A bone fracture (sometimes abbreviated FRX or Fx, Fx, or #) is a medical condition in which

there is a break in the continuity of the bone. A bone fracture can be the result of high force
impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones,
such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly
termed a pathological fracture. Nursing goal for a patient with fracture is to relieve pain,
education about upcoming surgery, promote comfort and promote healing.

Types of Fractures:

 Complete fracture: A fracture in which bone fragments separate completely.

 Incomplete fracture: A fracture in which the bone fragments are still partially joined.
 Linear fracture: A fracture that is parallel to the bone’s long axis.
 Transverse fracture: A fracture that is at a right angle to the bone’s long axis.
 Oblique fracture: A fracture that is diagonal to a bone’s long axis.
 Spiral fracture: A fracture where at least one part of the bone has been twisted.
 Comminuted fracture: A fracture in which the bone has broken into a number of pieces.
 Compacted fracture: A fracture caused when bone fragments are driven into each other.

Pathophysiology
The natural process of healing a fracture starts when the injured bone and surrounding tissues
bleed, forming a fracture Hematoma. The blood coagulates to form a blood clot situated between
the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the
blood clot. The new blood vessels bring phagocytes to the area, which gradually remove the non-
viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these
multiply and produce collagen  fibres. In this way the blood clot is replaced by a matrix of
collagen. Collagen’s rubbery consistency allows bone fragments to move only a small amount
unless severe or persistent force is applied.

At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in
the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and
transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved
out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to
show up on X-ray within 6 weeks in adults and less in children. This initial “woven” bone does
not have the strong mechanical properties of mature bone. By a process of remodeling, the
woven bone is replaced by mature “lamellar” bone. The whole process can take up to 18 months,
but in adults the strength of the healing bone is usually 80% of normal by 3 months after the
injury.

Several factors can help or hinder the bone healing process. For example, any form of nicotine
hinders the process of bone healing, and adequate nutrition (including calcium intake) will help
the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to
bear the weight, also builds bone strength. The bone shards can also embed in the muscle causing
great pain. Although there are theoretical concerns about NSAIDs slowing the rate of healing,
there is not enough evidence to warrant withholding the use of this type analgesic in simple
fractures

1 Acute Pain
Pain is a subjective unpleasant sensation resulting from stimulation of sensory nerve endings by
injury, or other harmful factors. Pain is activated when a pt’s pain threshold is reached. Pain
threshold is the point at which a stimulus activates pain receptors to produce a feeling of pain.
Pain usually accompanies inflammation. It results from the synthesis of prostaglandins, which
are hormones produced during the inflammatory process.

Nursing Nursing Inter- Expected

Assessment Planning Rationale
Dx ventions Outcome
S > Ø O > Acute Short term: > establish > to gain Short
pt. manifest Pain After 3days rapport > Pt’s trust > term: Pt’s
of NI, pt check and baseline pain shall
> intact will recorded VS data have
wound verbalize decreased
dressing on decrease > check Pt’s > to provide from 8/10
right leg pain, with general adequate rate  to
decrease condition intervention 4/10.
> pain from s
continuous 8/10 to 5 > reposition pt. Long
moderate below > provide term:
sharp- > instruct pt to comfort
stabbing Long term: do DBE Patient’s
pain whenever pain > to help pain shall
experience After 3days is felt alleviate have been
whenever of NI pain relieved
pt. turns on patient will > encourage to
her side; report relive do diversional > to help in
pain from pain activities such alleviating
radiates as chatting to pain
from the SO, listening
operative to music and > to be able
site down reading books to have an
to the toes idea on how
> note clients the pain is
> Pt’s pain response to relieved
rates 8/10 pain
> to have
Patient may > perform ion a
manifest: comprehensive complete
pain information
> and to
irritability
> increase assessment provide
in RR proper NI
> identify
> ways on how > to provide
restlessness to minimize comfort to
pain patient

2 Deficient Knowledge
Deficient Knowledge is the absence or deficiency of cognitive information related to specific
topic. The preoperative client may not be completely knowledgeable about surgical procedures,
particularly hepatic surgery. This may be due to low educational background because of financial
matters.

