camille fracture
TRANSCRIPT
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9 Fracture Nursing Care Plans
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 asa 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:
y Complete fracture: A fracture in which bone fragments separate completely.
y Incomplete fracture: A fracture in which the bone fragments are still partially joined.
y Linear fracture: A fracture that is parallel to the bones long axis.
y Transverse fracture: A fracture that is at a right angle to the bones long axis.
y Oblique fracture: A fracture that is diagonal to a bones long axis.
y Spiral fracture: A fracture where at least one part of the bone has been twisted.
y Comminuted fracture: A fracture in which the bone has broken into a number of pieces.
y 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 afew 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 clotis replaced by a matrix of collagen. Collagen¶s rubbery consistency allows bone fragments to move only a smallamount 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, boneis 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 ³woven´ bone does not have the strong mechanical properties of mature bone. By a process of
remodeling, the woven bone is replaced by mature ³lamellar´ bone. The whole process can take up to 18months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.
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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 bonestrength. 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 theuse of this type analgesic in simple fractures
1Acute Pain
Pain is a subjective unpleasant sensation resulting from stimulation of sensory nerve endings by injury, or otherharmful 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 resultsfrom the synthesis of prostaglandins, which are hormones produced during the inflammatory process.
AssessmentNursing
Dx Planning
Nursing
Interventions
Rationale Expected
Outcome
S > Ø
O > pt.manifest
> intactwound
dressing onright leg
>
continuous
moderatesharp-stabbing
painexperience
whenever pt. turns on
her side; pain
radiatesfrom the
operativesite down
to the toes
> Pt¶s pain
rates 8/10
Patient maymanifest:
Acute Pain Short term:
After 3daysof NI, pt
willverbalize
decrease pain, with
decrease pain from8/10 to 5
below
Long term:
After 3daysof NI patient
will reportrelive from
pain
> establish
rapport
> check andrecorded VS
> check Pt¶s
generalcondition
> reposition pt.
> instruct pt todo DBE
whenever painis felt
> encourage to
do diversionalactivities such
as chatting toSO, listening
to music and
reading books
> note clientsresponse to
pain
> performcomprehensive
pain
> to gain Pts
trust
> baselinedata
> to provide
adequateinterventions
> provide
comfort
> to help
alleviate pain
> to help in
alleviating pain
> to be ableto have an
idea on howthe pain is
relieved
> to haveion a
completeinformation
and to provide
Short term:
Pt¶s painshall have
decreasedfrom 8/10
rate to4/10.
Longterm:
Patient¶s pain shallhave been
relieved
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>
irritability
> increasein RR
>restlessness
assessment
> identify ways
on how tominimize pain
proper NI
> to provide
comfort to patient
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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 hepati
surgery. This may be due to low educational background because of financial matters.
Assessment Nursing Dx Planning Nursing
Interventions
Rationale Expected
Outcome
S > O
O > Patientmanifested:
Verbalizes
inadequateknowledge of
care/use of
immobilizationdevice,mobility
limitations,complications,
and follow-upcare.
Patientexpresses
concerns about
ability tomanageindependently
at home.
Confusion;asking
multiplequestions
Deficient
Knowledge
related to
new
condition
and
treatment
and
cognitivelimitations.
Short Term:
After 4hours of
nursinginterventions,
the patientwill
participate in
the learning process andwill verbalize
understandingof condition
process andtreatment.
Long Term:
After 1 day
of nursinginterventions,the patient
will assumeresponsibility
for ownlearning and
begin to look for
informationregarding
health.
Assess current
understanding of
treatment and
follow-up care.
Determine if hazards exist in
the home thatwill
compromise the patient¶s ability
to be effectivelymobile as home.
Perform
prescribedexercises
several times aday.
Identify andreport to
physician signsof neurovascular
compromise of extremity: pain,
numbness,tingling,
burning,swelling, or
discoloration.
Obtain proper nutrition
Involve patient/caregiver
in procedures.Supervise those
performing procedures and
Effective
discharge
planning is
based on a clear
understanding of
the needs of the
patient and
family members
who will assumecaregiver roles.
To prevent patient from
injury.
Regular exercise is
necessary tomaintain
muscle toneand promote
bone healing.
Early
assessment reduces the risk
of injury or complications
This promotes
bone/woundhealing and
preventconstipation.
Ability to
perform self-care procedures
decreases risk of infection and
Patient verbalizes
understanding of
and
demonstrates
ability to perform
postoperative
care after
discharge.
