing the bone formation to progress at a higher ratio, promoting healing of fractures and decreasing rate of bone turnover in the presence of osteoporosis.|
|Initiate or maintain electrical stimulation if used.||May be indicated to promote bone growth in the presence of delayed healing or nonunion.|
References and Sources
Recommended references and sources for this fracture nursing care plans:
- Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
- Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
- Hommel, A., Kock, M. L., Persson, J., & Werntoft, E. (2012). The Patient’s view of nursing care after hip fracture. ISRN nursing, 2012. [Link]
- Willis, L. (2019). Professional guide to diseases. Lippincott Williams & Wilkins. [Link]
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