Nursing Care Plan to the Client with Fractures of the Extremities and Extremities Surgery

Nursing Assessment 1. Assess for history of the injury, presence of factors that may cause pathologic fractures (osteoporosis, osteomyelitis, neoplastic diseases, etc.). 2. Assess presence of signs of fracture (edema, pain, loss of motion, crepitus, extremity disproportion or abnormal positioning). 3. Assess presence of signs and symptoms of soft tissues involvement (swelling, hemorrhage, impaired sensation in the extremity). 4. Assess extremity for presence of open fracture and severe external hemorrhage. 5. Assess vital signs, fluid balance and urine output. 6. Assess diagnostic tests and procedures for abnormal values. 7. Assess routine preoperative history. Nursing Diagnosis 1. Increased risk of hypovolemia and shock related to trauma and bleeding. 2. Increased risk of bone inflammation related to open fracture. 3. Increased risk of fat embolism related to fracture of the long bones. 4. Increased risk of severe fluid, electrolyte, and metabolic imbalances related to injury or inflammation. 5. Pain and immobility , related to diagnosis of fracture. 6. Increased risk of respiratory, cardiovascular, bowel, and skin complications related to a long period of immobility. 7. Anxiety related to the symptoms of disease and fear of the unknown. Nursing Plan and Interventions Goals 1. Increase comfort, decrease pain. 2. Prevent avoidable injury. 3. Prevent complications of immobility. 4. Provide optimal bone and wound healing. 5. Then surgical intervention prescribed, prevent postoperative complications. 6. Decreased anxiety with increased knowledge. Interventions 1. Provide emergency care if requires (hemostasis, respiratory care, prevention of shock). 2. Provide fracture fixation to prevent following injury of tissues. 3. Observe signs of fat embolism (especially during first 48 hours after the fracture). 4. Monitor fluids input and output continuously, insert IV catheter, urinary catheter. 5. Monitor clients vital signs. 6. Monitor clients laboratory tests results for abnormal values. 7. Administer IV therapy, analgesics, antibiotics, and other medications as prescribed. 8. Prepare client and his family for surgical intervention if required. 9. For client after surgical intervention provide routine postoperative care and teach about possible postoperative complications. 10. Provide care to client with cast (observe signs of circulatory impairment change in skin color and temperature, diminished distal pulses, pain and swelling of the extremity; protect the cast from damage). 11. Provide care to client in traction (check the weights are hanging freely, observe skin for irritation and site of skeletal traction insertion for signs of infection; use aseptic technique when cleaning the site of insertion). 12. In case of hip fracture and hip replacement maintain the adduction of the affected extremity.

13. Provide respiratory exercises to prevent lung complications. 14. Observe for signs of thrombophlebitis, report immediately. 15. Provide appropriate skin care to prevent pressure sores. 16. Encourage fluid intake and high-protein, high-vitamin, high-calcium diet. 17. Teach the client appropriate crutch-walking techniques . 18. Provide emotional support to client, explain all procedures to decrease anxiety and to obtain cooperation. 19. Instruct client regarding fracture healing process, diagnostic procedures, treatment and its complications, home care, daily activities, diet, restrictions and follow-up. Evaluation 1. Reports increased comfort, decreased pain. 2. No evidence of respiratory, vascular or skin complications of immobility. 3. Maintains stable vital signs, fluid and metabolic balance, nutritional state. 4. Has sufficient fracture healing rate. 5. Laboratory tests results shows no abnormalities. 6. No postoperative complications, or treatment complications. 7. Learned of crutch-walking, taking care of himself then possible. 8. Demonstration of understanding of fracture healing process, diagnostic and treatment procedures, trauma prevention, and need for follow-up.