11 Fracture Nursing Care Plans


In this nursing care plan guide are 11 nursing diagnosis for fracture. Know the assessment, goals, related factors, and nursing interventions with rationale for fracture in this guide.

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:

  1. Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).
  2. Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.
  3. Closed: The fracture does not extend through the skin.
  4. Open: Bone fragments extend through the muscle and skin, which is potentially infected.
  5. Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.

Nursing Care Plans

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: 

  1. Risk for Trauma: Falls
  2. Acute Pain
  3. Risk for Peripheral Neurovascular Dysfunction
  4. Risk for Impaired Gas Exchange
  5. Impaired Physical Mobility
  6. Impaired Skin Integrity
  7. Risk for Infection
  8. Deficient Knowledge
  9.  NEW  Risk for Injury
  10.  NEW  Self-Care Deficit
  11.  NEW  Constipation
  12. Other Nursing Diagnoses

Impaired Skin Integrity

Impaired Skin Integrity: At risk for altered epidermis and/or dermis.

Nursing Diagnosis

  • Skin/Tissue Integrity, impaired: actual/risk for

May be related to

  • Puncture injury; compound fracture; surgical repair; insertion of traction pins, wires, screws.
  • Altered sensation, circulation; accumulation of excretions/secretions
  • Physical immobilization

Possibly evidenced by (actual)

  • Reports of itching, pain, numbness, pressure in affected/surrounding area
  • Disruption of skin surface; invasion of body structures; destruction of skin layers/tissues

Desired Outcomes

  • Client will verbalize relief of discomfort.
  • Client will demonstrate behaviors/techniques to prevent skin breakdown/facilitate healing as indicated.
  • Client will achieve timely wound/lesion healing if present.
Nursing InterventionsRationale
Nursing Assessment
Examine the skin for open wounds, foreign bodies, rashes, bleeding, discoloration, duskiness, blanching.Provides information regarding skin circulation and problems that may be caused by application or restriction of cast, splint or traction apparatus, or edema formation that may require further medical intervention.
Assess the position of splint ring of traction device.Improper positioning may cause skin injury or breakdown.
Therapeutic Interventions
Massage skin and bony prominences. Keep the bed linens dry and free of wrinkles. Place water pads, other padding under elbows or heels as indicated.Reduces pressure on susceptible areas and risk of abrasions and skin breakdown.
Reposition frequently. Encourage use of trapeze if possible.Lessens constant pressure on the same areas and minimizes the risk of skin breakdown. Use of trapeze may reduce the risk of abrasions to elbows and heels.
Plaster cast application and skin care:
  • Cleanse skin with soap and water.
Provides a dry, clean area for cast application. Note: Excess powder may cake when it comes in contact with water and perspiration.
  • Rub gently with alcohol or dust with small amount of a zinc or stearate powder.
Useful for padding bony prominences, finishing cast edges, and protecting the skin.
  • Cut a length of stockinette to cover the area and extend several inches beyond the cast.
Prevents indentations or flattening over bony prominences and weight-bearing areas (back of heels), which would cause abrasion or tissue trauma. An improperly shaped or dried cast is irritating to the underlying skin and may lead to circulatory impairment.
  • Use the palm of hand to apply, hold, or move cast and support on pillows after application.
Uneven plaster is irritating to the skin and may result in abrasions.
  • Trim excess plaster from edges of the cast as soon as casting is completed.
Prevents skin breakdown caused by prolonged moisture trapped under the cast.
  • Promote cast drying by removing bed linen, exposing to circulating air.
Pressure can cause ulcerations, necrosis, or nerve palsies.
  • Observe for potential pressure areas, especially at the edges of and under the splint or cast.
These problems may be painless when nerve damage is present.
  • Pad (petal) the edges of the cast with waterproof tape.
Provides an effective barrier to cast flaking and moisture. Helps prevent the breakdown of cast material at edges and reduces skin irritation and excoriation.
  • Cleanse excess plaster from the skin while still wet, if possible.
Dry plaster may flake into the completed cast and cause skin damage.
Protect cast and skin in the perineal area:
  • Provide frequent perineal care
Prevents tissue breakdown and infection by fecal contamination.
  • Instruct patient and SO to avoid inserting objects inside casts;
“Scratching an itch” may cause tissue injury.
  • Massage the skin around the cast edges with alcohol;
Has a drying effect, which toughens the skin. Creams and lotions are not recommended because excessive oils can seal cast perimeter, not allowing the cast to “breathe.” Powders are not recommended because of the potential for excessive accumulation inside the cast.
  • Turn frequently to include the uninvolved side, back, and prone positions (as tolerated) with patient’s feet over the end of the mattress.
Minimizes pressure on feet and around cast edges.
Skin traction application and skin care:
  • Cleanse the skin with warm, soapy water.
Reduces the level of contaminants on the skin.
  • Apply tincture of benzoin.
“Toughens” the skin for the application of skin traction.
  • Apply commercial skin traction tapes (or make some with strips of moleskin or adhesive tape) lengthwise on opposite sides of the affected limb.
Traction tapes encircling a limb may compromise circulation.
  • Extend the tapes beyond the length of the limb.
Traction is inserted in line with the free ends of the tape.
  • Mark the line where the tapes extend beyond the extremity;
Allows for quick assessment of slippage.
  • Place protective padding under the leg and over bony prominences.
Minimizes pressure on these areas.
  • Wrap the limb circumference, including tapes and padding, with elastic bandages, being careful to wrap snugly but not too tightly.
Provides for appropriate traction pull without compromising circulation.
  • Palpate taped tissues daily and document any tenderness or pain.
If the area under tapes is tender, suspect skin irritation, and prepare to remove the bandage system.
  • Remove skin traction every 24 hr, per protocol; inspect and give skin care.
Maintains skin integrity.
Skeletal traction and fixation application and skin care:
  • Bend wire ends or cover ends of wires or pins with rubber or cork protectors or needle caps.
Prevents injury to other body parts.
  • Pad slings or frame with sheepskin, foam.
Prevents excessive pressure on the skin and promotes moisture evaporation that reduces the risk of excoriation.
  • Provide foam mattress, sheepskins, flotation pads, or air mattress as indicated.
Because of the immobilization of body parts, bony prominences other than those affected by the casting may suffer from decreased circulation.
  • Monovalve, bivalve, or cut a window in the cast, per protocol.
Allows the release of pressure and provides access for wound and skin care.

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 nursing2012. [Link]
  • Willis, L. (2019). Professional guide to diseases. Lippincott Williams & Wilkins. [Link]

See Also

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Musculoskeletal Care Plans

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