Nursing Care Plan for Fractures: Overview
Fracture Overview
Five major ones are as follow:
- Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).
- 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 Care Plan for Fractures
Here is a Sample of Nursing Care Plan for Fractures.
Nursing Care Plan for Fractures: Nursing Diagnosis
Nursing Care Plan for Fractures | Nursing Diagnosis of Fractures- Trauma, risk for Related to Loss of skeletal integrity (fractures)/movement of bone fragments
Possibly evidenced by
- [Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
- Bone Healing (NOC)
- Maintain stabilization and alignment of fracture(s).
- Display callus formation/beginning union at fracture site as appropriate.
- Risk Control (NOC)
- Demonstrate body mechanics that promote stability at fracture site.
Nursing Care Plan for Fractures: Nursing Intervention & Rationale
Nursing Care Plan for Fractures
Positioning (NIC)
Nursing Interventions of Fractures with Rationale: Independent
- Maintain bed rest/limb rest as indicated. Provide support of joints above and below fracture site, especially when moving/turning. Rationale: Provides stability, reducing possibility of disturbing alignment/muscle spasms, which enhances healing.
- Place a bedboard under the mattress or place patient on orthopedic bed. Rationale: Soft or sagging mattress may deform a wet (green) plaster cast, crack a dry cast, or interfere with pull of traction.
Nursing Care Plan for Fractures
Cast Care: Wet (NIC)
Nursing Interventions of Fractures with Rationale: Independent
- Support fracture site with pillows/folded blankets. Maintain neutral position of affected part with sandbags, splints, trochanter roll, footboard. Rationale: Prevents unnecessary movement and disruption of alignment. Proper placement of pillows also can prevent pressure deformities in the drying cast.
- Use sufficient personnel for turning. Avoid using abduction bar for turning patient with spica cast. Rationale: Hip/body or multiple casts can be extremely heavy and cumbersome. Failure to properly support limbs in casts may cause the cast to break.
- Evaluate splinted extremity for resolution of edema. Rationale: Coaptation splint (e.g., Jones-Sugar tong) may be used to provide immobilization of fracture while excessive tissue swelling is present. As edema subsides, readjustment of splint or application of plaster/fiberglass cast may be required for continued alignment of fracture.
Nursing Interventions of Fractures with Rationale
Traction/Immobilization Care (NIC)
Nursing Interventions of Fractures with Rationale: Independent
- Maintain position/integrity of traction (e.g., Buck, Dunlop, Pearson, Russell). Rationale: Traction permits pull on the long axis of the fractured bone and overcomes muscle tension/shortening to facilitate alignment and union. Skeletal traction (pins, wires, tongs) permits use of greater weight for traction pull than can be applied to skin tissues.
- Ascertain that all clamps are functional. Lubricate pulleys and check ropes for fraying. Secure and wrap knots with adhesive tape. Rationale: Ensures that traction setup is functioning properly to avoid interruption of fracture approximation.
- Keep ropes unobstructed with weights hanging free; avoid lifting/releasing weights. Rationale: Optimal amount of traction weight is maintained. Note: Ensuring free movement of weights during repositioning of patient avoids sudden excess pull on fracture with associated pain and muscle spasm.
- Assist with placement of lifts under bed wheels if indicated. Rationale: Helps maintain proper patient position and function of traction by providing counterbalance.
- Position patient so that appropriate pull is maintained on the long axis of the bone. Rationale: Promotes bone alignment and reduces risk of complications (e.g., delayed healing/nonunion).
- Review restrictions imposed by therapy, e.g., not bending at waist/sitting up with Buck traction or not turning below the waist with Russell traction. Rationale: Maintains integrity of pull of traction.
- Assess integrity of external fixation device. Rationale: Hoffman traction provides stabilization and rigid support for fractured bone without use of ropes, pulleys, or weights, thus allowing for greater patient mobility/comfort and facilitating wound care. Loose or excessively tightened clamps/nuts can alter the compression of the frame, causing misalignment.
Nursing Care Plan for Fractures
Nursing Interventions of Fractures with Rationale: Collaborative
- Review follow-up/serial x-rays. Rationale: Provides visual evidence of proper alignment or beginning callus formation/healing process to determine level of activity and need for changes in/additional therapy.
- Administer alendronate (Fosamax) as indicated. Rationale: Acts as a specific inhibitor of osteoclast-mediated bone resorption, allowing bone formation to progress at a higher ratio, promoting healing of fractures/decreasing rate of bone turnover in presence of osteoporosis.
- Initiate/maintain electrical stimulation if used. Rationale: May be indicated to promote bone growth in presence of delayed healing/nonunion.
