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 Peripheral Neurovascular Dysfunction
- Risk for Peripheral Neurovascular Dysfunction
Risk factors may include
- Reduction/interruption of blood flow
- Direct vascular injury, tissue trauma, excessive edema, thrombus formation
- Client will maintain tissue perfusion as evidenced by palpable pulses, skin warm/dry, normal sensation, usual sensorium, stable vital signs, and adequate urinary output for the individual situation.
|Assess capillary return, skin color, and warmth distal to the fracture.||Return of color should be rapid (3–5 sec). White, cool skin indicates arterial impairment. Cyanosis suggests venous impairment. Note: Peripheral pulses, capillary refill, skin color, and sensation may be normal even in the presence of compartmental syndrome because superficial circulation is usually not compromised.|
|Assess the entire length of injured extremity for swelling or edema formation. Measure injured extremity and compare with uninjured extremity. Note appearance and spread of hematoma.||An increasing circumference of the injured extremity may suggest general tissue swelling or edema but may reflect hemorrhage. Note: A 1-in increase in an adult thigh can equal approximately 1 unit of sequestered blood.|
|Investigate tenderness, swelling, pain on dorsiflexion of the foot (positive Homans’ sign).||There is an increased potential for thrombophlebitis and pulmonary emboli in patients immobile for several days. Note: The absence of a positive Homans’ sign is not a reliable indicator in many people, especially the elderly because they often have reduced pain sensation.|
|Evaluate the presence and quality of peripheral pulse distal to injury via palpation or Doppler. Compare with the uninjured limb.||A decreased or absent pulse may reflect vascular injury and necessitates immediate medical evaluation of circulatory status. Be aware that occasionally a pulse may be palpated even though circulation is blocked by a soft clot through which pulsations may be felt. In addition, perfusion through larger arteries may continue after increased compartment pressure has collapsed the arteriole or venule circulation in the muscle.|
|Investigate sudden signs of limb ischemia (decreased skin temperature, pallor, and increased pain).||Fracture dislocations of joints (especially the knee) may cause damage to adjacent arteries, with resulting loss of distal blood flow.|
|Monitor vital signs. Note signs of general pallor, cyanosis, cool skin, changes in mentation.||Inadequate circulating volume compromises systemic tissue perfusion.|
|Perform neurovascular assessments, noting changes in motor and sensory function. Ask the patient to localize pain and discomfort.||Impaired feeling, numbness, tingling, increased or diffuse pain occurs when circulation to nerves is inadequate or nerves are damaged.|
|Note reports of pain extreme for the type of injury or increasing pain on passive movement of extremity, development of paresthesia, muscle tension or tenderness with erythema, and change in pulse quality distal to the injury. Do not elevate extremity. Report symptoms to the physician at once.||Continued bleeding and edema formation within a muscle enclosed by tight fascia can result in impaired blood flow and ischemic myositis or compartmental syndrome, necessitating emergency interventions to relieve pressure and restore circulation.|
|Assess tissues around cast edges for rough places and pressure points. Investigate reports of “burning sensation” under the cast.||These factors may be the cause of or be indicative of tissue pressure, ischemia, leading to breakdown and necrosis.|
|Monitor location of supporting ring of splints or sling.||Traction apparatus can cause pressure on vessels and nerves, particularly in the axilla and groin, resulting in ischemia and possible permanent nerve damage.|
|Test stools or gastric aspirant for occult blood. Note continued bleeding at trauma or injection site(s) and oozing from mucous membranes.||Increased incidence of gastric bleeding accompanies fractures and trauma and may be related to stress or occasionally reflects a clotting disorder requiring further evaluation.|
|Monitor hemoglobin (Hb), hematocrit (Hct), coagulation studies such as prothrombin time (PT) levels.||Assists in the calculation of blood loss and effectiveness of replacement therapy. Coagulation deficits may occur secondary to major trauma, presence of fat emboli, or anticoagulant therapy.|
|Test sensation of peroneal nerve by pinch or pinprick in the dorsal web between the first and second toe, and assess the ability to dorsiflex toes if indicated.||Length and position of peroneal nerve increase risk of its injury in the presence of leg fracture, edema or compartmental syndrome, or malposition of traction apparatus.|
|Remove jewelry from affected limb.||May restrict circulation when edema occurs.|
|Maintain elevation of injured extremities unless contraindicated by the confirmed presence of the compartmental syndrome.||Promotes venous drainage and decreases edema. Note: In presence of increased compartment pressure, elevation of the extremity actually impedes arterial flow, decreasing perfusion.|
|Encourage patient to routinely exercise digits and joints distal to the injury. Ambulate as soon as possible.||Enhances circulation and reduces pooling of blood, especially in the lower extremities.|
|Apply ice bags around the fracture site for short periods of time on an intermittent basis for 24–72 hr.||Reduces edema and hematoma formation, which could impair circulation.|
|Avoid elevation and application of ice when acute compartment syndrome is suspected.||Elevation and ice application may aggravate impaired vascular supply in an extremity that is already experiencing ischemia due to developing compartment syndrome.|
|Review electromyography (EMG) and nerve conduction velocity (NCV) studies.||May be performed to differentiate between true nerve dysfunction, muscle weakness and reduced use due to secondary gain.|
|Administer IV fluids and blood products as needed.||Maintains circulating volume, enhancing tissue perfusion.|
|Split or bivalve cast as needed.||May be done on an emergency basis to relieve restriction and improve impaired circulation resulting from compression and edema formation in injured extremity.|
|Assist with intra-compartmental pressures as appropriate.||Elevation of pressure (usually to 30 mm Hg or more) indicates the need for prompt evaluation and intervention. Note: This is not a widespread diagnostic tool, so special interventions and training may be required.|
|Prepare for surgical intervention (fibulectomy, fasciotomy) as indicated.||Failure to relieve pressure or correct compartmental syndrome within 4–6 hr of onset can result in severe contractures or loss of function and disfigurement of extremity distal to injury or even necessitate amputation.|
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
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- Total Joint (Knee, Hip) Replacement | 5 Care Plans