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
Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.
- Acute Pain
May be related to
- Muscle spasms
- Movement of bone fragments, edema, and injury to the soft tissue
- Traction/immobility device
- Stress, anxiety
Possibly evidenced by
- Reports of pain
- Distraction; self-focusing/narrowed focus; facial mask of pain
- Guarding, protective behavior; alteration in muscle tone; autonomic responses
- Client will verbalize relief of pain.
- Client will display relaxed manner.
- Client will demonstrate ability to participate in activities with minimal complaints of discomfort.
- Client will demonstrate use of relaxation skills and diversional activities as indicated for individual situation.
|Assess and record the patient’s level of pain utilizing pain intensity rating scale including Wong Baker FACES pain rating scale, visual analog scale, and FLACC (face, legs, activity, crying, consolability) scale. Note relieving and aggravating factors, and nonverbal pain cues such as changes in vital signs, emotions, and behavior.||Influences the effectiveness of interventions. Many factors, including the level of anxiety, may affect the perception of pain.|
|Encourage patient to discuss problems related to the injury.||Helps alleviate anxiety. The patient may feel the need to relive the accident experience.|
|Maintain immobilization of affected part by means of bed rest, cast, splint, traction.||Relieves pain and prevents bone displacement and extension of tissue injury.|
|Elevate and support injured extremity.||Promotes venous return, decreases edema, and may reduce pain.|
|Avoid use of plastic sheets and pillows under limbs in cast.||Can increase discomfort by enhancing heat production in the drying cast.|
|Elevate bed covers; keep linens off toes.||Maintains body warmth without discomfort due to the pressure of bedclothes on affected parts.|
|Explain procedures before beginning them.||Allows patient to prepare mentally for activity and to participate in controlling the level of discomfort.|
|Medicate before care activities. Let the patient know it is important to request medication before pain becomes severe.||Promotes muscle relaxation and enhances participation.|
|Perform and supervise active and passive ROM exercises.||Maintains strength and mobility of unaffected muscles and facilitates resolution of inflammation in injured tissues.|
|Provide alternative comfort measures (massage, backrub, position changes).||Improves general circulation; reduces areas of local pressure and muscle fatigue.|
|Provide emotional support and encourage the use of stress management techniques (progressive relaxation, deep-breathing exercises, visualization or guided imagery); provide Therapeutic Touch.||Refocuses attention, promotes a sense of control, and may enhance coping abilities in the management of the stress of traumatic injury and pain, which is likely to persist for an extended period.|
|Identify diversional activities appropriate for patient age, physical abilities, and personal preferences.||Prevents boredom, reduces muscle tension, and can increase muscle strength; may enhance coping abilities.|
|Investigate any reports of unusual or sudden pain or deep, progressive, and poorly localized pain unrelieved by analgesics.||May signal developing complications (infection, tissue ischemia, compartmental syndrome).|
|Apply cold or ice pack first 24–72 hr and as necessary.||Reduces edema and hematoma formation, decreases pain sensation. Note: Length of application depends on degree of patient comfort and as long as the skin is carefully protected.|
|Administer medications as indicated:|
|Given to reduce pain or muscle spasms. Studies of ketorolac (Toradol) have proved it to be effective in alleviating bone pain, with longer action and fewer side effects than narcotic agents.|
|Maintain and monitor IV patient-controlled analgesia (PCA) using peripheral, epidural, or intrathecal routes of administration. Maintain safe and effective infusions and equipment.||Routinely administered or PCA maintains an adequate blood level of analgesia, preventing fluctuations in pain relief with associated muscle tension and spasms.|
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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Musculoskeletal Care Plans
Care plans related to the musculoskeletal system:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 8 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Laminectomy (Disc Surgery) | 8 Care Plans
- Osteoarthritis | 4 Care Plans
- Osteoporosis | 4 Care Plans
- Rheumatoid Arthritis | 6 Care Plans
- Scoliosis | 4 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans