Fractures, commonly known as broken bones, are a frequent injury across all age groups, stemming from various causes ranging from traumatic events like motor vehicle accidents to age-related conditions such as osteoporosis, and even repetitive stress as seen in athletes. Understanding the nuances of bone fractures and their subsequent nursing care is crucial for healthcare professionals. This article delves into the essential aspects of Bone Fracture Nursing Diagnosis, providing a detailed overview of fracture types, the nursing process involved, and comprehensive care plans to guide effective patient management and improve outcomes.
Understanding Bone Fractures: Types and Classifications
Bone fractures are disruptions in the continuity of a bone. They are categorized based on several factors, including the fracture pattern, location, and whether the fracture is open or closed. Recognizing these distinctions is fundamental in guiding appropriate medical and nursing interventions. Here are some primary types of fractures:
- Open (Compound) Fracture: This type of fracture is characterized by a break in the skin that exposes the bone to the external environment. Open fractures carry a higher risk of infection and require prompt medical attention, including antibiotics and surgical debridement.
Alt text: Image depicting an open fracture of the tibia with bone protruding through the skin, highlighting the severity and exposure risk.
- Closed Fracture: In contrast to open fractures, closed fractures occur when the bone is broken, but the overlying skin remains intact. While the risk of infection is lower compared to open fractures, internal tissue damage can still be significant.
Alt text: Illustration of a closed fracture of the femur, showcasing the broken bone within intact skin, emphasizing internal injury.
- Greenstick Fracture: Commonly observed in children, greenstick fractures are incomplete breaks where the bone bends and cracks but does not fully separate. This is due to the greater flexibility of children’s bones.
Alt text: X-ray image of a child’s forearm with a greenstick fracture, demonstrating the incomplete break and bending of the bone typical in pediatric cases.
- Comminuted Fracture: This severe type of fracture involves the bone shattering into three or more fragments. Comminuted fractures often result from high-impact trauma and may require complex surgical repair.
Alt text: Radiograph showing a comminuted fracture of the femur, illustrating multiple bone fragments resulting from a high-energy injury.
The Nursing Process for Bone Fracture Care
Nurses play a pivotal role in the holistic care of patients with fractures across various healthcare settings, from emergency rooms and urgent care centers to inpatient units and rehabilitation facilities. The nursing process—Assessment, Diagnosis, Planning, Implementation, and Evaluation—forms the framework for delivering patient-centered care. For patients with bone fractures, nursing care focuses on:
- Pain Management: Alleviating acute and chronic pain associated with the fracture and healing process.
- Promoting Mobility: Addressing physical limitations and facilitating safe movement and rehabilitation.
- Preventing Complications: Minimizing risks such as infection, neurovascular compromise, and constipation.
- Patient Education and Discharge Planning: Preparing patients and their families for home care, including medication management, activity modifications, and follow-up appointments.
Bone Fracture Nursing Care Plans: Examples and Interventions
Following a thorough nursing assessment and identification of pertinent nursing diagnoses, care plans are developed to prioritize interventions and achieve both short-term and long-term patient goals. Here are examples of nursing care plans for common nursing diagnoses associated with bone fractures:
1. Acute Pain related to Bone Fracture
Nursing Diagnosis: Acute Pain related to bone displacement, tissue trauma, muscle spasms, and edema secondary to bone fracture.
Related Factors:
- Bone displacement and instability at the fracture site.
- Soft tissue injury, including muscles, ligaments, and nerves surrounding the fracture.
- Muscle spasms resulting from bone injury and attempts to stabilize the fracture.
- Edema and inflammation contributing to pressure and pain.
As Evidenced By:
- Patient’s verbal report of pain, describing intensity, location, and character.
- Observable pain behaviors such as guarding of the affected area, grimacing, or restlessness.
- Physiological responses indicating pain, including diaphoresis, changes in heart rate, respiratory rate, and blood pressure.