Nursing Nursing Inter- Expected

Assessment Planning Rationale
Dx ventions Outcome
S>OO> Deficient Short Term: ▪ ▪ Assess current ▪ Effective Patient
Patient Knowledg After 4 hours understanding discharge verbalizes
manifested: e related to of nursing of treatment and planning is understanding
new interventions, follow-up care. based on a of and
▪ Verbalizes condition the patient ▪ Determine if clear demonstrates
inadequate and will hazards exist in understanding ability to
knowledge of treatment participate in the home that of the needs of perform
care/use of and the learning will the patient and postoperative
immobilizatio cognitive process and compromise the family care after
n device, limitations. will verbalize patient’s ability members who discharge.
mobility understandin to be effectively will assume Patient/caregive
limitations, g of mobile as home. caregiver roles. r verbalizes
complications, condition ▪ To prevent understanding
and follow-up process and ▪ Perform patient from of treatment,
care. treatment. prescribed injury. possible
exercises complications,
▪ Patient Long Term: several times a ▪ Regular and follow-up
expresses day. exercise is care.
concerns about ▪ After 1 day necessary to
ability to of nursing ▪ Identify and maintain
manage interventions, report to muscle tone
independently the patient physician signs and promote
at home. will assume of bone healing.
responsibility neurovascular
▪ Confusion; for own compromise of ▪ Early
asking learning and extremity: pain, assessment
multiple begin to look numbness, reduces the risk
questions for tingling, of injury or
 information burning, complications
regarding swelling, or
health. discoloration. ▪ This
promotes
▪ Obtain proper bone/wound
nutrition healing and
prevent
▪ Involve constipation.
patient/caregive
r in procedures. ▪ Ability to
Supervise those perform self-
performing care procedures
procedures and decreases risk
teach proper of infection
technique. and optimize
therapeutic
▪ Provide effect in the
patient with home care
medical environment.
supplies and
assistive devices ▪ Efforts to
needed enhance self-
care abilities
promotes
successful
transition/
accommodatio
n to home
environment.

Nursing
Nursing Expected
Assessment Planning Rationale
Dx Outcome
Interventions
S>Ø Acute Short > establish > to gain Short
Pain term: rapport Pt’s trust term:
O > pt.
manifest After > check and > baseline Pt’s pain
3days of recorded VS data shall
> intact NI, pt will have
wound verbalize > check Pt’s > to provide decreased
dressing on decrease general adequate from
right leg pain, with condition interventions 8/10 rate
decrease to 4/10.
> pain from > reposition > provide
continuous 8/10 to 5 pt. comfort Long
moderate below term:
sharp- > instruct pt to > to help
stabbing Long do DBE alleviate Patient’s
pain term: whenever pain pain pain shall
experience is felt have
whenever After > to help in been
pt. turns on 3days of > encourage to alleviating relieved
her side; NI patient do diversional pain
pain will report activities such
radiates relive as chatting to > to be able
from the from pain SO, listening to have an
operative to music and idea on how
site down reading books the pain is
to the toes relieved
> note clients
> Pt’s pain response to > to have
rates 8/10 pain ion a
complete
Patient > perform information
may comprehensive and to
manifest: pain provide
assessment proper NI
>
irritability > identify > to provide
ways on how comfort to
> increase to minimize patient
in RR pain

>
restlessness

3 Self-Care Deficit
Due to limitations in the individual’s ability to ambulate, she is prevented from performing
ADLs that allow her to manage her hygiene such as bathroom privileges, bathing, clothing
oneself.

Assessmen Nursing Expected

Nursing Dx Planning Rationale
t Interventions Outcome
>S:   Ø >O: Self-Care Short-Term: >Establish >to gain patient’s Short-Term:
Deficit related After 2 hours rapport trust and The patient
Patient may to of nursing >Monitor and cooperation >to shall have
manifest musculoskeleta interventions record vital have baseline verbalized
inability to: l impairment , the patient signs data knowledge
secondary to will of healthcare
-       Get fractured femur verbalize >Assess >to provide practices.
bath knowledge patient’s proper nursing
supplies of healthcare general interventions Long-Term:
practices. condition
-       Wash >to assess degree The patient
body or Long-Term: >Determine of disability shall have
body parts individual demonstrate
After 2 days strengths and >to enhance d techniques
-       Get in of nursing skills of the commitment to or lifestyle
and out of interventions client plan, optimizing changes to
bathroom , the patient outcomes meet self-
will >Promote care needs.
demonstrate client/SO >to discover
techniques or participation in barriers to
lifestyle problem participation in
changes to identification regimen.
meet self- and decision-
care needs. making >to conform to
client’s normal
>Plan time for schedule
listening to the
client/SO(s) >to assist in
correcting/dealin
>Develop plan g with situation
of care
appropriate to >to reduce risk of
individual injury
situation;
schedule
activities

>Encourage
food and fluid
choices
 reflecting
individual
likes and
abilities that
meet
nutritional
needs

>Review
safety
concerns;
modify
activities or
environment

4 Constipation
Peristaltic movement is influenced by an individual’s overall physical activity.  Since the patient
has been immobilized because of her condition, her ability to pass out stools on a regular basis
has been altered