Patient/caregiver
verbalizesunderstanding of
treatment, possible
complications,and follow-up
care.
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teach proper
technique.
Provide patientwith medical
supplies andassistive devices
needed
optimize
therapeuticeffect in the
home careenvironment.
Efforts to
enhance self-
care abilities promotessuccessful
transition/accommodation
to homeenvironment.
Assessment NursingDx Planning
Nursing
Interventions Rationale Expected
Outcome
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S > Ø
O > pt.manifest
> intact
wounddressing on
right leg
>continuous
moderatesharp-
stabbing pain
experiencewhenever
pt. turns on
her side; painradiates
from theoperative
site down tothe toes
> Pt¶s painrates 8/10
Patient maymanifest:
> irritability
> increase
in RR
>restlessness
Acute
Pain
Short term:
After 3days of
NI, pt willverbalize
decrease pain, with
decrease pain from
8/10 to 5 below
Long term:
After
3days of NI patient
will report
relive from pain
> establish
rapport
> check and
recorded VS
> check Pt¶sgeneral
condition
> reposition pt.
> instruct pt to
do DBEwhenever pain
is felt
> encourage todo diversional
activities suchas chatting to
SO, listening tomusic and
reading books
> note clientsresponse to
pain
> perform
comprehensive pain
assessment
> identify wayson how to
minimize pain
> to gain Pt¶s
trust
> baseline
data
> to provideadequate
interventions
> providecomfort
> to helpalleviate pain
> to help in
alleviating pain
> to be able
to have anidea on how
the pain isrelieved
> to have iona complete
informationand to
provide proper NI
> to provide
comfort to patient
Short
term:
Pt¶s pain
shall havedecreased
from 8/10rate to
4/10.
Longterm:
Patient¶s
pain shallhave been
relieved
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3 Self-Care Deficit
Due to limitations in the individual¶s ability to ambulate, she is prevented from performing ADLs that allow herto manage her hygiene such as bathroom privileges, bathing, clothing oneself.
Assessment Nursing Dx Planning Nursing
Interventions
Rationale Expected
Outcome
>S: Ø
>O:
Patient may
manifestinability to:
- Get bath
supplies
- Wash body or
body parts
- Get inand out of
bathroom
Self-Care Deficit
related to
musculoskeletal
impairment
secondary to
fractured femur
Short-Term:
After 2 hoursof nursinginterventions,
the patientwill verbalize
knowledge of healthcare
practices.
Long-Term:
After 2 days
of nursinginterventions,
the patientwill
demonstratetechniques or
lifestyle
changes tomeet self-care needs.
>Establish
rapport
>Monitor andrecord vital
signs
>Assess
patient¶sgeneral
condition
>Determineindividual
strengths andskills of the
client
>Promoteclient/SO
participation in
problemidentificationand decision-making
>Plan time for
listening to theclient/SO(s)
>Develop plan
of care
appropriate toindividualsituation;
scheduleactivities
>Encouragefood and fluid
choicesreflecting
>to gain patients
trust and
cooperation
>to have baselinedata
>to provide
proper nursinginterventions
>to assess degree
of disability
>to enhance
commitment to plan, optimizing
outcomes
>to discover barriers to
participation inregimen.
>to conform to
client¶s normalschedule
>to assist incorrecting/dealing
with situation
>to reduce risk of injury
Short-Term:
The patientshall haveverbalized
knowledgeof healthcare
practices.
Long-Term:
The patient
shall havedemonstrated
techniques or lifestyle
changes tomeet self-
care needs.
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individual likes
and abilitiesthat meet
nutritionalneeds
>Review
safety
concerns;modifyactivities 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
Assessment Nursing Dx Planning Nursing
Interventions
Rationale ExpectedOutcome
S > Ø
O > pt.manifest
> no BM
for 4days,with
hypoactive bowel
sound andno urge to
defecate
> with
frequentflatus
Patient may
manifest:
>irritability
> bloatingabdomen
>
restlessness
Constipation
r/t
decreased
physical
activity
Short term:
After 2hrs of NI, pt will
verbalizeunderstanding
of theappropriate
interventionsto promote
BM and prevent
constipation
Long term:
After 3days
of NI, patientwill establish
or regainnormal
pattern of bowel
functioning
> establish
rapport
> check andrecorded VS
> check Pt¶sgeneral
condition
> review daily
diet intake
> determineamount of fluid
intake
> encourage to
increase fiber
and highresidue diet
>instruct Pt. todrink warm
water and milk
> instruct theSO to
reposition the
> to gain Pts
trust
> baselinedata
> to provideadequate
interventions
> baseline to
Pt¶s diet
> todetermine if
fluid intakeis enough
> to promote
bowelelimination
> promoteBM
> provide
comfort toPt.
