Nursing Care Plan (NCP) for Fractures

Lesson Objective for Fractures Nursing Care Plan:

Upon completion of this nursing care plan for Fractures, nursing students will be able to:

• Provide comprehensive nursing care for patients with fractures, focusing on understanding the types of fractures, their pathophysiology, management strategies, and nursing interventions.
• This plan emphasizes pain management, promoting healing, preventing complications, and patient education for successful recovery.

Pathophysiology for Fractures

A fracture is a break in the continuity of a bone. It can range from a thin crack to a complete break. Fractures can be categorized as open (compound) where the bone breaks through the skin, or closed (simple) where the skin remains intact. They occur due to trauma, overuse, or diseases that weaken the bone (like osteoporosis).

• Analogy for Fractures
  • Imagine your bones are like the wooden beams that support a house. These beams keep the house stable and upright, just like your bones support your body and help you move. A fracture is like if one of these beams suddenly breaks or cracks.
  • When a beam in a house breaks, the stability of the whole house is affected. It might lean to one side, or a part of it might not be able to hold up weight anymore. Similarly, when you have a fracture, the broken bone can’t support your body the way it normally does, which can make it hard to move and cause a lot of pain.
  • Just like a broken beam in a house needs to be repaired and supported until it’s strong enough to hold up weight again, a broken bone needs to be set back into place and immobilized (like with a cast or splint) so it can heal properly. Over time, just as workers repair a broken beam to make it strong again, your body works to heal the broken bone.

Etiology for Fractures

• Trauma: 
  • Such as falls, motor vehicle accidents, or sports injuries.
• Pathological: 
  • Due to underlying diseases like osteoporosis or cancer.
• Stress Fractures: 
  • Resulting from repetitive forces, common in athletes.

Desired Outcomes for Fractures

• Effective pain management.
• Proper alignment and healing of the fracture.
• Prevention of complications such as infection (in open fractures) or deep vein thrombosis (DVT).
• Patient education on care, mobility, and rehabilitation.

Subjective Data for Fractures

• Reports of pain at the fracture site.
• Description of the incident leading to the injury.
• Concerns about mobility, self-care, and recovery time.

Objective Data for Fractures

• Physical examination findings (e.g., swelling, deformity, bruising).
• History of bone health issues or previous fractures.
• Diagnostic imaging confirming fracture type and location.
• Vital signs, especially in the context of trauma.
• Assessment for signs of complications such as infection or neurovascular compromise.

Assessment for Fractures

• Assess pain level.
• Monitor for signs of infection in open fractures.
• Evaluate neurovascular status distal to the fracture site.
• Assess patient’s mobility and self-care capabilities.

Nursing Diagnosis for Fractures

• Acute Pain related to bone fracture.
• Risk for Infection related to open fracture or surgical site.
• Impaired Physical Mobility related to fracture and immobilization.
• Knowledge Deficit regarding fracture management and self-care after discharge.

Nursing Interventions and Rationales for Fractures

• Pain Management: Administer prescribed analgesics and use non-pharmacological pain relief methods. 
  • Rationale: To reduce pain and promote comfort.
• Fracture Management: Ensure proper immobilization of the fracture and prepare for possible surgical intervention. 
  • Rationale: To promote healing and prevent further injury.
• Infection Prevention: Provide wound care for open fractures and monitor for signs of infection. 
  • Rationale: To prevent infection and promote healing.
• Mobility and Rehabilitation: Assist with mobility and provide or refer for physical therapy. 
  • Rationale: To restore function and prevent complications like muscle atrophy or DVT.
• Patient Education: Educate about fracture care, weight-bearing status, and follow-up care. 
  • Rationale: To enhance understanding and compliance with the treatment plan.

Evaluation for Fractures

• Monitor for effective pain control.
• Assess for signs of healing and absence of complications.
• Evaluate patient’s understanding and adherence to care plan.
• Monitor for improvement in mobility and progress in rehabilitation.

References:

• NURSING.com: Offers nursing care plans and resources for fracture management.
• Mayo Clinic: Provides comprehensive information on different types of fractures, symptoms, and treatments.
• NIH.gov: Features current research and clinical guidelines on the management of fractures.