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A fracture (sometimes abbreviated FRX or Fx, Fx, or #) is a discontinuity or break in a bone.

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).
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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 Priorities
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)
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4.
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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)

Discharge Goals
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).

2. Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI)


scans: Visualizes fractures, bleeding, and soft-tissue damage; differentiates between stress/trauma fractures
and bone neoplasms.
3. Arteriograms: May be done when occult vascular damage is suspected.
4. 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). Increased white blood
cell (WBC) count is a normal stress response after trauma.
5. Urine creatinine (Cr) clearance: Muscle trauma increases load of Cr for renal clearance.
6. Coagulation profile: Alterations may occur because of blood loss, multiple transfusions, or liver injury.

Additional Diagnoses
1. Trauma, risk forloss of skeletal integrity, weakness, balancing difficulties, reduced muscle coordination,
lack of safety precautions, history of previous trauma.
2. Mobility, impaired physicalneuromuscular skeletal impairment; pain/discomfort, restrictive therapies
(limb immobilization); psychological immobility.
3. Self-Care deficitmusculoskeletal impairment, decreased strength/endurance, pain.
4. Infection, risk forinadequate primary defenses: broken skin, traumatized tissues; environmental exposure;
invasive procedures, skeletal traction.
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:

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 bones long axis.
Transverse fracture: A fracture that is at a right angle to the bones long axis.
Oblique fracture: A fracture that is diagonal to a bones 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.
Check out the updated version of this post: 8 Fracture Nursing Care Plans

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 fibers. In this way the blood clot is replaced by a matrix of
collagen. Collagens 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 woven bone does not have the strong mechanical properties of mature bone. By a
process of remodeling, the woven bone is replaced by mature lamellar 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
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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

Neuromuscular skeletal impairment; pain/discomfort; restrictive therapies


(limb immobilization)

Psychological immobility
Possibly evidenced by

Inability to move purposefully within the physical environment, imposed


restrictions

Reluctance to attempt movement; limited ROM

Decreased muscle strength/control


Desired Outcomes

Regain/maintain mobility at the highest possible level.

Maintain position of function.

Increase strength/function of affected and compensatory body parts.

Demonstrate techniques that enable resumption of activities.


Nursing Interventions
Rationale
Assess degree of immobility
Patient may be restricted by selfproduced by injury/treatment and
view/self-perception out of
note patients perception of
proportion with actual physical
immobility.
limitations, requiring
information/interventions to
promote progress toward
wellness.
Encourage participation in
Provides opportunity for release
diversional/recreational activities.
of energy, refocuses attention,
Maintain stimulating environment,
enhances patients sense of selfe.g., radio, TV, newspapers,
control/self-worth, and aids in
personal possessions/pictures,
reducing social isolation.
clock, calendar, visits from
family/friends.
Instruct patient in/assist with
Increases blood flow to muscles
active/passive ROM exercises of
and bone to improve muscle tone,
affected and unaffected
maintain joint mobility; prevent
extremities.
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.
limbs and help maintain muscle
strength and mass. Note: These

Provide footboard, wrist splints,


trochanter/hand rolls as
appropriate.

Place in supine position


periodically if possible, when
traction is used to stabilize lower
limb fractures.
Instruct in/encourage use of
trapeze and post position for
lower limb fractures.

Assist with/encourage self-care


activities (e.g., bathing, shaving).

Provide/assist with mobility by


means of wheelchair, walker,
crutches, canes as soon as
possible. Instruct in safe use of
mobility aids.

Monitor blood pressure (BP) with


resumption of activity. Note
reports of dizziness.

exercises are contraindicated


while acute bleeding/edema is
present.
Useful in maintaining functional
position of extremities,
hands/feet, and preventing
complications (e.g.,
contractures/footdrop).
Reduces risk of flexion
contracture of hip.

Facilitates movement during


hygiene/skin care and linen
changes; reduces discomfort of
remaining flat in bed. 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.
Improves muscle strength and
circulation, enhances patient
control in situation, and promotes
self-directed wellness.
Early mobility reduces
complications of bed rest (e.g.,
phlebitis) and promotes healing
and normalization of organ
function. Learning the correct way
to use aids is important to
maintain optimal mobility and
patient safety.
Postural hypotension is a
common problem following
prolonged bed rest and may
require specific interventions
(e.g., tilt table with gradual

Reposition periodically and


encourage coughing/deepbreathing exercises.
Auscultate bowel sounds. Monitor
elimination habits and provide for
regular bowel routine. Place on
bedside commode, if feasible, or
use fracture pan. Provide privacy.

Encourage increased fluid intake


to 20003000 mL/day (within
cardiac tolerance), including
acid/ash juices.
Provide diet high in proteins,
carbohydrates, vitamins, and
minerals, limiting protein content
until after first bowel movement.

Increase the amount of


roughage/fiber in the diet. Limit
gas-forming foods.

elevation to upright position).


Prevents/reduces incidence of
skin and respiratory complications
(e.g., decubitus,
atelectasis, pneumonia).
Bed rest, use of analgesics, and
changes in dietary habits can slow
peristalsis and produce
constipation. Nursing measures
that facilitate elimination may
prevent/limit complications.
Fracture pan limits flexion of hips
and lessens pressure on lumbar
region/lower extremity cast.
Keeps the body well hydrated,
decreasing risk of urinary
infection, stone formation, and
constipation
In the presence of
musculoskeletal injuries, nutrients
required for healing are rapidly
depleted, often resulting in a
weight loss of as much as 20/30
lb during skeletal traction. This
can have a profound effect on
muscle mass, tone, and strength.
Note: Protein foods increase
contents in small bowel, resulting
in gas formation and constipation.
Therefore, gastrointestinal (GI)
function should be fully restored
before protein foods are
increased.
Adding bulk to stool helps prevent
constipation. Gas-forming foods
may cause abdominal distension,
especially in presence of
decreased intestinal motility.

