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 Injury
Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.
May be related to
- Altered sensory function
- Impaired mobility as a result of cast application
- Tissue hypoxia
- Impaired mobility resulting from skin or skeletal traction
Possibly evidenced by
- [not applicable]
- Client’s affected area will remain pink and warm.
- Child will report the presence of sensation and is able to move affected area.
- Client will maintain the traction.
- Child will achieve correct body alignment.
|Assess pulses in casted above or below the extremity, edema, coolness, inability to move digits, paleness or cyanosis, numbness of areas distal to the cast every 2 hours.||Reveals about the neurovascular status of an extremity after the application of a cast as swelling persists causing the cast to become tight and impairs circulation; a bivalved cast manages severe swelling to prevent tissue damage.|
|Assess the reason for and type of traction, extremity or body part affected.||Provides detail regarding the use of traction to realign bone ends, immobilized a part, correct a deformity, decrease muscle spasms, provide rest for an extremity; traction may be manual|
as in cast application, skin in which the pull is attached to the skin with bandages or straps, or skeletal in which the pull is
attached to a pin, wire, or tongs inserted into the bone at a distal position to the fracture.
|Assess the functioning part of the|
traction apparatus including appropriate weight amount and hanging, ropes in tract with secure knots, pulleys in original site with movable wheels, position of frames,
|Provides details required to assure the right traction applied to the body part.|
|Assess pressure points observing for|
redness or breakdown and reposition if possible; massage uninjured skin areas.
|Avoids lengthy pressure on skin that results in the breakdown and impaired blood flow to the area.|
|Observe paleness, numbness, or changes in movement of the body part; weakness or contractures of uninvolved muscles and joints: Assess pulses and monitor neurovascular status every 2 to 4 hours.||Reveals circulation changes brought about by traction and muscular changes resulting from immobilization.|
|Advise avoiding the use of a heated fan or dryer.||Heat makes outside of the cast dry but stay wet underneath, or may result in burns from heat conduction through the cast.|
|Dry the cast completely using a fan, turn every 2 hours, support on pillows and may use the palm of hands to lift or handle cast exposing as much of the cast to the air as possible.||Allows the cast to avoid indentations that may cause pressure areas. Let the cast to dry from inside out for 1/2 hour or more depending on the substance used for cast and type of cast.|
|Provide time for quiet play and encourage muscle and joint exercise.||Maintain the function of the muscle and joint.|
|Elevate casted part on a pillow until|
completely dry and during rest for a few days.
|Promotes a venous return to lessen swelling.|
|Clean plaster cast using vinegar and water; fiberglass casts are washed with mild soap and water.||Maintains cleanliness of the cast.|
|Petal cast if rough edges are present; massage skin near cast edges and note any reddened or abrasive areas.||Prevents skin irritation and breakdown.|
|Discard small articles or remove food that may be put into the cast.||Prevents pressure to injury and infection if the skin is broken under the cast.|
|Outline the area of drainage on the cast with a pen, and include date and time.||Monitors increases in drainage under the cast.|
|Provide muscle strengthening exercises, ROM of unaffected parts, isometric exercises appropriate.||Prepares for crutch walking if appropriate and maintains joint and muscle mobility.|
|Instruct parents to note and report any pain, swelling, musty odor from the cast; changes in neurovascular status in casted extremity, tightness or looseness of the cast.||Indicates the presence of infection or neurovascular compromise that may require a cast change.|
|Teach parents and child to avoid allowing the limb to hang down and maintain the elevation of the limb when sitting and support limb with a sling when standing; avoid standing for prolonged periods of time.||Maintains return venous flow and prevents fatigue from the heavy cast.|
|Reinforce to parents and child to restrict activities according to physician advice, to avoid placing articles, such as a coat hanger for scratching, into the cast.||Prevents damage to the cast and skin that may lead to infection or impair the desired effect of the cast.|
|Instruct parents to massage skin at the cast edges, refrain use of lotions and powder in these areas, and pad cast edges if needed.||Toughens skin to prevent breakdown and prevents infection by providing media for bacterial growth.|
|Encourage child in the use of crutches or application of sling.||Aids in mobility and promotes participation in activities.|
|Advise parents and child about the duration of cast presence, need for physical therapy as appropriate, and ways of maintaining clean cast.||Allows planning for continuing care if appropriate.|
|Maintain correct body alignment mostly in hips, legs, arms, and shoulders; realign the child after position changes.||Facilitates comfort and avoids deformity.|
|Maintain the position of the bed with head or foot elevated as appropriate.||Provides the amount of pull and countertraction desired.|
|Maintain nonadhesive straps or bandages used; do not remove or change unless permitted while someone maintains traction; note tightness or looseness that may cause ineffective traction.||Supplies attachment for pull in skin traction.|
|Encourage ROM to unaffected joints, apply foot plate if appropriate.||Avoids contractures and foot drop.|
|Provide visitation from significant others, move the bed to the area of activity with friends.||Provides and promotes social interactions.|
|Encourage diversional activities such as reading, watching tv, games while in traction.||Promotes movement without disturbing traction.|
|Assist child to perform ADL activities independently as much as possible; facilitate self-care with assistive aids.||Promotes independence in self-care within limitations of age and immobilization.|
|Cleanse and dress pin site daily; apply antiseptic ointment as ordered; observe skin for infection at the site; check screws within metal clamp for accurate attachment of clamp to traction; do not remove|
|Provides attachment for pull in skeletal traction and treats pin site to avoid infection.|
|Instruct child of amount and type of|
movement allowed while in traction.
|Guarantees that the amount of activity is not exceeded and will not affect traction.|
|Teach parents and child as appropriate for the age regarding the purpose of traction and duration of time traction must be in place.||Provides information to aid with adjusting with immobility.|
|Provide assurance to parents that traction will play a part in the healing process of the fracture.||Promotes positive feedback to treatment.|
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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