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:

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 “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

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.

AssessmentNursing Dx

PlanningNursing Inter-ventions

RationaleExpected Outcome

S > Ø O > pt. manifest

> intact wound dressing on right leg

> continuous moderate sharp-stabbing 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

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

> perform comprehensive pain assessment

> identify ways on how

> 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

Short term: Pt’s pain shall have decreased from 8/10 rate to 4/10.

Long term:

Patient’s pain shall have been relieved

> restlessness

to minimize pain

> to provide comfort to patient

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.


PlanningNursing Inter-ventions


S > O O > Patient manifested:

▪ Verbalizes inadequate knowledge of care/use of immobilization device, mobility limitations, complications, and follow-up care.

▪ Patient expresses concerns about ability to manage independently at home.

▪ Confusion; asking multiple questions

Deficient Knowledge related to new condition and treatment and cognitive limitations.

Short Term: ▪ After 4 hours of nursing interventions, the patient will participate in the learning process and will verbalize understanding of condition process and treatment.

Long Term:

▪ After 1 day of nursing interventions, the patient will assume responsibility for own learning and begin to look for information regarding health.

▪ Assess current understanding of treatment and follow-up care. ▪ Determine if hazards exist in the home that will compromise the patient’s ability to be effectively mobile as home.

▪ Perform prescribed exercises several times a day.

▪ Identify and report to physician signs of neurovascular compromise of extremity: pain, numbness, tingling, burning, swelling, or discoloration.

▪ Effective discharge planning is based on a clear understanding of the needs of the patient and family members who will assume caregiver roles. ▪ To prevent patient from injury.

▪ Regular exercise is necessary to maintain muscle tone and promote bone healing.

▪ Early assessment reduces the risk of injury or complications

▪ This

Patient verbalizes understanding of and demonstrates ability to perform postoperative care after discharge. Patient/caregiver verbalizes understanding of treatment, possible complications, and follow-up care.

▪ Obtain proper nutrition

▪ Involve patient/caregiver in procedures. Supervise those performing procedures and teach proper technique.

▪ Provide patient with medical supplies and assistive devices needed

promotes bone/wound healing and prevent constipation.

▪ Ability to perform self-care procedures decreases risk of infection and optimize therapeutic effect in the home care environment.

▪ Efforts to enhance self-care abilities promotes successful transition/ accommodation to home environment.


PlanningNursing

InterventionsRationale

Expected Outcome

S > Ø

O > pt. manifest

> intact wound dressing on right leg

> continuous moderate sharp-stabbing pain experience whenever pt. turns on her side; pain radiates from the operative site down to the toes

> Pt’s pain rates 8/10


> 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


> 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

> perform comprehensive pain assessment

> identify ways on how to minimize pain

> to gain Pt’s trust

> baseline data


> 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.

Long term:

Patient’s pain shall have been relieved

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.

Assessment

Nursing Dx PlanningNursing Interventions


>S: Ø >O:

Patient may manifest inability to:

- Get bath supplies

- Wash body or body parts

- Get in and out of bathroom

Self-Care Deficit related to musculoskeletal impairment secondary to fractured femur

Short-Term: After 2 hours of nursing interventions, the patient will verbalize knowledge of healthcare practices.

Long-Term:

After 2 days of nursing interventions, the patient will demonstrate techniques or lifestyle changes to meet self-care needs.

>Establish rapport >Monitor and record vital signs

>Assess patient’s general condition

>Determine individual strengths and skills of the client

>Promote client/SO participation in problem identification and decision-making

>Plan time for listening to the client/SO(s)

>Develop plan of care appropriate to individual situation; schedule activities

>Encourage food and fluid choices

>to gain patient’s trust and cooperation >to have baseline data

>to provide proper nursing interventions

>to assess degree of disability

>to enhance commitment to plan, optimizing outcomes

>to discover barriers to participation in regimen.

>to conform to client’s normal schedule

>to assist in correcting/dealing with situation

>to reduce risk of injury

Short-Term: The patient shall have verbalized knowledge of healthcare practices.

Long-Term:

The patient shall have demonstrated techniques or lifestyle changes to meet self-care needs.

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

Assessment

Nursing Dx PlanningNursing Interventions


S > Ø O > pt. manifest

> no BM for 4days, with hypoactive bowel sound and no urge to defecate

> with frequent flatus


>

Constipation r/t decreased physical activity

Short term: After 2hrs of NI, pt will verbalize understanding of the appropriate interventions to promote BM and prevent constipation

Long term:

After 3days of NI, patient will establish or regain normal pattern of

> establish rapport > check and recorded VS


> review daily diet intake

> determine amount of fluid intake

> encourage to increase fiber and high residue diet



> baseline to Pt’s diet

> to determine if fluid intake is enough

> to promote bowel

Short term: Patient shall have

verbalized understanding on the Interventions given to promote BM

Long term:

Patient shall have regained normal pattern of bowel functioning

irritability

> bloating abdomen

> restlessness

bowel functioning

>instruct Pt. to drink warm water and milk

> instruct the SO to reposition the patient every 2hrs

> encourage to eat fruits and vegetables

> assisted eating

> provide health teachings on the condition of the patient

> change diaper

elimination

> promote BM

> provide comfort to Pt.

> for proper nutrition

>help and determine the amount of food Pt. taking

> answer pt. concerns

> for comfort measures

> 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.


PlanningNursing Interventions


>S: Ø >O:


- with an intact wound dressing

Activity Intolerance related to post operative condition

Short term: After 2 days of nursing interventions, the patient will be able to identify techniques

> establish rapport > Check Vital signs

> assess Pt’s general

> gain Pt’s trust > baseline data

> to provide proper NI

> to monitor

Short term: Patient shall have identified techniques that can enhance activity

- can sit on bed but limited mobility

- pain when moving

- eagerness to walk and do ADL

- Patient may manifest

- irritability

- restlessness

that can enhance activity intolerance.

