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There are more than 150 fracture classifications (see this Wikipedia entry). Five major ones are as follow: 1. Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick). 2. 3. 4. 5. 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.
1. Prevent further bone/tissue injury. 2. Alleviate pain. 3. Prevent complications. 4. Provide information about condition/prognosis and treatment needs.
8 Fracture Nursing Care Plan (NCP)
1. Risk for Trauma — Fracture Nursing Care Plan (NCP) 2. Acute Pain — Fracture Nursing Care Plan (NCP) 3. 4. 5. 6. Risk for Peripheral Neurovascular Dysfunction — Fracture Nursing Care Plan (NCP) Risk for Impaired Gas Exchange — Fracture Nursing Care Plan (NCP) Impaired Physical Mobility — Fracture Nursing Care Plan (NCP) Impaired Skin Integrity — Fracture Nursing Care Plan (NCP)
7. Risk for Infection — Fractures Nursing Care Plan (NCP) 8. Knowledge Deficit — Fractures Nursing Care Plan (NCP)
1. Fracture stabilized. 2. Pain controlled. 3. Complications prevented/minimized. 4. Condition, prognosis, and therapeutic regimen understood. 5. Plan in place to meet needs after discharge.
Diagnostic Studies for Fracture
1. X-ray examinations: Determines location and extent of fractures/trauma, may reveal preexisting and yet undiagnosed fracture(s).
5. traumatized tissues. pain. lack of safety precautions. risk for—loss of skeletal integrity. or osteogenesis imperfecta. Bone scans. A bone fracture (sometimes abbreviated FRX or Fx. tomograms. A bone fracture can be the result of high force impact or stress. or trivial injury as a result of certain medical conditions that weaken the bones. Infection. 3. Mobility. and soft-tissue damage. or liver injury. Types of Fractures: Complete fracture: A fracture in which bone fragments separate completely. Coagulation profile: Alterations may occur because of blood loss. Additional Diagnoses 1. Transverse fracture: A fracture that is at a right angle to the bone’s long axis. Oblique fracture: A fracture that is diagonal to a bone’s long axis. 3. 6. differentiates between stress/trauma fractures and bone neoplasms. bleeding. computed tomography (CT)/magnetic resonance imaging (MRI) scans: Visualizes fractures. environmental exposure. restrictive therapies (limb immobilization). Arteriograms: May be done when occult vascular damage is suspected. reduced muscle coordination. weakness. decreased strength/endurance. Fx. impaired physical—neuromuscular skeletal impairment. Increased white blood cell (WBC) count is a normal stress response after trauma. 4. education about upcoming surgery. Linear fracture: A fracture that is parallel to the bone’s long axis. or #) is a medical condition in which there is a break in the continuity of the bone. such as osteoporosis. Nursing goal for a patient with fracture is to relieve pain. Check out the updated version of this post: 8 Fracture Nursing Care Plans . 2. history of previous trauma. Trauma. Spiral fracture: A fracture where at least one part of the bone has been twisted. Urine creatinine (Cr) clearance: Muscle trauma increases load of Cr for renal clearance. bone cancer. multiple transfusions. invasive procedures. promote comfort and promote healing. where the fracture is then properly termed a pathological fracture.2. balancing difficulties. Incomplete fracture: A fracture in which the bone fragments are still partially joined. psychological immobility. Complete blood count (CBC): Hematocrit (Hct) may be increased (hemoconcentration) or decreased (signifying hemorrhage at the fracture site or at distant organs in multiple trauma). risk for—inadequate primary defenses: broken skin. 4. Comminuted fracture: A fracture in which the bone has broken into a number of pieces. skeletal traction. Compacted fracture: A fracture caused when bone fragments are driven into each other. Self-Care deficit—musculoskeletal impairment. pain/discomfort.
The blood coagulates to form a blood clot situated between the broken fragments. it becomes rubbery. The new blood vessels bring phagocytes to the area. Although there are theoretical concerns about NSAIDs slowing the rate of healing. In fact. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibers. some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. Pathophysiology Acute Pain Deficient Knowledge Self-Care Deficit Conspitation Activity Intolerance Impaired Physical Mobility Situational Low Self-Esteem Readiness for Enhanced Therapeutic Regimen Risk for Infection Impaired Physical Mobility — Fracture Nursing Diagnosis: Impaired Physical Mobility May be related to . forming a fracture Hematoma. 9. 4. In this way the blood clot is replaced by a matrix of collagen. By a process of remodeling. 6. 8. which gradually remove the nonviable material. there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures Navigation 1. if the mineral is dissolved out of bone. 2.Pathophysiology The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. 7. For example. Weight-bearing stress on bone. bone is a mineralized collagen matrix. any form of nicotine hinders the process of bone healing. but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury. Collagen’s rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. after the bone has healed sufficiently to bear the weight. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. and adequate nutrition (including calcium intake) will help the bone healing process. 10. also builds bone strength. This mineralization of the collagen matrix stiffens it and transforms it into bone. Several factors can help or hinder the bone healing process. The whole process can take up to 18 months. At this stage. the woven bone is replaced by mature “lamellar” bone. 3. The bone shards can also embed in the muscle causing great pain. This initial “woven” bone does not have the strong mechanical properties of mature bone. 5.
