In this nursing care plan guide are 11 nursing diagnoses for patients with fractures. Know the assessment, goals, related factors, and nursing interventions with rationale for fracture in this guide.
A fracture is a 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 the weakening of the bones. Fracture is sometimes abbreviated FRX or Fx, Fx, or #.
Types of Fracture
There are many 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 Plans
Creating nursing care plans for clients with fractures, whether in a cast or traction, is based on preventing complications during healing. Performing an accurate nursing assessment regularly allows the nursing staff to manage the patient’s pain and prevent complications. In emergency trauma care, basics include triage, assessment and maintaining the airway, breathing, and circulation, protecting the cervical spine, and assessing the level of consciousness.
- Risk for Falls
- Acute Pain
- Risk for Peripheral Neurovascular Dysfunction
- Risk for Impaired Gas Exchange
- Impaired Physical Mobility
- Impaired Skin Integrity
- Risk for Infection
- Deficient Knowledge
- Risk for Injury
- Self-Care Deficit
Risk for Falls
Risk factors may include
- Loss of skeletal integrity (fractures)/movement of bone fragments
- Getting up without assistance
- Client will maintain stabilization and alignment of fracture(s).
- Client will display callus formation/beginning union at fracture site as appropriate.
- Client will demonstrate body mechanics that promote stability at the fracture site.
Nursing Interventions and Rationale
1. Maintain bed rest or limb rest as indicated. Provide support of joints above and below the fracture site, especially when moving and turning.
Provides stability, reducing the possibility of disturbing alignment and muscle spasms, which enhances healing.
2. Secure a bed board under the mattress or place the patient on the orthopedic bed.
A soft or sagging mattress may deform a wet (green) plaster cast, crack a dry cast, or interfere with traction pull.
3. Support fracture site with pillows or folded blankets. Maintain a neutral position of the affected part with sandbags, splints, trochanter roll, footboard.
Prevents unnecessary movement and disruption of alignment. Proper placement of pillows also can prevent pressure deformities in the drying cast.
4. Use sufficient personnel when turning. Avoid using an abduction bar when turning a patient with a spica cast.
Hip, body, or multiple casts can be extremely heavy and cumbersome. Failure to properly support limbs in casts may cause the cast to break.
5. Observe and evaluate splinted extremity for resolution of edema.
Coaptation splint (Jones-Sugar tong) may be used to immobilize fracture while excessive tissue swelling is present. As edema subsides, readjustment of splint or application of plaster or fiberglass cast may be required for continued alignment of the fracture.
6. Maintain position or integrity of traction.
Traction permits pulling on the fractured bone’s long axis and overcoming muscle tension or shortening to facilitate alignment and union. Skeletal traction (pins, wires, tongs) permits greater weight for traction pull than can be applied to skin tissues.
7. Ascertain that all clamps are functional. Lubricate pulleys and check ropes for fraying. Secure and wrap knots with adhesive tape.
Ensures that traction setup is functioning properly to avoid interruption of fracture approximation.
8. Keep ropes unobstructed with weights hanging free; avoid lifting or releasing weights.
An optimal amount of traction weight is maintained. Ensuring free movement of weights during patient repositioning avoids sudden excess pull on fracture with associated pain and muscle spasm.
9. Assist with placement of lifts under bed wheels if indicated.
Helps maintain proper patient position and function of traction by providing a counterbalance.
10. Position the patient, so that appropriate pull is maintained on the long axis of the bone.
Promotes bone alignment and reduces the risk of complications (delayed healing and nonunion).
11. Review restrictions imposed by therapy such as not bending at the waist and sitting up with Buck traction or not turning below the waist with Russell traction.
Maintains integrity of pull of traction.
12. Assess the integrity of the external fixation device.
Hoffman traction provides stabilization and rigid support for fractured bone without ropes, pulleys, or weights, thus allowing for greater patient mobility, comfort and facilitating wound care. Loose or excessively tightened clamps or nuts can alter the compression of the frame, causing misalignment.
13. Review follow-up and serial X-rays.
Provides visual evidence of proper alignment or beginning callus formation and healing process to determine the level of activity and need for changes in or additional therapy.
14. Administer alendronate (Fosamax) as indicated.
Acts as a specific inhibitor of osteoclast-mediated bone resorption, allowing the bone formation to progress at a higher ratio, promoting healing of fractures and decreasing the rate of bone turnover in the presence of osteoporosis.
15. Initiate or maintain electrical stimulation, if used.
It may be indicated to promote bone growth in the presence of delayed healing or nonunion.