Long term goal:

After 2 weeks of Nursing Interventions, the patient will report measurable increase in activity tolerance.

condition

> Note client reports of weakness, pain and difficulty accomplishing task/ADL

> Provide position of comfort and assisted with ADL

> Assess emotional and psychological factors affecting the current situation.

> Encourage to increase intake of CHON for tissue repair.

> Encourage intake of vitamin supplements

the patient’s ability to do activity

> to be able for the patient to be comfortable and gain confidence in doing ADL

>To determine the emotional and psychological response of the patient regarding her disease condition

> To enhance patients health condition.

> For health maintenance

intolerance.

Long term:

Patient shall have reported measurable increase in activity tolerance

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.


PlanningNursing Interventions


S > Φ 0 > Patient

Impaired physical mobility

Short term: After 4 hours of NI

>note for motor agility >observe client

>note in congruencies with

Short term: Patient demonstrate

manifested:

>pain

>swelling

>shortness of

breath

>dependence

>inability to participate in activities

>Patient may manifest:

>edema

>decrease reaction time

>pressure ulcers

related to body weakness and disease condition (Fracture)

patient will be able to demonstrate techniques and behaviors that enable resumption of activities.

Long Term:

After 4 days of NI patient will be able to maintain or increase strength and function of affected body part

when unaware

>determine complication related to immobility

>encouraged participation in self care

>encourage adequate intake of fluids and nutritious foods

>support affected part by using pillows

a

reports and abilities >assess patient functional ability

>to promote optimum level of functioning

>to maximize energy production

>to reduce risk of pressure ulcers

d

Techniques and behaviors that enable resumption of activities.

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.

Assessment Nursing Dx PlanningNursing Interventions


>S: Ø >O:


Situational low Self-esteem related to functional

Short term: After 2 days of nursing interventions, the patient

> establish rapport > Check vital signs


>to know

Short term: Patient shall have identified feelings and

- weaknes

- eagerness to walk and do ADLs

- self-negating verbalizations

- non- assertive behavior

- Indecisive behavior

> Patient may manifest:

-loneliness

-helplessness

impairments secondary to VA

will be able to identify feelings and underlying dynamics for negative perception of self.

Long term goal:

After 2 weeks of Nursing Interventions, the patient will Demonstrate behaviors to restore positive self-esteem.

> assess Pt’s general condition

> determine individual situation related to low self-esteem in the present circumstances

> encourage expression of feelings anxiety

> assist client to problem-solve situation, developing plan of action and setting goals to achieve desired outcome

> Provide position of comfort and assisted with ADL

> Assess emotional and psychological factors affecting the current situation.

> Encourage to increase intake of CHON for tissue repair.

current general condition of patient

> to know what are the appropriate action for the care of the patient

> to facilitate grieving the loss

> enhances commitment to plan, optimizing outcomes

> to be able for the patient to be comfortable and gain confidence in doing ADL

>To determine the emotional and psychological response of the patient regarding her disease condition

> To enhance patients health condition.

underlying dynamics for negative perception of self.

Long term:

Patient shall have demonstrated behaviors to restore positive self-esteem.

> Encourage intake of vitamin supplements

> For health maintenance

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.

Assessment Nursing Dx PlanningNursing Interventions


S >O 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 sitting on bed

>Patient may also manifest:

>eagerness to go home

Readiness for enhanced therapeutic management regimen

Short term: After 3hours of NI, pt will demonstrate proactive management by participating in treatment regimen.

Long term:

After 2 weeks of NI, patient will remain free from complications of

illness and have achieved a greater extent of recovery.

I> establish rapport > check and record VS


> give due recognition to patient’s initiative to comply with medical management

>empower patient to manage illness by explaining actions of drugs and benefits from complying to course of treatment


> to provide adequate

interventions

> serves as a motivation to continue desirable behavior

>knowing the benefits of treatment make the patient understand

the importance of such interventions in restoring his/her

Short term: Patient shall have demonstrated proactive management by participating in treatment regimen.

Long term:

Patient shall have remained free from complications of

illness and have achieved a greater extent of recovery.

>eagerness to learn ways to prevent further complications

health

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.

Assessment Nursing Dx PlanningNursing Inter-ventions


S > Ø O > patient may manifest:

▪ increase in WBC count

▪ redness, swelling, purulent discharge at incision site

▪ hyperthermia

Risk for Infection r/t musculo skeletal impairment

Short Term: After 2 hours of nursing interventions, the patient will verbalize understanding of individual causative/risk factor.

Long Term:

After 1 day of nursing interventions, the patient will demonstrate techniques, lifestyle changes to promote safe environment.

▪ Monitor temperature. ▪ Assess incisions for redness, drainage, swelling, and increased pain.

▪ Instruct patient/caregiver to wash hands before contact with postoperative patient. Teach use of aseptic technique during dressing change, wound care, or handling or manipulating of tubes/drains.

▪ Instruct caregiver in administration

▪ For the first 24 to 48 hours postoperatively, temperatures of up to 38.5 degrees Celsius are expected as a normal response to surgery. Beyond 48 hours, temperature should return to patient’s baseline. ▪ Incisions that have been closed with sutures or staples should be free of redness, swelling, and drainage. Some incisional discomfort is

Patient remains free of infection as evidenced by healing wound/incision that is free of redness, swelling, purulent discharge, and pain; and by normal temperature within 48 hours postoperatively

of antibiotics and antipyretics as prescribed.

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

Fracture Nursing Care Plans

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