Short term:
Patient shallhave
verbalized
understandingon the
Interventionsgiven to
promote BM
Long term:
Patient shall
have regainednormal
pattern of bowel
functioning
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patient every
2hrs
> encourage toeat fruits and
vegetables
> assisted
eating
> providehealth
teachings onthe condition
of the patient
> changediaper
> for proper
nutrition
>help anddetermine
the amountof food Pt.
taking
> answer pt.
concerns
> for comfort
measures
> followDoctor¶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.
Assessment Nursing Dx Planning Nursing
Interventions
Rationale Expected
Outcome
>S: Ø
>O:
Patient maymanifest:
- with anintact wound
dressing
- can sit on
bed but limitedmobility
- pain whenmoving
- eagernessto walk and do
ADL
Activity
Intolerance
related to
post
operative
condition
Short term:
After 2 daysof nursing
interventions,the patient
will be ableto identify
techniquesthat can
enhanceactivity
intolerance.
Long termgoal:
After 2weeks of
NursingInterventions,
the patient
> establish
rapport
> Check Vitalsigns
> assess Pt¶sgeneralcondition
> Note client
reports of
weakness, painand difficultyaccomplishing
task/ADL
> Provide position of
comfort andassisted with
> gain
Pts trust
> baselinedata
> to provide proper NI
> to monitor the patient¶s
ability to do
activity
> to be able
for the patient to be
comfortableand gain
confidence indoing ADL
Short term:
Patient shallhave identified
techniques thatcan enhance
activityintolerance.
Long term:
Patient shall
have reportedmeasurableincrease in
activity tolerance
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- Patient
may manifest
- irritability
-
restlessness
will report
measurableincrease in
activitytolerance.
ADL
> Assess
emotional and psychological
factorsaffecting the
current
situation.
> Encourage toincrease intake
of CHON for tissue repair.
> Encourage
intake of vitamin
supplements
>To
determine theemotional
and psychological
response of the patient
regarding her
diseasecondition
> To enhance patients
healthcondition.
> For healthmaintenance
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6 Impaired Physical Mobility
Mobility impairments include upper body and/or lower body disabilities. The condition may be caused by birthdefect, injury, or illness. Some patients use their leg or hand braces, canes, walkers, prostheses, or do without
aids using other parts of their bodies.
Assessment
Nursing
Dx
Planning Nursing
Interventions
Rationale Expected
Outcome
S >
0 > Patient
manifested:
>pain
>swelling
>shortnessof
breath
>dependence
>inability to participate in
activities
>Patientmay
manifest:
>edema
>decrease
reaction time
>pressure
ulcers
Impaired
physical
mobility
related to
body
weakness
and
disease
condition(Fracture)
Short term:
After 4hours of NI
patient will be able to
demonstratetechniques
and
behaviorsthat enableresumption
of activities.
Long
Term:
After 4 daysof NI patient
will be able
to maintainor increasestrength and
function of affected
body part
>note for motor
agility
>observe client
when unaware
>determine
complicationrelated to
immobility
>encouraged participation in
self care
>encourageadequate intake
of fluids andnutritious
foods
>support
affected part by using
pillows
a
>note in
congruencies
with reports
and abilities
>assess patient
functionalability
>to promote
optimumlevel of
functioning
>to
maximizeenergy
production
>to reducerisk of
pressureulcers
Short term:
Patientdemonstrated
Techniques
and behaviors
that enable
resumptionof activities.
Long Term:
Patient was
able tomaintain or
increasestrength and
function of
affected body part.
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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 willshe is recovering from operative state.
Assessment Nursing Dx Planning Nursing
Interventions
Rationale Expected Outcome
>S: Ø
>O:
Patient may
manifest:
- weaknes
- eagerness to
walk and doADLs
- self-negating
verbalizations
- non-
assertive behavior
-
Indecisive behavior
> Patient maymanifest:
-loneliness
-helplessness
Situational
low Self-
esteem
related to
functional
impairments
secondary
to VA
Short term:
After 2 daysof nursinginterventions,
the patientwill be able
to identify
feelings andunderlyingdynamics for
negative perception of
self.
Long termgoal:
After 2
weeks of NursingInterventions,
the patientwill
Demonstrate behaviors to
restore positive self-
esteem.
