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Nursing Care Plan for Fractures: Overview

Nursing Care Plan for Fractures

Type of Fractures

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A fracture is a discontinuity or break in a bone. There are more than 150 fracture classifications.

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.

Stable fractures are usually treated with casting. Unstable fractures that are unlikely to reduce may require surgical fixation.

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

  1. 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.
  2. 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

  1. 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.
  2. 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.
  3. 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

  1. 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.
  2. 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.
  3. 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.
  4. Assist with placement of lifts under bed wheels if indicated. Rationale: Helps maintain proper patient position and function of traction by providing counterbalance.
  5. 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).
  6. 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.
  7. 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

  1. 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.
  2. 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.
  3. Initiate/maintain electrical stimulation if used. Rationale: May be indicated to promote bone growth in presence of delayed healing/nonunion.

Nursing Care Plan for Fractures: Overview; Nursing Care Plan for Fractures: Nursing Priorities & Discharge Goals; Nursing Care Plan for Fractures: Nursing Diagnosis; Nursing Care Plan for Fractures: Nursing Intervention with Rationale. Nursing Care Plan for Fractures.