- Distraction behaviors or difficulty concentrating due to pain.
Expected Outcomes:
- The patient will report a pain level of 3 out of 10 or less within 24-48 hours of implementing pain management strategies.
- The patient will demonstrate relaxed body posture and utilize effective pain relief measures, both pharmacological and non-pharmacological.
- The patient will achieve improved comfort levels that facilitate rest and participation in rehabilitation activities.
Nursing Assessments:
- Comprehensive Pain Assessment: Utilize age-appropriate and cognitively suitable pain scales (e.g., numeric rating scale, Wong-Baker FACES scale for children, FLACC scale for non-verbal patients) to quantify pain intensity. Assess pain location, quality (sharp, throbbing, aching), onset, duration, aggravating and relieving factors.
- Vital Signs Monitoring: Regularly monitor blood pressure, heart rate, and respiratory rate as elevations can indicate pain. Note trends and responses to pain management interventions.
- Neurovascular Assessment: Evaluate the affected extremity for signs of neurovascular compromise, including pain, pallor, pulselessness, paresthesia, and paralysis (the 5 P’s). Changes may indicate compartment syndrome or nerve compression, exacerbating pain.
- Assessment of Pain Relief Effectiveness: Re-assess pain levels within one hour after administering pain medication or implementing non-pharmacological pain relief measures to evaluate their effectiveness.
Nursing Interventions:
- Pharmacological Pain Management: Administer analgesics as prescribed, which may include opioids for severe acute pain, NSAIDs to reduce inflammation and pain, and adjuvant analgesics as needed. Ensure timely and consistent medication administration.
- Non-Pharmacological Pain Relief Techniques: Implement complementary therapies such as:
- Thermal Applications: Apply ice packs to reduce swelling and pain in the acute phase and heat for muscle spasm relief in later stages.
- Massage: Gentle massage around the fracture site (avoiding direct pressure on the fracture) to promote relaxation and reduce muscle tension.
- Distraction Techniques: Engage the patient in activities to divert attention from pain, such as reading, watching movies, or conversation.
- Relaxation and Breathing Exercises: Teach and encourage deep breathing and relaxation techniques to reduce pain perception and promote calmness.
- Positioning and Support: Ensure proper positioning of the fractured limb, often elevated to reduce edema. Utilize splints, casts, or traction as prescribed to immobilize and support the fracture.
- Patient Education on Pain Management: Educate the patient about their pain medications, including dosage, frequency, potential side effects, and precautions (e.g., avoiding driving or alcohol consumption with narcotics). Instruct on the importance of reporting unrelieved pain and not altering dosages without provider advice.
2. Impaired Physical Mobility related to Bone Fracture
Nursing Diagnosis: Impaired Physical Mobility related to loss of bone integrity, pain, prescribed movement restrictions, reluctance to move, and potential muscle weakness.
Related Factors:
- Disruption of bone structure and instability.
- Pain and discomfort limiting movement.
- Medical prescriptions for activity restriction (e.g., non-weight bearing).
- Psychological reluctance to move due to fear of pain or re-injury.
- Muscle deconditioning from disuse.
As Evidenced By:
- Patient reports of difficulty moving, stiffness, or pain on movement.
- Observable limitations in range of motion, both active and passive.
- Decreased muscle strength and endurance.
- Unwillingness or reluctance to attempt movement.
Expected Outcomes:
- The patient will demonstrate increased mobility and participation in activities of daily living (ADLs) within the limits of their fracture and treatment plan.
- The patient will utilize assistive devices safely and effectively to enhance mobility.
- The patient will maintain or improve muscle strength and prevent complications of immobility.
Nursing Assessments:
- Assessment of Mobility Limitations: Evaluate the extent of physical limitations by assessing range of motion, muscle strength, balance, and gait. Determine the patient’s ability to perform ADLs.
- Pain and Psychological Factors Assessment: Assess pain levels before, during, and after movement. Evaluate for psychological factors such as fear, anxiety, or depression that may hinder mobility.
