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 Impaired Gas Exchange
Risk for Impaired Gas Exchange: At risk for excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.
- Gas Exchange, risk for impaired
Risk factors may include
- Altered blood flow; blood/fat emboli
- Alveolar/capillary membrane changes: interstitial, pulmonary edema, congestion
- Client will maintain adequate respiratory function, as evidenced by absence of dyspnea/cyanosis; respiratory rate and arterial blood gases (ABGs) within patient’s normal range.
|Monitor respiratory rate and effort. Note stridor, use of accessory muscles, retractions, development of central cyanosis.||Tachypnea, dyspnea, and changes in mentation are early signs of respiratory insufficiency and may be the only indicator of developing pulmonary emboli in the early stage. Remaining signs and symptoms reflect advanced respiratory distress or impending failure.|
|Auscultate breath sounds, noting the development of unequal, hyperresonant sounds; also note the presence of crackles, rhonchi, wheezes and inspiratory crowing or croupy sounds.||Changes or presence of adventitious breath sounds reflects developing respiratory complications such as atelectasis, pneumonia, emboli, adult respiratory distress syndrome (ARDS). Inspiratory crowing reflects upper airway edema and is suggestive of fat emboli.|
|Note increasing restlessness, confusion, lethargy, stupor.||Impaired gas exchange or presence of pulmonary emboli can cause deterioration in the patient’s level of consciousness as hypoxemia or acidosis develops.|
|Inspect skin for petechiae above nipple line; in the axilla, spreading to abdomen or trunk; buccal mucosa, hard palate; conjunctival sacs and retina.||This is the most characteristic sign of fat emboli, which may appear within 2–3 days after injury.|
|Observe sputum for signs of blood.||Hemoptysis may occur with pulmonary emboli.|
|Monitor laboratory studies (Serial ABGs;Hb, calcium, erythrocyte sedimentation rate (ESR), serum lipase, fat screen, platelets) as appropriate.||Anemia, hypocalcemia, elevated ESR and lipase levels, fat globules in blood, urine, sputum, and decreased platelet count (thrombocytopenia) are often associated with fat emboli.|
|Handle injured tissues and bones gently, especially during the first several days.||This may prevent the development of fat emboli (usually seen in first 12–72 hr), which are closely associated with fractures, especially of the long bones and pelvis.|
|Instruct and assist with deep-breathing and coughing exercises. Reposition frequently.||Promotes alveolar ventilation and perfusion. Repositioning promotes drainage of secretions and decreases congestion in dependent lung areas.|
|Assist with incentive spirometry.||Increases available O2 for optimal tissue oxygenation.|
|Administer supplemental oxygen if indicated.||Decreased Pao2 and increased Paco2 indicate impaired gas exchange or developing failure.|
|Administer medications as indicated:||Used for prevention of thromboembolic phenomena, including deep vein thrombosis and pulmonary emboli. Steroids have been used with some success to prevent or treat fat embolus.|
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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- Osteoarthritis | 4 Care Plans
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- Scoliosis | 4 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans