9 Fracture Nursing Care Plans

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 non-viable 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.

or other harmful factors. Pain is activated when a pt¶s pain threshold is reached. Pain usually accompanies inflammation. with decrease pain from 8/10 to 5 below Pt¶s pain > check and > baseline shall have decreased recorded VS data from 8/10 > check Pt¶s > to provide rate to 4/10. The bone shards can also embed in the muscle causing great pain. and adequate nutrition (including calcium intake) will help the bone healing process. manifest > intact wound dressing on right leg > continuous moderate sharpstabbing pain experience whenever pt. general adequate condition interventions Long term: > reposition pt. Pain threshold is the point at which a stimulus activates pain receptors to produce a feeling of pain. 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. listening > to be able to music and to have an reading books idea on how the pain is > note clients relieved response to pain > to have ion a > perform complete comprehensive information pain and to provide . pain radiates from the operative site down to the toes > Pt¶s pain rates 8/10 Patient may manifest: After 3days of NI. Assessment S>Ø Nursing Dx Planning Nursing Rationale Expected Outcome Interventions Acute Pain Short term: > establish rapport > to gain Pt s Short term: trust O > pt. turns on her side. also builds bone strength. any form of nicotine hinders the process of bone healing. Although there are theoretical concerns about NSAIDs slowing the rate of healing. after the bone has healed sufficiently to bear the weight. For example. > provide comfort Patient¶s > instruct pt to Long term: do DBE pain shall > to help have been whenever pain alleviate relieved After 3days is felt pain of NI patient will report > encourage to > to help in relive from do diversional alleviating pain activities such pain as chatting to SO. pt will verbalize decrease pain. Weight-bearing stress on bone. It results from the synthesis of prostaglandins.Several factors can help or hinder the bone healing process. which are hormones produced during the inflammatory process.

> irritability > increase in RR > restlessness assessment proper NI > identify ways > to provide on how to comfort to minimize pain patient .

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

optimize therapeutic effect in the Provide patient home care environment. with medical supplies and assistive devices Efforts to needed enhance selfcare abilities promotes successful transition/ accommodation to home environment.teach proper technique. Assessment Nursing Dx Nursing Planning Interventions Rationale Expected Outcome .

manifest > intact wound dressing on right leg > continuous moderate sharpstabbing pain experience whenever pt. below > instruct pt to Long term: do DBE whenever pain After is felt 3days of NI patient > encourage to will report do diversional relive from activities such pain as chatting to SO. 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: > establish rapport After 3days of > check and NI. pt will recorded VS verbalize decrease > check Pt¶s pain. with general decrease condition pain from 8/10 to 5 > reposition pt. listening to music and reading books > note clients response to pain > perform comprehensive pain assessment > identify ways on how to minimize pain > to gain Pt¶s trust > baseline data > to provide adequate interventions > provide comfort > to help alleviate pain > to help in alleviating pain > to be able to have an idea on how the pain is relieved > to have ion a complete information and to provide proper NI > to provide comfort to patient Short term: Pt¶s pain shall have decreased from 8/10 rate to 4/10.S>Ø O > pt. turns on her side. Long term: Patient¶s pain shall have been relieved .

bathing. Assessment Nursing Dx >S: Ø Planning Nursing Rationale Expected Outcome Short-Term: Interventions Self-Care Deficit Short-Term: >Establish related to rapport >O: musculoskeletal After 2 hours of nursing >Monitor and impairment Patient may secondary to interventions. general condition Long-Term: >to assess degree The patient shall have >Determine of disability After 2 days individual demonstrated of nursing techniques or strengths and >to enhance interventions. >to provide proper nursing Long-Term: interventions . clothing oneself. optimizing changes to will meet selfoutcomes demonstrate >Promote care needs. 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. she is prevented from performing ADLs that allow her to manage her hygiene such as bathroom privileges. techniques or client/SO >to discover lifestyle participation in barriers to changes to problem participation in meet selfidentification regimen. skills of the commitment to lifestyle the patient client plan.3 Self-Care Deficit Due to limitations in the individual¶s ability to ambulate. record vital the patient signs manifest fractured femur >to gain patient s trust and cooperation inability to: Get bath supplies Wash body or body parts Get in and out of bathroom will verbalize knowledge of >Assess healthcare patient¶s practices. schedule activities >Encourage food and fluid choices reflecting The patient shall have >to have baseline verbalized knowledge data of healthcare practices.

