A bone fracture (sometimes abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a break in the continuity of the bone.

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, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathological fracture. Nursing goal for a patient with fracture is to relieve pain, education about upcoming surgery, promote comfort and promote healing. Types of Fractures:
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Complete fracture: A fracture in which bone fragments separate completely. Incomplete fracture: A fracture in which the bone fragments are still partially joined. Linear fracture: A fracture that is parallel to the bone¶s long axis. 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. Spiral fracture: A fracture where at least one part of the bone has been twisted. Comminuted fracture: A fracture in which the bone has broken into a number of pieces. Compacted fracture: A fracture caused when bone fragments are driven into each other.

Pathophysiology
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture Hematoma. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring phagocytes to the area, which gradually remove the nonviable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen¶s rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. This initial ³woven´ bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature ³lamellar´ bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury. Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. The bone shards can also embed in the muscle causing great pain. Although there are theoretical concerns about NSAIDs slowing the rate of healing, there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures

1 Acute Pain
Pain is a subjective unpleasant sensation resulting from stimulation of sensory nerve endings by injury, or other harmful factors. Pain is activated when a pt¶s pain threshold is reached. Pain threshold is the point at which a stimulus activates pain receptors to produce a feeling of pain. Pain usually accompanies inflammation. It results from the synthesis of prostaglandins, which are hormones produced during the inflammatory process. Nursing Nursing InterExpected Planning Rationale Dx ventions Outcome S > Ø O > Acute Short term: > establish > to gain Short pt. manifest Pain After 3days rapport > Pt¶s trust > term: Pt¶s of NI, pt check and baseline data pain shall will recorded VS have > intact verbalize wound > to provide decreased decrease from 8/10 dressing on > check Pt¶s adequate pain, with general right leg interventions rate to decrease 4/10. condition pain from > > provide 8/10 to 5 Long continuous > reposition pt. comfort below term: moderate sharp> instruct pt to > to help stabbing Long term: do DBE Patient¶s alleviate pain shall pain whenever pain pain experience After 3days is felt have been of NI patient whenever > to help in relieved pt. turns on will report > encourage to alleviating relive from do diversional pain her side; pain pain activities such radiates as chatting to > to be able from the SO, listening to have an operative to music and idea on how site down reading books the pain is to the toes relieved > note clients > Pt¶s pain response to > to have rates 8/10 pain ion a complete Patient may information > perform manifest: comprehensive and to provide pain > proper NI assessment irritability > identify ways > to provide > increase comfort to on how to minimize pain patient Assessment

in RR > restlessness

2 Deficient Knowledge
Deficient Knowledge is the absence or deficiency of cognitive information related to specific topic. The preoperative client may not be completely knowledgeable about surgical procedures, particularly hepatic surgery. This may be due to low educational background because of financial matters. Nursing Nursing InterExpected Planning Rationale Dx ventions Outcome S>OO> Deficient Short Term: Assess current Effective Patient Patient verbalizes Knowledge After 4 hours understanding discharge manifested: of treatment and planning is understanding of related to of nursing interventions, follow-up care. based on a and new Determine if clear demonstrates Verbalizes condition the patient inadequate will hazards exist in understanding ability to and knowledge of treatment participate in the home that of the needs of perform the learning will the patient and postoperative and care/use of care after immobilization cognitive process and compromise the family limitations. will verbalize patient¶s ability members who discharge. device, understanding to be effectively will assume Patient/caregiver mobility of condition mobile as home. caregiver roles. verbalizes limitations, process and To prevent understanding of complications, treatment. patient from treatment, Perform and follow-up injury. possible care. prescribed complications, Long Term: exercises and follow-up several times a Regular Patient care. exercise is expresses After 1 day day. necessary to concerns about of nursing ability to interventions, Identify and maintain muscle tone manage the patient report to will assume physician signs and promote independently responsibility of neurovascular bone healing. at home. for own compromise of Confusion; learning and extremity: pain, Early begin to look numbness, assessment asking multiple for tingling, reduces the risk information burning, of injury or questions regarding swelling, or complications health. discoloration. This promotes Assessment

Obtain proper bone/wound nutrition healing and prevent constipation. Involve patient/caregiver in procedures. Ability to Supervise those perform selfperforming care procedures procedures and decreases risk teach proper of infection and technique. optimize therapeutic Provide patient effect in the with medical home care environment. supplies and assistive devices needed Efforts to enhance selfcare abilities promotes successful transition/ accommodation to home environment.