Assessmen Nursing Expected

Nursing Dx Planning Rationale
t Interventions Outcome
S > Ø O > Constipatio Short term: > establish > to gain Short term:
pt. manifest n r/t After 2hrs of rapport > Pt’s trust > Patient shall
decreased NI, pt will check and baseline have
> no BM physical verbalize recorded VS data
for 4days, activity understandin verbalized
with g of the > check Pt’s > to provide understandin
hypoactive appropriate general adequate g on the
bowel interventions condition intervention Interventions
sound and to promote s given to
no urge to BM and > review daily promote BM
defecate prevent diet intake > baseline to
constipation Pt’s diet Long term:
> with > determine
frequent Long term: amount of > to Patient shall
flatus fluid intake determine if have regained
After 3days fluid intake normal
Patient may of NI, patient > encourage to is enough pattern of
manifest: will establish increase fiber bowel
or regain and high > to functioning
> normal residue diet promote
pattern of bowel
irritability bowel >instruct Pt. to elimination
functioning drink warm
> bloating water and milk > promote
abdomen BM
> instruct the
> SO to > provide
restlessness reposition the comfort to
patient every Pt.
2hrs
> for proper
> encourage to nutrition
eat fruits and
vegetables >help and
determine
> assisted the amount
eating of food Pt.
taking
>  provide
health > answer pt.
teachings on concerns
the condition
of the patient > for
comfort
> change measures
diaper
> follow
Doctor’s
order

5 Activity Intolerance
Surgery that was done to the patient resulted in the immobility and inability of the patient to do
simple ADLs due to  the weakness and pain in her right  leg.

Nursing Nursing Expected

Assessment Planning Rationale
Dx Interventions Outcome
>S:   Ø >O: Activity Short term: > establish > gain Pt’s  Short term:
Intoleranc After 2 days rapport > trust > Patient shall
Patient may e related to of nursing Check Vital baseline data have    
manifest: post interventions signs identified
operative , the patient > to provide techniques that
-       with an condition will be able > assess Pt’s proper NI can enhance
intact wound to   identify general activity
dressing techniques > to monitor
 that can intolerance.
-       can sit on enhance condition the patient’s
bed but limited activity ability to do Long term:
mobility intolerance. > Note client activity
reports of Patient shall
-       pain when Long term weakness, pain > to be able have reported
moving goal: and difficulty for the measurable
accomplishing patient to be increase in
-       eagerness After 2 task/ADL comfortable activity tolerance
to walk and do weeks of and gain
ADL Nursing > Provide confidence in
Interventions position of doing ADL
-       Patient , the patient comfort and
may manifest will report assisted with >To
measurable ADL determine the
-       irritability increase in emotional
activity > Assess and
-       tolerance. emotional and psychologica
restlessness psychological l response of
factors the patient
affecting the regarding her
current disease
situation. condition

> Encourage to > To enhance

increase intake patients
of CHON for health
tissue repair. condition.

> Encourage > For health

intake of maintenance
vitamin
supplements

6 Impaired Physical Mobility

Mobility impairments include upper body and/or lower body disabilities. The condition may be
caused by birth defect, injury, or illness. Some patients use their leg or hand braces, canes,
walkers, prostheses, or do without aids using other parts of their bodies.

Nursing Nursing Expected

Assessment Planning Rationale
Dx Interventions Outcome
S > Φ 0 >  Impaired Short term: >note for >note in Short term:
Patient physical After 4 motor agility congruencie Patient
mobility hours of NI >observe client s with demonstrate
manifested: related to patient will when unaware reports and d
body be able to abilities
>pain weakness demonstrate >determine >assess Techniques
and techniques complication patient and
>swelling disease and related to functional behaviors
condition behaviors immobility ability that enable
>shortness (Fracture that enable resumption
of ) resumption >encouraged >to  promote of activities.
of activities. participation in optimum
breath self care level of Long Term:
Long functioning
>dependenc Term: >encourage Patient was
e adequate >to able to
After 4 days intake of fluids maximize maintain or
>inability to of NI and nutritious energy increase
participate patient will foods production strength and
in activities be able to function of
maintain or >support >to reduce affected
>Patient increase affected part risk of body part.
may strength and by using pressure
manifest: function of pillows ulcers
affected
>edema body part a

>decrease
reaction
time

>pressure
ulcers

7 Situational Low Self-Esteem

A person normally have a confidence to whatever he may do, to be able to do the things that are
needed for her care, having a social life and interaction to people in the case of the patient having
a low self esteem happens when your capabilities were altered and you can no longer do the
usual routines that you are doing before will she is recovering from operative state.

