Fractures are broken bones. Fractures can occur from trauma such as motor vehicle accidents, age-related conditions like osteoporosis, or from overuse such as stress fractures in athletes.
There are also different kinds of fractures. Here are some examples:
- Open [compound] fracture. Bone has broken through the skin.
- Closed fracture. The bone does not puncture through the skin.
- Greenstick fracture. Frequently seen in children when the bone has bent but does not break.
- Comminuted fracture. The bone is shattered in multiple places.
The Nursing Process
Nurses may care for patients with fractures in many settings such as emergency departments, urgent care centers, or inpatient units following surgical repairs. Fractures can be minor such as a broken toe only requiring splinting or major such as a hip, neck, or femur fracture requiring surgery, inpatient care, and months of recovery. Nurses assist with pain control, overcoming activity limitations, preventing further complications, and discharge planning.
Nursing Care Plans Related to Fractures
Acute Pain Care Plan
Acute pain with a fracture results from injury to the surrounding tissues, muscles, and nerves.
Nursing Diagnosis: Acute Pain
Related to:
- Bone displacement
- Compromised tissue
- Muscle spasms
- Edema
As evidenced by:
- Verbalization of pain
- Guarding behavior
- Facial grimacing or crying
- Diaphoresis
- Restlessness
- Distracted behavior
- Tachypnea, tachycardia, and increased blood pressure
Expected Outcomes:
- Patient will report pain of 2/10 or less by discharge
- Patient will display signs of comfort as evidenced by resting with eyes closed and vital signs within normal limits
- Patient will utilize nonpharmacologic pain relief measures
Acute Pain Assessment
1. Assess for pain.
Using appropriate pain scales based on age and cognitive level [numeric, Wong-Baker FACES, FLACC] assess the severity of pain. The nurse should also assess the location, characteristics, and frequency of pain.
2. Monitor vital signs.
An elevated blood pressure and heart rate is a normal response to pain. These vital signs should improve once appropriate pain measures are instituted.
3. Assess pain relief.
After administering pain medications, the nurse should follow up within an hour to assess the effectiveness of medications or interventions.
Acute Pain Interventions
1. Administer analgesics.
Acute fractures usually warrant narcotic pain relief which may be oral or IV. NSAIDs such as Ibuprofen or Naproxen treat inflammation and are often given in conjunction with narcotics.
2. Provide alternative comfort measures.
Patients should not rely solely on medication. Implement alternative measures that alleviate the patient’s pain such as ice packs, heat, massage, distraction, and controlled breathing.
3. Support the injured area.
A fractured extremity should remain elevated to reduce swelling. Utilize splints or traction devices as ordered. Immobilize the fractured area and follow weight-bearing instructions to promote healing.
4. Instruct on medications at discharge.
Patients should be instructed to not take pain medications more frequently than prescribed. If the dose ordered is not controlling their pain they should contact their provider. Instruct on other precautions with narcotics such as not operating vehicles, and possible side effects such as drowsiness, dizziness, nausea, and constipation.
Risk For Constipation Care Plan
Opioids used for pain will cause constipation as they slow down gastric emptying and peristalsis. Untreated constipation can have uncomfortable and serious consequences.
Nursing Diagnosis: Risk For Constipation
Related to:
- Immobility
- Opioid use
- Change in eating pattern
- Insufficient fluid intake
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not occurred yet and the goal of nursing interventions is aimed at prevention.
Expected Outcomes:
- Patient will have a solid bowel movement at least every 3 days
- Patient will report no straining or discomfort with defecation
- Patient will implement 2 measures to prevent constipation
Risk For Constipation Assessment
1. Auscultate bowel sounds.
Assess for the presence, location, and characteristics of bowel sounds.
2. Assess the patient’s normal bowel pattern.
Not everyone has a bowel movement daily. Bowel movements every 2-3 days are considered normal as long as the patient is not experiencing discomfort.
Risk For Constipation Interventions
1. Administer stool softeners or laxatives.
The most common side effect of opioid medications is constipation. When prescribed these medications a stool softener should be used prophylactically in conjunction. For severe constipation, enemas may be required.
2. Educate on the risk and prevention of constipation.
Educate that patient that constipation is increased due to their immobility and use of opioids [if taking]. Stool softeners should be taken before constipation occurs to prevent impaction or serious complications such as a bowel obstruction.
3. Increase fluids.
Fluids keep stools soft and easier to pass. Patients should drink plenty of water [if not contraindicated] as well as juices such as prune juice. Hot beverages like tea also stimulate bowel movements.
4. Increase mobility as tolerated.
Immobility from fractures can also slow down peristalsis. While the patient must first follow activity instructions, once the patient may safely ambulate or exercise, this should be encouraged.
Impaired Physical Mobility Care Plan
Fractures impair the ability to ambulate, complete ADLs, and increase the risk of falls and other injuries.