Consult with physical/occupational


therapist and/or rehabilitation
specialist.

Initiate bowel program (stool


softeners, enemas, laxatives) as
indicated.
Refer to psychiatric clinical nurse
specialist/therapist as indicated.

Useful in creating individualized


activity/exercise program. Patient
may require long-term assistance
with movement, strengthening,
and weight-bearing activities, as
well as use of adjuncts, e.g.,
walkers, crutches, canes;
elevated toilet seats; pickup
sticks/reachers; special eating
utensils.
Done to promote regular bowel
evacuation.
Patient/SO may require more
intensive treatment to deal with
reality of current
condition/prognosis, prolonged
immobility, perceived loss of
control.

Acute Pain Fracture


Nursing Diagnosis: Acute Pain
May be related to
Muscle spasms

Movement of bone fragments, edema, and injury to the soft tissue

Traction/immobility device

Stress, anxiety
Possibly evidenced by

Reports of pain

Distraction; self-focusing/narrowed focus; facial mask of pain

Guarding, protective behavior; alteration in muscle tone; autonomic


responses
Desired Outcomes

Verbalize relief of pain.

Display relaxed manner; able to participate in activities, sleep/rest


appropriately.

Demonstrate use of relaxation skills and diversional activities as indicated


for individual situation.
Nursing Interventions
Rationale
Maintain immobilization of
Relieves pain and prevents bone
affected part by means of bed
displacement/extension of tissue
rest, cast, splint, traction.
injury.
Elevate and support injured
Promotes venous return,
extremity.
decreases edema, and may
reduce pain.
Avoid use of plastic
Can increase discomfort by
sheets/pillows under limbs in cast.
enhancing heat production in the
drying cast.
Elevate bed covers; keep linens
Maintains body warmth without
off toes.
discomfort due to pressure of
bedclothes on affected parts.
Evaluate/document reports of
Influences choice of/monitors
pain/discomfort, noting location
effectiveness of interventions.
and characteristics, including
Many factors, including level of
intensity (010 scale), relieving
anxiety, may affect perception
and aggravating factors. Note
of/reaction to pain. Note: Absence
nonverbal pain cues (changes in
of pain expression does not
vital signs and
necessarily mean lack of pain.
emotions/behavior). Listen to
reports of family member/SO
regarding patients pain.
Encourage patient to discuss
Helps alleviate anxiety. Patient
problems related to injury.
may feel need to relive the
accident experience.
Explain procedures before
Allows patient to prepare
beginning them.
mentally for activity and to
participate in controlling level of
discomfort.
Medicate before care activities.
Promotes muscle relaxation and
Let patient know it is important to
enhances participation.
request medication before pain
becomes severe.

Perform and supervise


active/passive ROM exercises.

Provide alternative comfort


measures, e.g., massage, back
rub, position changes.
Provide emotional support and
encourage use of stress
management techniques, e.g.,
progressive relaxation, deepbreathing exercises,
visualization/guided imagery;
provide Therapeutic Touch.
Identify diversional activities
appropriate for patient age,
physical abilities, and personal
preferences.
Investigate any reports of
unusual/sudden pain or deep,
progressive, and poorly localized
pain unrelieved by analgesics.
Apply cold/ice pack first 2472 hr
and as necessary.

Administer medications as
indicated: narcotic and
nonnarcotic analgesics,
e.g., morphine, meperidine
(Demerol), hydrocodone
(Vicodin); injectable and oral
nonsteroidal anti-inflammatory
drugs (NSAIDs), e.g., ketorolac
(Toradol), ibuprofen (Motrin);
and/or muscle relaxants, e.g.,

Maintains strength/mobility of
unaffected muscles and facilitates
resolution of inflammation in
injured tissues.
Improves general circulation;
reduces areas of local pressure
and muscle fatigue.
Refocuses attention, promotes
sense of control, and may
enhance coping abilities in the
management of the stress of
traumatic injury and pain, which
is likely to persist for an extended
period.
Prevents boredom, reduces
muscle tension, and can increase
muscle strength; may enhance
coping abilities.
May signal developing
complications; e.g., infection,
tissue ischemia, compartmental
syndrome.
Reduces edema/hematoma
formation, decreases pain
sensation. Note: Length of
application depends on degree of
patient comfort and as long as the
skin is carefully protected.
Given to reduce pain and/or
muscle spasms. Studies of
ketorolac (Toradol) have proved it
to be effective in alleviating bone
pain, with longer action and fewer
side effects than narcotic agents.

cyclobenzaprine (Flexeril),
carisoprodol
(Soma), diazepam (Valium).
Administer analgesics around the
clock for 35 days.
Maintain/monitor IV patientcontrolled analgesia (PCA) using
peripheral, epidural, or intrathecal
routes of administration. Maintain
safe and effective
infusions/equipment.

Routinely administered or PCA


maintains adequate blood level of
analgesia, preventing fluctuations
in pain relief with associated
muscle tension/spasms.