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 Skin Integrity
- 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
- 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.
|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.|
|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:|
|Provides a dry, clean area for cast application. Note: Excess powder may cake when it comes in contact with water and perspiration.|
|Useful for padding bony prominences, finishing cast edges, and protecting the skin.|
|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.|
|Uneven plaster is irritating to the skin and may result in abrasions.|
|Prevents skin breakdown caused by prolonged moisture trapped under the cast.|
|Pressure can cause ulcerations, necrosis, or nerve palsies.|
|These problems may be painless when nerve damage is present.|
|Provides an effective barrier to cast flaking and moisture. Helps prevent the breakdown of cast material at edges and reduces skin irritation and excoriation.|
|Dry plaster may flake into the completed cast and cause skin damage.|
|Protect cast and skin in the perineal area:|
|Prevents tissue breakdown and infection by fecal contamination.|
|“Scratching an itch” may cause tissue injury.|
|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.|
|Minimizes pressure on feet and around cast edges.|
|Skin traction application and skin care:|
|Reduces the level of contaminants on the skin.|
|“Toughens” the skin for the application of skin traction.|
|Traction tapes encircling a limb may compromise circulation.|
|Traction is inserted in line with the free ends of the tape.|
|Allows for quick assessment of slippage.|
|Minimizes pressure on these areas.|
|Provides for appropriate traction pull without compromising circulation.|
|If the area under tapes is tender, suspect skin irritation, and prepare to remove the bandage system.|
|Maintains skin integrity.|
|Skeletal traction and fixation application and skin care:|
|Prevents injury to other body parts.|
|Prevents excessive pressure on the skin and promotes moisture evaporation that reduces the risk of excoriation.|
|Because of the immobilization of body parts, bony prominences other than those affected by the casting may suffer from decreased circulation.|
|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 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