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
Impaired Physical Mobility
Impaired Physical Mobility: Limitation in independent, purposeful physical movement of the body or of one or more extremities.
- Impaired Physical Mobility
May be related to
- Neuromuscular skeletal impairment; pain/discomfort; restrictive therapies (limb immobilization)
- Unfamiliarity with the use of immobilization devices
- Psychological immobility
Possibly evidenced by
- Inability to move purposefully within the physical environment, imposed restrictions
- Reluctance to attempt movement; limited ROM
- Decreased muscle strength/control
- Client will regain/maintain mobility at the highest possible level.
- Client will maintain position of function.
- Client will increase strength/function of affected and compensatory body parts.
- Client will demonstrate techniques that enable resumption of activities.
|Assess the degree of immobility produced by injury or treatment and note patient’s perception of immobility.||Patient may be restricted by self-view or self-perception out of proportion with actual physical limitations, requiring information or interventions to promote progress toward wellness.|
|Assess the health literacy and cultural practices of the patient.||Helps ensure the choosen and presented materials are culturally and educationally appropriate.|
|Auscultate bowel sounds. Monitor elimination habits and provide for regular bowel routine. Place on bedside commode, if feasible, or use fracture pan. Provide privacy.||Bed rest, use of analgesics, and changes in dietary habits can slow peristalsis and produce constipation. Nursing measures that facilitate elimination may prevent or limit complications. Fracture pan limits flexion of hips and lessens pressure on lumbar region and lower extremity cast.|
|Monitor blood pressure (BP) with the resumption of activity. Note reports of dizziness.||Postural hypotension is a common problem following prolonged bed rest and may require specific interventions (tilt table with gradual elevation to upright position).|
|Encourage participation in diversional or recreational activities. Maintain a stimulating environment (radio, TV, newspapers, personal possessions, pictures, clock, calendar, visits from family and friends).||Provides an opportunity for release of energy, refocuses attention, enhances patient’s sense of self-control and self-worth, and aids in reducing social isolation.|
|Teach patient or assist with active and passive ROM exercises of affected and unaffected extremities.||Increases blood flow to muscles and bone to improve muscle tone, preserve joint mobility; prevent contractures or atrophy and calcium resorption from disuse|
|Encourage use of isometric exercises starting with the unaffected limb.||Isometrics contract muscles without bending joints or moving limbs and help maintain muscle strength and mass. Note: These exercises are contraindicated while acute bleeding and edema are present.|
|Provide footboard, wrist splints, trochanter or hand rolls as appropriate.||Useful in maintaining a functional position of extremities, hands, and feet, and preventing complications (contractures, foot drop).|
|Place in supine position periodically if possible, when traction is used to stabilize lower limb fractures.||Reduces risk of flexion contracture of the hip.|
|Instruct and encourage the use of trapeze and “post position” for lower limb fractures.||Facilitates movement during hygiene or skin care and linen changes; reduces the discomfort of remaining flat in bed. “Post position” involves placing the uninjured foot flat on the bed with the knee bent while grasping the trapeze and lifting the body off the bed.|
|Assist with self-care activities (bathing, shaving).||Improves muscle strength and circulation, enhances patient control in the situation, and promotes self-directed wellness.|
|Provide and assist with the use of mobility aids such as wheelchair, walker, crutches, and canes.||Early mobility reduces complications of bed rest (phlebitis) and promotes healing and normalization of organ function. Learning the correct way to use aids is important to maintain optimal mobility and patient safety.|
|Reposition periodically and encourage coughing and deep-breathing exercises.||Prevents or reduces the incidence of skin and respiratory complications (decubitus, atelectasis, pneumonia).|
|Instruct the patient and family in care of an extemity in external fixator, performance of prescribed exercises while in the fixator, and signs and symptoms of complications.||Knowledge will help ensure optimal healing and immediate interventions in case of complications.|
|Encourage increased fluid intake to 2000–3000 mL per day (within cardiac tolerance), including acid or ash juices.||Keeps the body well hydrated, decreasing the risk of urinary infection, stone formation, and constipation|
|Provide a diet high in proteins, carbohydrates, vitamins, and minerals, limiting protein content until after first bowel movement.||In the presence of musculoskeletal injuries, nutrients required for healing are rapidly depleted, often resulting in a weight loss of as much as 20 to 30 lb during skeletal traction. This can have a profound effect on muscle mass, tone, and strength. Note: Protein foods increase contents in the small bowel, resulting in gas formation and constipation. Therefore, the gastrointestinal (GI) function should be fully restored before protein foods are increased.|
|Increase the amount of roughage or fiber in the diet. Limit gas-forming foods.||Adding bulk to stool helps prevent constipation. Gas-forming foods may cause abdominal distension, especially in the presence of decreased intestinal motility.|
|Initiate bowel program (stool softeners, enemas, laxatives) as indicated.||Done to promote regular bowel evacuation.|
|Teach patient and significant others in the use of analgesics and instruct non pharmacological pain management such as imagery, relaxation, and distractions.||Effective pain intervention will enhance the patient’s ability to engage in appropriate activity and exercises.|
|Consult with a physical, occupational therapist or rehabilitation specialist.||Useful in creating individualized activity and exercise program. Patient may require long-term assistance with movement, strengthening, and weight-bearing activities, as well as the use of adjuncts (walkers, crutches, canes); elevated toilet seats; pickup sticks or reachers; special eating utensils.|
|Refer to psychiatric clinical nurse specialist or therapist as indicated.||Patient or SO may require more intensive treatment to deal with the reality of current condition, prognosis, prolonged immobility, perceived loss of control.|
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:
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- Juvenile Rheumatoid Arthritis | 4 Care Plans
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- Osteoporosis | 4 Care Plans
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- Total Joint (Knee, Hip) Replacement | 5 Care Plans