- Support System Evaluation: Determine the availability of support systems at home, including caregivers and resources necessary for mobility assistance and home modifications.
Nursing Interventions:
- Promote Independence in Mobility: Encourage the patient to participate in self-care activities to the extent possible, fostering independence and self-esteem.
- Pre-medication for Movement: Administer pain medication prior to planned activities such as physical therapy or ambulation to enhance comfort and participation.
- Collaboration with Physical and Occupational Therapy (PT/OT): Actively collaborate with PT/OT to develop and implement individualized mobility plans, including therapeutic exercises, gait training, and instruction on assistive devices (canes, crutches, walkers).
- Assistive Devices and Safety Measures: Ensure the patient has and knows how to use appropriate assistive devices. Implement safety measures to prevent falls, such as ensuring clear pathways, using non-slip footwear, and providing assistance with transfers.
- Progressive Mobilization: Gradually increase activity levels as tolerated, following physician orders and PT/OT recommendations. Encourage regular, gentle exercises to maintain muscle tone and prevent stiffness.
3. Risk for Constipation related to Bone Fracture Management
Nursing Diagnosis: Risk for Constipation related to decreased physical activity, opioid analgesic use, altered dietary patterns, and insufficient fluid intake associated with bone fracture management.
Related Factors:
- Reduced physical activity and prolonged bed rest slowing bowel motility.
- Opioid analgesics decreasing gastrointestinal peristalsis.
- Changes in dietary intake, potentially reduced fiber.
- Inadequate fluid intake due to decreased mobility or appetite.
Expected Outcomes:
- The patient will maintain a bowel movement frequency of at least once every three days, without straining or discomfort.
- The patient will verbalize understanding of measures to prevent constipation and implement at least two preventative strategies.
- The patient will report absence of symptoms associated with constipation, such as abdominal distension or pain.
Nursing Assessments:
- Bowel Sound Assessment: Auscultate bowel sounds in all four quadrants to assess bowel activity. Note the presence, frequency, and character of bowel sounds.
- Usual Bowel Pattern History: Inquire about the patient’s normal bowel habits, including frequency, consistency, and any regular routines to promote bowel movements.
Nursing Interventions:
- Prophylactic Stool Softeners and Laxatives: Administer stool softeners or mild laxatives as prescribed, especially when opioid analgesics are used. Prophylactic use is often more effective than treating established constipation.
- Patient Education on Constipation Prevention: Educate the patient about the increased risk of constipation due to immobility and opioid use. Instruct on preventive measures, including dietary modifications, fluid intake, and activity as tolerated.
- Increase Fluid Intake: Encourage increased oral fluid intake, aiming for at least 2-3 liters per day (unless contraindicated by other medical conditions). Recommend water, fruit juices (especially prune juice), and warm liquids to stimulate bowel movements.
- Promote Dietary Fiber Intake: Encourage a diet rich in fiber, including whole grains, fruits, and vegetables, to add bulk to stools and facilitate bowel movements.
- Encourage Activity and Mobility: As mobility improves and as permitted by the treatment plan, encourage increased physical activity to stimulate peristalsis and improve bowel function.
Conclusion
Effective nursing care for patients with bone fractures requires a comprehensive understanding of fracture types, potential complications, and patient-specific needs. Utilizing well-structured nursing care plans focused on key nursing diagnoses such as acute pain, impaired physical mobility, and risk for constipation ensures holistic and patient-centered care. By implementing evidence-based assessments and interventions, nurses can significantly contribute to improved patient outcomes, enhanced recovery, and a better quality of life following a bone fracture.
References
- Wilkinson, J. M., & Treas, L. S. (2016). Fundamentals of nursing: Volume 1. F.A. Davis Company.
- Ackley, B. J., & Ladwig, G. B. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care. Elsevier.
- Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification 2018-2020. Thieme.
