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
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
- Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs
May be related to
- Lack of exposure/recall
- Information misinterpretation/unfamiliarity with information resources
Possibly evidenced by
- Questions/request for information, statement of misconception
- Inaccurate follow-through of instructions, development of preventable complications
- Client will verbalize understanding of the condition, prognosis, and potential complications.
- Client will correctly perform necessary procedures and explain reasons for actions.
|Review pathology, prognosis, and future expectations.||Provides knowledge base from which patient can make informed choices. Note: Internal fixation devices can ultimately compromise the bone’s strength, and intramedullary nails and rods or plates may be removed at a future date.|
|Discuss dietary needs.||A low-fat diet with adequate quality protein and rich in calcium promotes healing and general well-being.|
|Discuss individual drug regimen as appropriate.||Proper use of pain medication and antiplatelet agents can reduce the risk of complications. Long-term use of alendronate (Fosamax) may reduce the risk of stress fractures. Note: Fosamax should be taken on an empty stomach with plain water because absorption of the drug may be altered by food and some medications (antacids, calcium supplements).|
|Reinforce methods of mobility and ambulation as instructed by a physical therapist when indicated.||Most fractures require casts, splints, or braces during the healing process. Further damage and delay in healing could occur secondary to improper use of ambulatory devices.|
|Suggest use of a backpack.||Provides a place to carry necessary articles and leaves hands free to manipulate crutches; may prevent undue muscle fatigue when one arm is casted.|
|List activities patient can perform independently and those that require assistance.||Organizes activities around need and who is available to provide help.|
|Identify available community services (rehabilitation teams, home nursing or homemaker services).||Provides assistance to facilitate self-care and support independence. Promotes optimal self-care and recovery.|
|Encourage patient to continue active exercises for the joints above and below the fracture.||Prevents joint stiffness, contractures, and muscle wasting, promoting earlier return to independence in activities of daily living (ADLs).|
|Discuss importance of clinical and therapy follow-up appointments.||Fracture healing may take as long as a year for completion, and patient cooperation with the medical regimen facilitates the proper union of bone. Physical therapy (PT) or occupational therapy (OT) may be indicated for exercises to maintain and strengthen muscles and improve function. Additional modalities such as low-intensity ultrasound may be used to stimulate healing of lower-forearm or lower-leg fractures.|
|Review proper pin and wound care.||Reduces risk of bone or tissue trauma and infection, which can progress to osteomyelitis.|
|Recommend cleaning external fixator regularly.||Keeping the device free of dust and contaminants reduces the risk of infection.|
|Identify signs and symptoms requiring medical evaluation (severe pain, fever, chills, foul odors; changes in sensation, swelling, burning, numbness, tingling, skin discoloration, paralysis, white or cool toes or fingertips; warm spots, soft areas, cracks in the cast).||Prompt intervention may reduce the severity of complications such as infection or impaired circulation. Note: Some darkening of the skin (vascular congestion) may occur normally when walking on the casted extremity or using casted arm; however, this should resolve with rest and elevation.|
|Discuss care of “green” or wet cast.||Promotes proper curing to prevent cast deformities and associated misalignment and skin irritation. Note: Placing a “cooling” cast directly on rubber or plastic pillows traps heat and increases drying time.|
|Suggest the use of a blow-dryer to dry small areas of dampened casts.||Cautious use can hasten drying.|
|Demonstrate the use of plastic bags to cover plaster cast during wet weather or while bathing. Clean soiled cast with a slightly dampened cloth and some scouring powder.||Protects from moisture, which softens the plaster and weakens the cast. Note: Fiberglass casts are being used more frequently because they are not affected by moisture. In addition, their light weight may enhance patient participation in desired activities.|
|Emphasize the importance of not adjusting clamps and nuts of an external fixator.||Tampering may alter compression and misalign fracture.|
|Recommend use of adaptive clothing.||Facilitates dressing and grooming activities.|
|Suggest ways to cover toes, if appropriate (stockinette or soft socks).||Helps maintain warmth and protect from injury.|
|Instruct patient to continue exercises as permitted.||Reduces stiffness and improves the strength and function of the affected extremity.|
|Inform patient that the skin under the cast is commonly mottled and covered with scales or crusts of dead skin;||It will be several weeks before normal appearance returns.|
|Wash the skin gently with soap, povidone-iodine (Betadine), or pHisoDerm, and water. Lubricate with a protective emollient;||A new skin is extremely tender because it has been protected beneath a cast.|
|Inform patient that muscles may appear flabby and atrophied (less muscle mass). Recommend supporting the joint above and below the affected part and the use of mobility aids (elastic bandages, splints, braces, crutches, walkers, or canes).||Muscle strength will be reduced and new or different aches and pains may occur for awhile secondary to loss of support.|
|Elevate the extremity as needed.||Swelling and edema tend to occur after cast removal.|
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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