FRACTURE 

is the medical term used for a broken bone. They

occur when the physical force exerted on the bone is stronger
than the bone itself. They commonly happen because of car
accidents, falls or sports injuries. 

COMPLETE: Fracture line involves entire cross-section of the

bone, and bone fragments are usually displaced. The break goes
completely through the bone, separating it in two. It can be
classified as: transverse: straight across the bone. oblique:
oblique line across the bone.

Transverse - the break is straight across the bone

Linear - the breaks runs in the direction of the bone

shaft
Oblique - the line of the fracture is at an oblique angle
to the bone shaft
Spinal - the fracture line partially encircle the bone
 MANAGEMENT Occasionally, it might need to put the
fractured part in traction. This treatment uses pulleys and weights to
stretch the muscles and tendons around the broken bone. Traction
aligns the bone to promote healing or for Surgery the treatment may
use stainless-steel screws, plates and fixators, or frames that hold the
bone steady.

ACUTE PAIN related to Movement of bone fragments, edema, and injury to the
soft tissue and traction/immobility device as evidenced by verbalization of pain,
guarding, protective behavior; alteration in muscle tone; autonomic responses.

PLANNING; After care Client will verbalize relief of pain. Client will display
relaxed manner.

NURSING INTERVENTION RATIONALE

Assess and record the patient’s level of Influences the effectiveness of
pain utilizing pain intensity rating interventions
scale. Note relieving and aggravating
factors, and nonverbal pain cues such
as changes in vital signs, emotions, and
behavior.

Maintain immobilization of affected Relieves pain and prevents

part by means of bed rest, cast, splint, bone displacement and extension of
traction. tissue injury.

Elevate and support injured extremity. Promotes venous return, decreases

edema, and may reduce pain.

Avoid use of plastic sheets and pillows Can increase discomfort by enhancing
under limbs in cast. heat production in the drying cast.

Elevate bed covers; keep linens off
toes.
Provide alternative comfort
measures (massage, backrub, position
changes).
Provide emotional support and
Maintains body warmth without
discomfort due to the pressure of
bedclothes on affected parts.
Improves general circulation; reduces
areas of local pressure and
muscle fatigue.
encourage the use of stress
management techniques (progressive
relaxation, deep-breathing exercises,
visualization or guided imagery);
provide Therapeutic Touch.
Investigate any reports of unusual or
sudden pain or deep, progressive, and
poorly localized pain unrelieved by
analgesics.
Refocuses attention, promotes a 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.
May signal developing complications 
(infection, tissue ischemia,
compartmental syndrome).

EVALUATION After care Client verbalized relief of pain. Client displayed

relaxed manner.

IMPAIRED SKIN INTEGRITY related to insertion of traction pins, wires,

screws, physical immobilization as evidenced by verbalization of itching,
pain, numbness, pressure in affected/surrounding area, disruption of
skin surface; invasion of body structures; destruction of skin
layers/tissues

PLANNING; After care Client will verbalize relief of discomfort. Client will
demonstrate behaviors/techniques to prevent skin
breakdown/facilitate healing as indicated.

NURSING INTERVENTION RATIONALE

Examine the skin for open wounds,
foreign bodies, rashes, bleeding,
discoloration, duskiness, blanching.
Assess the position of splint ring of
traction device..
Provides information regarding
skin circulation and problems that
may be caused by application or
restriction of cast, splint or
traction apparatus, or edema
formation that may require
further medical intervention.
Improper positioning may cause
 skin injury or breakdown.
Massage skin and bony prominences.
Keep the bed linens dry and free of Reduces pressure on susceptible
wrinkles. Place water pads, other
areas and risk of abrasions and
padding under elbows or heels as
indicated.. skin breakdown.

Reposition frequently. Encourage use

of trapeze if possible.
Instruct patient and SO to avoid
inserting objects inside casts;
Lessens constant pressure on the
same areas and minimizes the
risk of skin breakdown. Use of
trapeze may reduce the risk of
abrasions to elbows and heels.

“Scratching an itch” may cause

tissue injury.
Turn frequently to include the
uninvolved side, back, and prone
positions (as tolerated) with patient’s
feet over the end of the mattress.
Minimizes pressure on feet and
around cast edges.

EVALUATION After care Client verbalized relief of discomfort. Client

demonstrated behaviors/techniques to prevent skin
breakdown/facilitate healing as indicated.