and aids in personal possessions/pictures. calendar. Maintain stimulating environment. radio. Note: These . Instruct patient in/assist with Increases blood flow to muscles active/passive ROM exercises of and bone to improve muscle tone. limited ROM Decreased muscle strength/control Desired Outcomes Regain/maintain mobility at the highest possible level. of energy. Increase strength/function of affected and compensatory body parts. control/self-worth. pain/discomfort. clock.g. reducing social isolation. Demonstrate techniques that enable resumption of activities. TV. Encourage participation in Provides opportunity for release diversional/recreational activities. Nursing Interventions Rationale Assess degree of immobility Patient may be restricted by selfproduced by injury/treatment and view/self-perception out of note patient’s perception of proportion with actual physical immobility. affected and unaffected maintain joint mobility. contractures/atrophy and calcium resorption from disuse Encourage use of isometric Isometrics contract muscles exercises starting with the without bending joints or moving unaffected limb. restrictive therapies (limb immobilization) Psychological immobility Possibly evidenced by Inability to move purposefully within the physical environment. limitations. limbs and help maintain muscle strength and mass. visits from family/friends.. requiring information/interventions to promote progress toward wellness.Neuromuscular skeletal impairment. newspapers. prevent extremities. imposed restrictions Reluctance to attempt movement. Maintain position of function. refocuses attention. enhances patient’s sense of selfe.
and preventing complications (e. Useful in maintaining functional position of extremities. Reduces risk of flexion contracture of hip. trochanter/hand rolls as appropriate.. walker. Facilitates movement during hygiene/skin care and linen changes. Early mobility reduces complications of bed rest (e. shaving). Postural hypotension is a common problem following prolonged bed rest and may require specific interventions (e. bathing. enhances patient control in situation. Place in supine position periodically if possible. phlebitis) and promotes healing and normalization of organ function.Provide footboard.. exercises are contraindicated while acute bleeding/edema is present. and promotes self-directed wellness. “Post position” involves placing the uninjured foot flat on the bed with the knee bent while grasping the trapeze and lifting the body off the bed. Instruct in safe use of mobility aids. when traction is used to stabilize lower limb fractures. canes as soon as possible. Provide/assist with mobility by means of wheelchair. Instruct in/encourage use of trapeze and “post position” for lower limb fractures. reduces discomfort of remaining flat in bed.g.. contractures/footdrop). Note reports of dizziness.g. Assist with/encourage self-care activities (e. Monitor blood pressure (BP) with resumption of activity. Learning the correct way to use aids is important to maintain optimal mobility and patient safety. hands/feet.g. wrist splints. tilt table with gradual .g.. Improves muscle strength and circulation. crutches.
resulting in gas formation and constipation. Nursing measures that facilitate elimination may prevent/limit complications. and strength. Adding bulk to stool helps prevent constipation. Place on bedside commode. carbohydrates. Provide privacy. often resulting in a weight loss of as much as 20/30 lb during skeletal traction. gastrointestinal (GI) function should be fully restored before protein foods are increased. and minerals. vitamins.. Monitor elimination habits and provide for regular bowel routine. This can have a profound effect on muscle mass. and constipation In the presence of musculoskeletal injuries. atelectasis. Prevents/reduces incidence of skin and respiratory complications (e. elevation to upright position). pneumonia). Encourage increased fluid intake to 2000–3000 mL/day (within cardiac tolerance). limiting protein content until after first bowel movement. Provide diet high in proteins. decubitus. including acid/ash juices.g. . tone. or use fracture pan. Bed rest. Keeps the body well hydrated. if feasible. stone formation. Fracture pan limits flexion of hips and lessens pressure on lumbar region/lower extremity cast. decreasing risk of urinary infection. Therefore. Note: Protein foods increase contents in small bowel. Auscultate bowel sounds. Increase the amount of roughage/fiber in the diet. nutrients required for healing are rapidly depleted.Reposition periodically and encourage coughing/deepbreathing exercises. use of analgesics. Gas-forming foods may cause abdominal distension. Limit gas-forming foods. and changes in dietary habits can slow peristalsis and produce constipation. especially in presence of decreased intestinal motility.