Assessment

Nursing Dx

Nursing Planning Interventions Rationale

Expected Outcome

S>Ø O > pt. manifest > intact wound dressing on right leg > continuous moderate sharpstabbing pain experience whenever pt. turns on her side; pain radiates from the operative site down to the toes > Pt¶s pain rates 8/10 Patient may manifest: > irritability > increase in RR > restlessness

Acute Pain

Short term: After 3days of NI, pt will verbalize decrease pain, with decrease pain from 8/10 to 5 below Long term: After 3days of NI patient will report relive from pain

> establish rapport > check and recorded VS > check Pt¶s general condition > reposition pt. > instruct pt to do DBE whenever pain is felt > encourage to do diversional activities such as chatting to SO, listening to music and reading books > note clients response to pain

> to gain Pt¶s trust > baseline data

Short term:

Pt¶s pain shall have > to provide decreased from adequate interventions 8/10 rate to 4/10. > provide Long comfort term: > to help alleviate Patient¶s pain shall pain have been > to help in relieved alleviating pain > to be able to have an idea on how the pain is relieved

> to have ion a complete information > perform comprehensive and to pain provide proper NI assessment > identify ways on how to minimize pain > to provide comfort to patient

3 Self-Care Deficit

Due to limitations in the individual¶s ability to ambulate, she is prevented from performing ADLs that allow her to manage her hygiene such as bathroom privileges, bathing, clothing oneself. NursingInterExpected Rationale ventions Outcome >S: Ø >O: Self-Care Short-Term: >Establish >to gain patient¶s Short-Term: Deficit related After 2 hours rapport trust and The patient of nursing >Monitor and cooperation >to shall have Patient may to musculoskeletal interventions, record vital have baseline verbalized manifest impairment the patient signs data knowledge inability to: secondary to will verbalize of healthcare fractured femur knowledge of >Assess practices. >to provide Get healthcare patient¶s bath proper nursing practices. general interventions Long-Term: supplies condition Long-Term: >to assess degree The patient Wash >Determine of disability shall have body or After 2 days individual demonstrated body parts of nursing strengths and >to enhance techniques or interventions, skills of the commitment to lifestyle Get in the patient client plan, optimizing changes to and out of will meet selfoutcomes bathroom demonstrate >Promote care needs. techniques or client/SO >to discover lifestyle participation in barriers to changes to problem participation in meet selfidentification regimen. care needs. and decisionmaking >to conform to client¶s normal >Plan time for schedule listening to the client/SO(s) >to assist in correcting/dealing >Develop plan with situation of care appropriate to >to reduce risk of individual injury situation; schedule activities Assessment Nursing Dx Planning >Encourage food and fluid choices

reflecting individual likes and abilities that meet nutritional needs >Review safety concerns; modify activities or environment

4 Constipation
Peristaltic movement is influenced by an individual¶s overall physical activity. Since the patient has been immobilized because of her condition, her ability to pass out stools on a regular basis has been altered NursingInterExpected Rationale ventions Outcome S > Ø O > Constipation Short term: > establish > to gain Short term: pt. manifest r/t decreased After 2hrs of rapport > Pt¶s trust > Patient shall physical NI, pt will check and baseline data have verbalize recorded VS > no BM activity understanding for 4days, > to provide verbalized of the with > check Pt¶s adequate understanding appropriate general hypoactive interventions on the interventions condition bowel Interventions to promote sound and > baseline to given to BM and no urge to promote BM > review daily Pt¶s diet prevent defecate diet intake constipation Long term: > to determine if > with > determine Long term: amount of fluid fluid intake Patient shall frequent is enough have regained flatus intake After 3days normal of NI, patient > encourage to > to promote pattern of Patient may will establish increase fiber bowel manifest: bowel or regain elimination functioning and high normal > irritability residue diet pattern of > promote bowel > bloating >instruct Pt. to BM functioning drink warm Assessment Nursing Dx Planning

abdomen > restlessness

water and milk > provide comfort to > instruct the Pt. SO to reposition the > for proper patient every nutrition 2hrs >help and > encourage to determine eat fruits and the amount vegetables of food Pt. taking > assisted eating > answer pt. concerns > provide > for health teachings on comfort the condition measures of the patient > follow Doctor¶s > change order diaper