References and Sources
Recommended references and sources for this fracture nursing care plans:
- Auer, R., & Riehl, J. (2017). The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: an analysis of the National Trauma Databank. Journal of clinical orthopaedics and trauma, 8(1), 38-44.
- Biz, C., Fantoni, I., Crepaldi, N., Zonta, F., Buffon, L., Corradin, M., … & Ruggieri, P. (2019). Clinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution study. International journal of orthopaedic and trauma nursing, 32, 32-40.
- Brent, L., Hommel, A., Maher, A. B., Hertz, K., Meehan, A. J., & Santy-Tomlinson, J. (2018). Nursing care of fragility fracture patients. Injury, 49(8), 1409-1412.
- Buckley, J. (2002). Massage and aromatherapy massage: Nursing art and science. International Journal of Palliative Nursing, 8(6), 276-280.
- Desnita, O., Noer, R. M., & Agusthia, M. (2021, July). Cold Compresses Effect of on Postoperative Orif Pain in Fracture Patients. In KaPIN Conference (pp. 133-140).
- DiFazio, R., & Atkinson, C. C. (2005). Extremity fractures in children: when is it an emergency?. Journal of pediatric nursing, 20(4), 298-304.
- Griffioen, M. A., Ziegler, M. L., O’Toole, R. V., Dorsey, S. G., & Renn, C. L. (2019). Change in pain score after administration of analgesics for lower extremity fracture pain during hospitalization. Pain Management Nursing, 20(2), 158-163.
- 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]
- Lin, Y. C., Lee, S. H., Chen, I. J., Chang, C. H., Chang, C. J., Wang, Y. C., … & Hsieh, P. H. (2018). Symptomatic pulmonary embolism following hip fracture: A nationwide study. Thrombosis research, 172, 120-127.
- Maher, A. B., Meehan, A. J., Hertz, K., Hommel, A., MacDonald, V., O’Sullivan, M. P., … & Taylor, A. (2012). Acute nursing care of the older adult with fragility hip fracture: an international perspective (Part 1). International Journal of Orthopaedic and Trauma Nursing, 16(4), 177-194.
- McDonald, E., Winters, B., Nicholson, K., Shakked, R., Raikin, S., Pedowitz, D. I., & Daniel, J. N. (2018). Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery. Foot & Ankle International, 39(10), 1135–1140. https://doi.org/10.1177/1071100718782489
- McDonald, E., Winters, B., Shakked, R., Pedowitz, D., Raikin, S., & Daniel, J. (2017). Effect of Post-Operative Toradol Administration on Bone Healing After Ankle Fracture Fixation. Foot & Ankle Orthopaedics, 2(3), 2473011417S000288.
- Metsemakers, W. J., Kuehl, R., Moriarty, T. F., Richards, R. G., Verhofstad, M. H. J., Borens, O., … & Morgenstern, M. (2018). Infection after fracture fixation: current surgical and microbiological concepts. Injury, 49(3), 511-522.
- Neri, E., Maestro, A., Minen, F., Montico, M., Ronfani, L., Zanon, D., … & Barbi, E. (2013). Sublingual ketorolac versus sublingual tramadol for moderate to severe post-traumatic bone pain in children: a double-blind, randomised, controlled trial. Archives of disease in childhood, 98(9), 721-724.
- Pan, Y., Mei, J., Wang, L., Shao, M., Zhang, J., Wu, H., & Zhao, J. (2019). Investigation of the incidence of perioperative pulmonary embolism in patients with below-knee deep vein thrombosis after lower extremity fracture and evaluation of retrievable inferior vena cava filter deployment in these patients. Annals of vascular surgery, 60, 45-51.
- Patterson, J. T., Tangtiphaiboontana, J., & Pandya, N. K. (2018). Management of pediatric femoral neck fracture. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 26(12), 411-419.
- Patzakis, M. J., & Wilkins, J. (1989). Factors influencing infection rate in open fracture wounds. Clinical orthopaedics and related research, (243), 36-40.
- Resch, S., Bjärnetoft, B., & Thorngren, K. G. (2005). Preoperative skin traction or pillow nursing in hip fractures: a prospective, randomized study in 123 patients. Disability and rehabilitation, 27(18-19), 1191-1195.
- Rothberg, D. L., & Makarewich, C. A. (2019). Fat embolism and fat embolism syndrome. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(8), e346-e355.
- Willis, L. (2019). Professional guide to diseases. Lippincott Williams & Wilkins. [Link]
- Wilson, D., & Hockenberry, M. J. (2014). Wong’s Clinical Manual of Pediatric Nursing-E-Book. Elsevier Health Sciences.
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