> establish
rapport
> Check vitalsigns
> assess Pt¶sgeneral
condition
> determineindividual
situationrelated to low
self-esteem inthe present
circumstances
> encourage
expression of feelingsanxiety
> assist clientto problem-
solve situation,developing
plan of actionand setting
goals to
achieve desiredoutcome
> Provide position of
comfort andassisted with
ADL
> Assess
> to gain Pts
trust
> baselinedata
>to knowcurrent
generalcondition of
patient
> to knowwhat are the
appropriateaction for the
care of the patient
> to facilitategrieving theloss
> enhancescommitment
to plan,optimizing
outcomes
> to be able
for the patient to becomfortable
and gainconfidence in
doing ADL
>To
determine theemotional
Short term:
Patient shallhave identifiedfeelings and
underlyingdynamics for
negative
perception of self.
Long term:
Patient shall
havedemonstrated
behaviors torestore positive
self-esteem.
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emotional and
psychologicalfactors
affecting thecurrent
situation.
> Encourage to
increase intakeof CHON for tissue repair.
> Encourageintake of
vitaminsupplements
and
psychologicalresponse of
the patientregarding her
diseasecondition
> To enhance patientshealth
condition.
> For health
maintenance
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/shedemonstrates eagerness to integrate these into his/her daily living.
Assessment Nursing Dx Planning Nursing
Interventions
Rationale Expected
Outcome
S >O
O>Patient
manifested:
>compliance
to medicalmanagement
AEBimmediate
availing of oral meds
once prescribed
>willingness
to doDoctor¶s
orders of mobilizing
affected limb by dangling
leg while
Readiness
for enhanced
therapeutic
management
regimen
Short term:
After 3hours
of NI, pt willdemonstrate
proactivemanagement
by participating
in treatmentregimen.
Long term:
After 2 weeksof NI, patient
will remainfree from
complicationsof
illness and
haveachieved a
I> establish
rapport
> check andrecord VS
> check Pt¶sgeneral
condition
> give duerecognition to
patient¶sinitiative to
comply withmedical
management
>empower
patient tomanage illness
by explainingactions of
drugs and
> to gain Pts
trust
> baselinedata
> to provideadequate
interventions
> serves as amotivation
to continue
desirable behavior
>knowingthe benefits
of treatmentmake the
patientunderstand
Short term:
Patient shall
havedemonstrated
proactivemanagement
by participating
in treatmentregimen.
Long term:
Patient shallhave
remained freefrom
complicationsof
illness and
haveachieved a
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sitting on bed
>Patient may
also manifest:
>eagerness to
go home
>eagerness tolearn ways to
preventfurther
complications
greater extent
of recovery.
benefits from
complying tocourse of
treatment
the
importanceof such
interventionsin restoring
his/her health
greater extent
of recovery.
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 itslife cycle. In this case, the dressing and broken skin can be the reservoir that may lead to infection.
Assessment Nursing Dx Planning Nursing
Interventions
Rationale Expected
Outcome
S > Ø
O > patient
maymanifest:
increase in
WBC count
redness,
swelling, purulent
discharge atincision site
hyperthermia
Risk for
Infection r/t
musculo
skeletal
impairment
Short Term:
After 2 hours
of nursinginterventions,
the patientwill verbalizeunderstanding
of individualcausative/risk
factor.
Long Term:
After 1 day of nursing
interventions,the patient
willdemonstrate
techniques,lifestyle
changes to promote safe
environment.
Monitor
temperature.
Assessincisions for
redness,drainage,swelling, and
increased pain.
Instruct patient/caregiver
to wash hands before contact
with postoperative
patient. Teachuse of aseptic
techniqueduring dressing
change, woundcare, or
handling or manipulating of
tubes/drains.
For the first 24
to 48 hours
postoperatively,
temperatures
of up to 38.5
degrees Celsius
are expected as
a normal
response to
surgery. Beyond
48 hours,
temperature
should return
to patients
baseline.
Incisions thathave been
closed withsutures or
staples should be free of
redness,swelling, and
drainage.
Patient remains
free of infection
as evidenced by
healing
wound/incision
that is free of
redness,
swelling,
purulent
discharge, and
pain; and by
normal
temperature
within 48 hours
postoperatively.
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Instruct
caregiver inadministration
of antibiotics and antipyretics
as prescribed.
Some
incisionaldiscomfort is
expected.These
incisions areusually kept
covered by a
large adhesive bandage for 24to 48 hours;
beyond 48hours, there is
no need for adressing.
Hand
washingremains the
most effectivemethod of infection
control.
Reduce fever and risk of
infection