NURSING CARE PLAN WITH A FRACTURE

BY:
GROUP 6

1. AZIZATUN NISA

131211123048

2. ALFIYANTO ZAKI

131211123058

3. DIAS RISKY PRATIWI

131211123062

4. RONAL SURYA ADITIYA

131211123063

5. DESAK NYOMAN T

131211123064

6. PRIYANGGA DWI W

131211123061

7. YULIA

131211123065

8. NURUL AINI

131211230066

9. YULIZA UTAMI

131211230067

FACULTY OF NURSING
AIRLANGGA UNIVERSITY
SURABAYA
2012

PREFACE
We really grateful to the Most Glorious and the Most Merciful Allah SWT, we can
finished this case report about Nursing care Planning with Fracture ontime. This paper is
written as a part of process in studying English in nursing science and technology.
Special thanks to all of our colleagues in class B 15 who have participated in our
seminar discussion about the case in this paper. We aware that still there are many lack in this
paper so we could use some direction and we always open to your suggestion to make it better.
At last, we hope this paper may brings much advantages to all of us.

Surabaya, October 2012

Author

NURSING CARE PLAN WITH A FRACTURE

1. Definition
A fracture is defined as a break or disruption in the continuity of a bone. With a fracture,
injury to surrounding soft tissue also occurs. The severity of soft tissue injury depends on
location and severity of the break. (Linton,2012).
2. Patophysiologi
The severity of a fracture usually depends on the force that caused the fracture. If
the bone breaking point has been exceeded only slightly, then the bone may crack rather
than breaking all the way through. If the force is extreme, such as in an automobile
collision or gunshot wound, the bone may shatter. When fracture occurs, muscles that
were attached to the ends of the bone are disrupted. The muscles can undergo spasm and
pull the fracture fragmen of position. Large muscles groups can create massive spasm
that displace even large bones, such as the femur. Although the proximal portion of the
fractured bone remains in place, the distal portion can become displaced in response to
both the causative force and the spasm in the associated muscles. Fracture fragments may
be displaced sideways, at an angle (angulated), or as overriding bone segments. The may
also be rotated or offset.
In addition, the periosteum and blood vessels in the cortex and marrow of the
fractured bone are disrupted. Soft tissue damage frequently occurs. Bleeding occurs both
from the soft tissue and form the damaged ends of the bone. In the medullary canal, a
hematoma forms between the fracture fragments and beneath the periosteum. Bone tissue
surrounding the fracture site dies, creating an intense inflammatory response.
Vasodilation, edema, pain, loss of function, exudation of plasma and leukocytes, and
infiltration of other white blood cells develop. These phatophysiologic response also are
the initial step in bone healing. (Black, Hawks, 2009)
3. Cause and Risk Factors
Fractures are most commonly caused by trauma to the bone, especially as a result
of automobile accidents and falls. Bone desease such as bone cancer also can lead to a
fracture. Hip fractured in older adults usually are associated with falls. Risk factors for
hip fractures include osteoporosis, advanced age, caucasion race, use of certain drugs
including psychotropic and corticosteroids agent, and female gender.Older Caucasian

women have high osteoporosis and therefore are at increased risk for fractures. This risk
can be reduced by targeting these women for preventive measures throughout life.
Osteoporosis in easier to prevent than to treat.
In adult the bones most commonly fractured are the ribs. Fractures of the femur
are most common in young and middle age adults, where as hip and wrist fractures are
most common in older adults. In 2006, hip fractures accounted for more than 316,000
hospital admissions. Each year, more than $ billion is spent in direct and indirect cost
associated with hip fracture (Linton,2012).
4. Signs and Systoms
a. Pain
Immediate, severe pain is felt at the time of injury. After injury, pain may result from
muscle spasm, overriding of this fractured ends of the bone, of damage to adjacent
structures.
b. Deformity
Strong muscle pull may cause bone fragment to override; therefore aligment and
contour changes occur, such as (1) angulation, rotation, and limb shortening;(2) Bone
despression; or (3) altered curves in the injured site, especially when compared with
the opposite site. Swelling (edema) may appear rapidly from locatization of serous
fluid at the fracture site and extravasation of blood into adjacent tissues. Bruising
(ecchymosis) may result from subcutaneous bleeding. Muscle spasms-involuntary
muscle contractions near the fracture-may occur.
c. Tenderness
Tenderness over the fracture site is due to underlying injuries.
d. Impaired sensation(numbness)
Sensation may be impaired as a result of nerve damage or nerve entrapment from
edema, bleeding, or bony fragments.
e. Loss Of Normal Function
Normal Function may be lost because of instability of the fractured bone, pain, or
muscle spasm.
f. Paralysis
Paralysis may be caused by nerve damage.
g. Abnormal Mobility
Movement of a part that is normally immobile is due to instability when the long
bones are fractured.
h. Crepitius
Crepitus result from broken bone ends rubbing together. Grating sensations or sounds
are felt or head if the injured part is moved.

i. Hypovolemic shock
Hypovolemic shock may result from blood loss or other injuries.
(Linton,2012)

NURSING DIAGNOSIS : Acute Pain related to edema, movement of bone fragments, and
muscle spasm as avidanced by pain descriptors, guarding, crying.
PATIENT GOAL : Reports satisfaction with fine relief measures.
OUTCOMES (NOC):Pain control (Uses preventive measures, Uses nonanalgesic relief
measures, uses analgesics as recommended, reports uncontrolled symptoms to health care
professional, reports pain controlled)
INTERVENTIONS (NIC) AND RATIONALES
Pain management
1. Perform comprehensive assessment of pain to include location, characteristics,
onset/duration, intensive or severity of pain, and precipitating factors to plan appropriate
interventions.
2. Provide pation optimal pain relief with prescribed, analgesics to relieve pain and promote
muscle relaxation.
3. Notivy physician if measures are unsuccessfull or if current complaint is a signification
change from patients past experience of pain since this may indicate an impending
compartment syndrome.
4. Teach the use of nonpharmacologic techniques (e.g. relaxation, guided, inagary, hot/clod
application, and massage) before, after, and if possible, during painfull activities; bfore
pain occurs or increases; and along with other pain, relief measures ti reduce edema and
promote comfort

CASE
Assesment
1. Health Hystory :
Mrs. K. age 80 th, was admitted for a Colles fracture in the left wrist 2 days ago.
Before the injury she lived alone and cared for herself. She was active, alert, and
independent. Since the fracture repair, she has complained of pain for the area of
the break but has had no signs of infection. Her physician is ready to discharge
2.

her to her home.

Physical Examination
Blood pressure : 160/90 mm/hg; Pulse : 98 beats per minute with slight
irregularity; respiration 20 breaths per minute; Temperature : 36,3 C measured
orally. Height 156 cm; Weight : 47 kg, Alert and oriented to time, place and
person. Needs assistance with activities of daily living (ADL), particularly
bathing, dressing, and toileting. Cast on left arm from above her elbow to her
finger

References

Black, J. & Hawks, J. (2009). Medical Surgical Nursing Clinical Management for
Positive Outcome. ( 8 th ed).St. Louis Missouri: Elsevier Saunders
Lewis, et al. (2011). Medical Surgical Nursing, Assesment and Management of
Clinical Problem. New South Wales: Mosby Inc
Linton, Adrianne Dill. (2012). Introduction to Medical Surgical Nursing. St. Louis
Missouri: Elsevier Saunders