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

proper NI . Assessment >S: Ø Nursing Dx Planning Nursing Rationale > gain Pt s trust Expected Outcome Short term: Interventions Activity Short term: > establish Intolerance rapport After 2 days related to of nursing > Check Vital post interventions. > assess Pt¶s general condition Patient shall have identified > baseline techniques that data can enhance > to provide activity intolerance. assisted with doing ADL the patient will be able to identify techniques that can enhance activity intolerance. > assisted taking eating > answer pt. signs operative the patient condition >O: Patient may manifest: with an intact wound dressing can sit on bed but limited mobility pain when moving eagerness to walk and do ADL > to monitor Long term: > Note client the patient¶s reports of ability to do Patient shall have reported weakness. concerns > provide health teachings on > for the condition comfort of the patient measures > change diaper > follow Doctor¶s order 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.patient every 2hrs > for proper nutrition > encourage to >help and eat fruits and determine vegetables the amount of food Pt. pain activity measurable and difficulty Long term accomplishing > to be able increase in goal: activity tolerance task/ADL for the patient to be After 2 > Provide comfortable weeks of position of and gain Nursing comfort and confidence in Interventions.

> Encourage > For health intake of maintenance vitamin supplements . condition > Encourage to increase intake > To enhance of CHON for patients tissue repair. health condition.Patient may manifest restlessness irritability will report measurable increase in activity tolerance. ADL >To determine the emotional > Assess emotional and and psychological psychological response of factors affecting the the patient regarding her current disease situation.

injury. >encouraged optimum Long Term: participation in level of self care functioning Patient was Long Term: able to >encourage >to adequate intake maximize maintain or After 4 days of fluids and energy increase of NI patient nutritious production strength and will be able foods function of to maintain >to reduce affected or increase >support body part. prostheses. walkers.6 Impaired Physical Mobility Mobility impairments include upper body and/or lower body disabilities. Some patients use their leg or hand braces. or illness. The condition may be caused by birth defect. or do without aids using other parts of their bodies. risk of strength and affected part pressure function of by using ulcers affected pillows body part a . Assessment S> Nursing Dx Planning Nursing Rationale Expected Outcome Interventions Impaired physical 0 > Patient mobility manifested: related to body >pain weakness and >swelling disease >shortness condition (Fracture) of Short term: >note for motor >note in Short term: agility congruencies After 4 with reports Patient hours of NI >observe client and abilities demonstrated breath >dependence >inability to participate in activities >Patient may manifest: >edema >decrease reaction time >pressure ulcers patient will be able to demonstrate techniques and behaviors that enable resumption of activities. canes. when unaware >assess patient functional ability Techniques and >determine behaviors complication that enable related to resumption immobility >to promote of activities.

plan of action outcomes esteem.weaknes . and setting goals to > to be able achieve desired for the outcome patient to be comfortable and gain > Provide confidence in position of doing ADL comfort and assisted with >To ADL determine the emotional > Assess . Assessment >S: Ø Nursing Dx Planning Nursing Rationale Expected Outcome Interventions Situational Short term: > establish low Selfrapport After 2 days esteem > Check vital related to of nursing interventions. related to low what are the Patient shall self-esteem in appropriate have Long term the present action for the demonstrated goal: circumstances care of the behaviors to restore positive patient After 2 self-esteem. anxiety loss the patient will > assist client > enhances Demonstrate to problemcommitment behaviors to solve situation. dynamics for > determine patient negative Long term: individual perception of situation > to know self. > encourage weeks of expression of > to facilitate Nursing feelings grieving the Interventions.nonassertive behavior Indecisive behavior > Patient may manifest: -loneliness -helplessness Patient shall have identified > baseline feelings and data underlying dynamics for >to know negative current perception of condition general underlying condition of self.eagerness to walk and do ADLs .self-negating verbalizations . signs functional the patient impairments will be able > assess Pt¶s secondary to identify general to VA feelings and > to gain Pt s Short term: trust >O: Patient may manifest: . to be able to do the things that are needed for her care. to plan. 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. restore developing optimizing positive self.7 Situational Low Self-Esteem A person normally have a confidence to whatever he may do.