5 Activity Intolerance
Surgery that was done to the patient resulted in the immobility and inability of the patient to do simple ADLs due to the weakness and pain in her right leg. Nursing NursingInterPlanning Dx ventions >S: Ø >O: Activity Short term: > establish Intolerance After 2 days rapport > Check Vital Patient may related to of nursing interventions, signs manifest: post operative the patient with condition will be able > assess Pt¶s to identify general an intact techniques condition wound that can dressing enhance > Note client activity reports of can sit intolerance. weakness, pain on bed but and difficulty limited Long term accomplishing Assessment Rationale > gain Pt¶s trust > baseline data > to provide proper NI > to monitor the patient¶s ability to do activity Expected Outcome Short term: Patient shall have identified techniques that can enhance activity intolerance.

Long term: > to be able Patient for the

mobility pain when moving eagerness to walk and do ADL Patient may manifest irritability restlessness

goal:

patient to be shall have comfortable reported and gain measurable After 2 > Provide confidence in increase in weeks of position of doing ADL activity Nursing comfort and tolerance Interventions, assisted with the patient ADL >To will report determine the emotional measurable > Assess increase in emotional and and activity psychological psychological response of tolerance. factors affecting the the patient regarding her current disease situation. condition > Encourage to increase intake > To enhance of CHON for patients tissue repair. health condition. > Encourage > For health intake of maintenance vitamin supplements

task/ADL

6 Impaired Physical Mobility
Mobility impairments include upper body and/or lower body disabilities. The condition may be caused by birth defect, injury, or illness. Some patients use their leg or hand braces, canes, walkers, prostheses, or do without aids using other parts of their bodies. Nursing NursingInterExpected Planning Rationale Dx ventions Outcome S> 0 > Impaired Short term: >note for >note in Short term: Patient physical After 4 motor agility congruencies Patient manifested: mobility hours of NI >observe client with reports demonstrated related to patient will when unaware and abilities body be able to >assess >pain Techniques weakness demonstrate >determine patient and techniques complication functional behaviors >swelling and disease and ability related to that enable resumption >shortness condition behaviors immobility (Fracture) that enable >to promote of activities. of resumption >encouraged optimum Assessment

breath >dependence >inability to participate in activities >Patient may manifest: >edema >decrease reaction time >pressure ulcers

of activities. participation in level of self care functioning Long >encourage >to Term: adequate intake maximize After 4 days of fluids and energy production of NI patient nutritious will be able foods >to reduce to maintain risk of or increase >support strength and affected part pressure ulcers function of by using pillows affected body part a

Long Term: Patient was able to maintain or increase strength and function of affected body part.

7 Situational Low Self-Esteem
A person normally have a confidence to whatever he may do, to be able to do the things that are needed for her care, having a social life and interaction to people in the case of the patient having a low self esteem happens when your capabilities were altered and you can no longer do the usual routines that you are doing before will she is recovering from operative state. NursingInterventions >S: Ø >O: Situational Short term: > establish low Self- After 2 days rapport > Patient may esteem of nursing Check vital related to interventions, signs manifest: functional the patient - weaknes impairments will be able > assess Pt¶s secondary to identify general feelings and condition - eagerness to to VA underlying walk and do dynamics for > determine ADLs negative individual perception of situation - selfself. related to low negating self-esteem in verbalizations Long term the present - nonAssessment Nursing Dx Planning Expected Outcome > to gain Pt¶s Short term: trust > Patient shall baseline data have identified >to know feelings and underlying current general dynamics for condition of negative patient perception of self. > to know what are the Long term: appropriate action for the Patient shall care of the have demonstrated Rationale