Nursing Expected
Assessment Nursing Dx Planning Rationale
Interventions Outcome
>S:  Ø >O: Situational Short term: > establish > to gain Pt’s Short term:
low Self- After 2 days rapport > trust > Patient  shall
Patient may esteem of nursing Check vital baseline data have     
manifest: related to interventions, signs identified
functional the patient >to know feelings and
 impairment will be able underlying
-  weaknes s secondary to   identify > assess Pt’s current dynamics for
to VA feelings and general general negative
- eagerness to underlying condition condition of perception of
walk and do dynamics for patient self.
ADLs negative > determine
perception of individual > to know Long term:
- self- self. situation what are the
negating related to low appropriate Patient  shall
verbalizations Long term self-esteem in action for the have
goal: the present care of the demonstrated
- non- circumstances patient behaviors to
assertive After 2 restore positive
behavior weeks of > encourage > to facilitate self-esteem.
Nursing expression of grieving the
-       Interventions feelings loss
Indecisive , the patient anxiety
behavior will > enhances
Demonstrate > assist client commitment
> Patient may behaviors to to problem- to plan,
manifest: restore solve situation, optimizing
positive self- developing outcomes
-loneliness esteem. plan of action
and setting > to be able
-helplessness goals to for the
achieve patient to be
desired comfortable
outcome and gain
confidence in
> Provide doing ADL
position of
comfort and >To
assisted with determine the
ADL emotional
and
> Assess psychologica
emotional and l response of
psychological the patient
factors regarding her
affecting the disease
current condition
situation.
> To enhance
> Encourage to patients
increase intake health
of CHON for
 tissue repair. condition.

> Encourage > For health

intake of maintenance
vitamin
supplements

8 Readiness for Enhanced Therapeutic Regimen

Therapeutic management regimen is a set of program for the treatment of the illness and is
sequelae that is satisfactory for meeting specific health goals.  Patient is exhibits readiness to this
regimen when he/she demonstrates eagerness to integrate these into his/her daily living.

Nursing Expected
Assessment Nursing Dx Planning Rationale
Interventions Outcome
S >O Readiness Short term: I> establish > to gain Short term:
O>Patient for After 3hours rapport > Pt’s trust > Patient shall
manifested: enhanced of NI, pt will check and baseline have
therapeutic demonstrate record VS data demonstrated
>compliance managemen proactive proactive
to medical t regimen management > check Pt’s > to provide management
management by general adequate by
AEB participating condition participating
immediate in treatment intervention in treatment
availing of regimen. > give due s regimen.
oral meds recognition to
once Long term: patient’s > serves as a Long term:
prescribed initiative to motivation
After 2 comply with to continue Patient shall
>willingness weeks of NI, medical desirable have
to do patient will management behavior remained free
Doctor’s remain free from
orders of from >empower >knowing complication
mobilizing complication patient to the benefits s of
affected limb s of manage illness of treatment
by dangling by explaining make the illness and
leg while illness and actions of patient have
sitting on bed have drugs and understand achieved a
achieved a benefits from greater extent
>Patient may greater extent complying to the of recovery.
also of recovery. course of importance
manifest: treatment of such
intervention
>eagerness to s in
go home restoring
his/her
>eagerness to health
learn ways to
prevent
further
complication
s

9 Risk for Infection

Risk for infection occurs when a person is at risk for being invaded by pathogenic organisms.
Transmission of an infectious agent from a source to a susceptible host occurs within an
environment. Organisms live and multiply in a reservoir. The reservoir provides what the
organisms needs for survival at a specific stage in its life cycle. In this case, the dressing and
broken skin can be the reservoir that may lead to infection.

Nursing Inter- Expected

Assessment Nursing Dx Planning Rationale
ventions Outcome
S > Ø O > Risk for Short Term: ▪ Monitor ▪ For the first Patient
patient may Infection r/t After 2 hours temperature. ▪ 24 to 48 hours remains free of
manifest: musculo of nursing Assess incisions postoperatively infection as
skeletal interventions, for redness, , temperatures evidenced by
▪ increase in impairmen the patient drainage, of up to 38.5 healing
WBC count t will verbalize swelling, and degrees Celsius wound/incisio
understandin increased pain. are expected as n that is free of
▪ redness, g of a normal redness,
swelling, individual ▪ Instruct response to swelling,
purulent causative/risk patient/caregive surgery. purulent
discharge at factor. r to wash hands Beyond 48 discharge, and
incision site before contact hours, pain; and by
Long Term: with temperature normal
▪ postoperative should return to temperature
hyperthermi After 1 day patient. Teach patient’s within 48
a of nursing use of aseptic baseline. ▪ hours
interventions, technique Incisions that postoperativel
the patient during dressing have been y
will change, wound closed with
demonstrate care, or sutures or
techniques, handling or staples should
lifestyle manipulating of be free of
changes to tubes/drains. redness,
promote safe swelling, and
environment. ▪ Instruct drainage. Some
 incisional
caregiver in discomfort is
administration expected.
of antibiotics These incisions
and antipyretics are usually kept
as prescribed. covered by a
large adhesive
bandage for 24
to 48 hours;
beyond 48
hours, there is
no need for a
dressing.

▪ Hand washing
remains the
most effective
method of
infection
control.

▪ Reduce fever
and risk of
infection