> give due recognition to > serves as a Long term: patient¶s motivation Long term: initiative to to continue After 2 weeks comply with desirable Patient shall of NI. pt will demonstrate regimen I> establish rapport > to gain Pt s Short term: trust O>Patient manifested: >compliance to medical management AEB immediate availing of oral meds once prescribed >willingness to do Doctor¶s orders of mobilizing affected limb by dangling leg while Patient shall > check and > baseline have demonstrated record VS data proactive proactive management > check Pt¶s > to provide management by by general adequate participating condition participating in treatment interventions in treatment regimen. patient medical have behavior will remain management remained free free from >knowing from complications >empower the benefits complications of patient to of treatment of manage illness make the illness and illness and by explaining patient have actions of understand have achieved a drugs and achieved a .emotional and psychological factors affecting the current situation. and psychological response of the patient regarding her disease condition > Encourage to increase intake > To enhance of CHON for patients tissue repair. > Encourage intake of > For health vitamin maintenance supplements 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. Assessment S >O Nursing Dx Planning Nursing Rationale Expected Outcome Interventions Readiness Short term: for enhanced therapeutic After 3hours management of NI. Patient is exhibits readiness to this regimen when he/she demonstrates eagerness to integrate these into his/her daily living. regimen. health condition.

sitting on bed >Patient may also manifest: >eagerness to go home >eagerness to learn ways to prevent further complications greater extent benefits from of recovery. of such interventions in restoring his/her health 9 Risk for Infection Risk for infection occurs when a person is at risk for being invaded by pathogenic organisms. or handling or manipulating of tubes/drains. Organisms live and multiply in a reservoir. understanding swelling. lifestyle changes to promote safe environment. are expected as redness. the dressing and broken skin can be the reservoir that may lead to infection. O > patient may manifest: increase in WBC count redness. postoperatively. of individual increased pain. impairment degrees Celsius that is free of will verbalize drainage. The reservoir provides what the organisms needs for survival at a specific stage in its life cycle. the patient will demonstrate techniques.5 wound/incision the patient redness. as evidenced by of nursing Assess temperatures healing interventions. a normal response to purulent causative/risk surgery. and by patient/caregiver 48 hours. Instruct pain. and drainage. and swelling. After 2 hours musculo For the first 24 Patient remains to 48 hours free of infection postoperatively. complying to course of treatment the greater extent importance of recovery. purulent discharge at incision site hyperthermia interventions. and factor. swelling. Beyond discharge. Transmission of an infectious agent from a source to a susceptible host occurs within an environment. wound care. Teach use of aseptic technique during dressing change. Long Term: to wash hands temperature normal before contact should return temperature After 1 day of with to patient s within 48 hours nursing postoperative baseline. In this case. . patient. swelling. incisions for skeletal of up to 38. Assessment S>Ø Nursing Dx Planning Nursing Rationale Expected Outcome Interventions Risk for Short Term: Monitor Infection r/t temperature. Incisions that have been closed with sutures or staples should be free of redness.

Instruct caregiver in administration of antibiotics and antipyretics as prescribed. Some incisional discomfort is expected. These incisions are usually kept covered by a large adhesive bandage for 24 to 48 hours. beyond 48 hours. there is no need for a dressing. Hand washing remains the most effective method of infection control. Reduce fever and risk of infection .