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 Infection
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
- Risk for Infection
Risk factors may include
- Inadequate primary defenses: broken skin, traumatized tissues; environmental exposure
- Invasive procedures, skeletal traction
- Client will achieve timely wound healing, be free of purulent drainage or erythema, and be afebrile.
|Inspect the skin for preexisting irritation or breaks in continuity.||Pins or wires should not be inserted through skin infections, rashes, or abrasions (may lead to bone infection).|
|Assess pin sites and skin areas, noting reports of increased pain, burning sensation, presence of edema, erythema, foul odor, or drainage.||May indicate the onset of local infection or tissue necrosis, which can lead to osteomyelitis.|
|Assess muscle tone, reflexes, and ability to speak.||Muscle rigidity, tonic spasms of jaw muscles, and dysphagia reflect the development of tetanus.|
|Observe wounds for the formation of bullae, crepitation, bronze discoloration of the skin, frothy or fruity-smelling drainage.||Signs suggestive of gas gangrene infection.|
|Line perineal cast edges with plastic wrap.||Damp, soiled casts can promote the growth of bacteria.|
|Instruct patient not to touch the insertion sites.||Minimizes opportunity for contamination.|
|Investigate abrupt onset of pain and limitation of movement with localized edema and erythema in injured extremity.||May indicate the development of osteomyelitis.|
|Monitor vital signs. Note presence of chills, fever, malaise, changes in mentation.||Hypotension, confusion may be seen with gas gangrene; tachycardia, chills, fever reflect developing sepsis.|
|Monitor laboratory and diagnostic studies:|
|Anemia may be noted with osteomyelitis; leukocytosis is usually present with infective processes.|
|Elevated in osteomyelitis.|
|Identifies infective organism and effective antimicrobial agent(s).|
|Hot spots signify increased areas of vascularity, indicative of osteomyelitis.|
|Provide sterile pin or wound care according to protocol, and exercise meticulous handwashing.||May prevent cross-contamination and possibility of infection.|
|Institute prescribed isolation procedures.||Presence of purulent drainage requires wound and linen precautions to prevent cross-contamination.|
|Administer medications as indicated:|
|Wide-spectrum antibiotics may be used prophylactically or may be geared toward a specific microorganism.|
|Given prophylactically because the possibility of tetanus exists with any open wound. Note: Risk increases when injury or wound(s) occur in “field conditions” (outdoor, rural areas, work environment).|
|Provide wound or bone irrigations and apply warm or moist soaks as indicated.||Local debridement and cleansing of wounds reduce microorganisms and incidence of systemic infection. Continuous antimicrobial drip into bone may be necessary to treat osteomyelitis, especially if blood supply to the bone is compromised.|
|Assist with procedures (incision and drainage, placement of drains, hyperbaric oxygen therapy).||Numerous procedures may be carried out in the treatment of local infections, osteomyelitis, gas gangrene.|
|Prepare for surgery, as indicated.||Sequestrectomy (removal of necrotic bone) is necessary to facilitate healing and prevent extension of the infectious process.|
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