pickup sticks/reachers. e. Useful in creating individualized activity/exercise program. Acute Pain — Fracture Nursing Diagnosis: Acute Pain May be related to Muscle spasms Movement of bone fragments. walkers. elevated toilet seats. prolonged immobility. and weight-bearing activities. strengthening.g. self-focusing/narrowed focus. Patient/SO may require more intensive treatment to deal with reality of current condition/prognosis. as well as use of adjuncts.. and injury to the soft tissue Traction/immobility device Stress. edema. Patient may require long-term assistance with movement. protective behavior. facial mask of pain Guarding.Consult with physical/occupational therapist and/or rehabilitation specialist. Initiate bowel program (stool softeners. . laxatives) as indicated. canes. alteration in muscle tone. anxiety Possibly evidenced by Reports of pain Distraction. crutches. special eating utensils. Done to promote regular bowel evacuation. autonomic responses Desired Outcomes Verbalize relief of pain. enemas. perceived loss of control. Refer to psychiatric clinical nurse specialist/therapist as indicated.
cast. splint. sleep/rest appropriately. traction.Display relaxed manner. keep linens Maintains body warmth without off toes. Encourage patient to discuss Helps alleviate anxiety. Patient problems related to injury. relieving anxiety. Explain procedures before Allows patient to prepare beginning them. discomfort due to pressure of bedclothes on affected parts. Elevate and support injured Promotes venous return. request medication before pain becomes severe. . Evaluate/document reports of Influences choice of/monitors pain/discomfort. decreases edema. extremity. able to participate in activities. Nursing Interventions Rationale Maintain immobilization of Relieves pain and prevents bone affected part by means of bed displacement/extension of tissue rest. Elevate bed covers. including Many factors. Note of/reaction to pain. including level of intensity (0–10 scale). Note: Absence nonverbal pain cues (changes in of pain expression does not vital signs and necessarily mean lack of pain. Promotes muscle relaxation and Let patient know it is important to enhances participation. Avoid use of plastic Can increase discomfort by sheets/pillows under limbs in cast. noting location effectiveness of interventions. may feel need to relive the accident experience. Demonstrate use of relaxation skills and diversional activities as indicated for individual situation. Medicate before care activities. Listen to reports of family member/SO regarding patient’s pain. mentally for activity and to participate in controlling level of discomfort. enhancing heat production in the drying cast. emotions/behavior). injury. and characteristics. and may reduce pain. may affect perception and aggravating factors.
and may enhance coping abilities in the management of the stress of traumatic injury and pain. Apply cold/ice pack first 24–72 hr and as necessary. reduces muscle tension. .g.. and/or muscle relaxants. may enhance coping abilities. Refocuses attention. and personal preferences. decreases pain sensation. e. infection.. deepbreathing exercises. Reduces edema/hematoma formation. Given to reduce pain and/or muscle spasms. e. Studies of ketorolac (Toradol) have proved it to be effective in alleviating bone pain. compartmental syndrome.. hydrocodone (Vicodin). Investigate any reports of unusual/sudden pain or deep. position changes.Perform and supervise active/passive ROM exercises.. injectable and oral nonsteroidal anti-inflammatory drugs (NSAIDs).g. physical abilities. Provide alternative comfort measures. which is likely to persist for an extended period. reduces areas of local pressure and muscle fatigue. back rub. with longer action and fewer side effects than narcotic agents. e.. May signal developing complications. ibuprofen (Motrin). Identify diversional activities appropriate for patient age. Improves general circulation. meperidine (Demerol). e. visualization/guided imagery.g. Prevents boredom. progressive.g.. progressive relaxation. and poorly localized pain unrelieved by analgesics. Provide emotional support and encourage use of stress management techniques. e. promotes sense of control. massage.g. provide Therapeutic Touch. ketorolac (Toradol).g. and can increase muscle strength. morphine. Note: Length of application depends on degree of patient comfort and as long as the skin is carefully protected. e. Administer medications as indicated: narcotic and nonnarcotic analgesics. Maintains strength/mobility of unaffected muscles and facilitates resolution of inflammation in injured tissues. tissue ischemia.
or intrathecal routes of administration. Administer analgesics around the clock for 3–5 days. carisoprodol (Soma). epidural. Maintain safe and effective infusions/equipment.cyclobenzaprine (Flexeril). Maintain/monitor IV patientcontrolled analgesia (PCA) using peripheral. . Routinely administered or PCA maintains adequate blood level of analgesia. preventing fluctuations in pain relief with associated muscle tension/spasms. diazepam (Valium).