assertive behavior Indecisive behavior > Patient may manifest: -loneliness -helplessness

goal:

circumstances patient

After 2 > encourage weeks of expression of Nursing feelings Interventions, anxiety the patient > enhances will > assist client commitment Demonstrate to problemto plan, behaviors to solve situation, optimizing restore outcomes developing positive self- plan of action esteem. and setting > to be able goals to for the achieve desired patient to be outcome comfortable and gain confidence in > Provide doing ADL position of comfort and assisted with >To ADL determine the emotional and > Assess emotional and psychological psychological response of factors the patient affecting the regarding her current disease situation. condition > Encourage to > To enhance increase intake patients of CHON for health tissue repair. condition. > Encourage intake of vitamin supplements > For health maintenance

behaviors to restore > to facilitate positive selfgrieving the esteem. loss

8 Readiness for Enhanced Therapeutic Regimen
Therapeutic management regimen is a set of program for the treatment of the illness and is sequelae that is satisfactory for meeting specific health goals. Patient is exhibits readiness to this regimen when he/she demonstrates eagerness to integrate these into his/her daily living.

NursingInterventions S >O Readiness Short term: I> establish O>Patient for After 3hours rapport > manifested: enhanced of NI, pt will check and therapeutic demonstrate record VS >compliance management proactive regimen management > check Pt¶s to medical by management general participating condition AEB in treatment immediate regimen. availing of > give due oral meds recognition to Long term: patient¶s once prescribed initiative to After 2 weeks comply with of NI, patient medical >willingness to do will remain management free from Doctor¶s orders of complications >empower of mobilizing patient to manage illness affected limb by dangling by explaining illness and actions of leg while have sitting on bed achieved a drugs and greater extent benefits from of recovery. complying to >Patient may course of also manifest: treatment >eagerness to go home Assessment Nursing Dx Planning >eagerness to learn ways to prevent further complications

Expected Outcome > to gain Short term: Pt¶s trust > Patient shall baseline data have demonstrated > to provide proactive management adequate by interventions participating in treatment > serves as a regimen. motivation to continue Long term: desirable behavior Patient shall have >knowing remained free the benefits from of treatment complications of make the patient understand illness and have achieved a the importance greater extent of recovery. of such interventions in restoring his/her health Rationale

9 Risk for Infection
Risk for infection occurs when a person is at risk for being invaded by pathogenic organisms. Transmission of an infectious agent from a source to a susceptible host occurs within an environment. Organisms live and multiply in a reservoir. The reservoir provides what the organisms needs for survival at a specific stage in its life cycle. In this case, the dressing and broken skin can be the reservoir that may lead to infection.

NursingInterExpected Rationale ventions Outcome S > Ø O > Risk for Short Term: Monitor For the first Patient patient may Infection r/t After 2 hours temperature. 24 to 48 hours remains free of manifest: Assess incisions postoperatively, infection as musculoskeletal of nursing interventions, for redness, temperatures of evidenced by impairment the patient drainage, up to 38.5 healing increase in will verbalize swelling, and degrees Celsius wound/incision WBC count understanding increased pain. are expected as that is free of of individual a normal redness, redness, causative/risk Instruct response to swelling, swelling, factor. purulent patient/caregiver surgery. purulent discharge, and to wash hands Beyond 48 discharge at pain; and by Long Term: before contact hours, incision site normal temperature with After 1 day of postoperative should return to temperature within 48 patient. Teach patient¶s nursing hyperthermia hours interventions, use of aseptic baseline. Incisions that postoperatively technique the patient during dressing have been will demonstrate change, wound closed with sutures or techniques, care, or staples should handling or lifestyle manipulating of be free of changes to redness, promote safe tubes/drains. swelling, and environment. drainage. Some Instruct incisional caregiver in administration discomfort is expected. of antibiotics and antipyretics These incisions as prescribed. are usually kept covered by a large adhesive bandage for 24 to 48 hours; beyond 48 hours, there is no need for a dressing. Assessment Nursing Dx Planning Hand washing remains the most effective method of infection

control. Reduce fever and risk of infection

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