Introduction to fracture

Bones form the skeleton of the body and allow the body to be supported against gravity
and to move and function in the world. Bones also protect some body parts, and the bone
marrow is the production center for blood products.
Bone is not a stagnant organ. It is the body's reservoir of calcium and is always
undergoing change under the influence of hormones. Parathyroid hormone increases
blood calcium levels by leeching calcium from bone, while calcitonin has the opposite
effect, allowing bone to accept calcium from the blood.

A fracture is a medical condition that occurs when a person’s bones are subject
to cracks or breakage. While fractures are known as broken bones, the term
“break” does not form part of the medical terminology used in orthopedics.

Many fractures are caused by a high force, stress or strong impact on the bone.
Fractures occur as a result of traumas caused by falls, car accidents, or injuries
from playing sports. Sometimes fractures may be a result of diseases such as
osteoporosis, a condition characterized by “porous” bones, osteogenesis
imperfecta, and some types of cancer. Overuse may also lead to stress fractures,
which are manifested by miniature cracks appearing on the surface of the bone.

There are various classifications of fractures based on the characteristics of each

injury. A closed fracture is a fracture where a person’s skin remains intact. Open
or compound fractures involve a wound caused when the fractured bone
punctures the surrounding skin. This kind of fracture carries a high risk of
infection as the open wound exposes the fractured bone to all kinds of
contamination. Open or compound fractures are considered medical emergencies
that need immediate surgical and antibiotic treatment to remove all traces of dirt,
dead tissue, and contaminants.

Simple fractures are a classification of fractures that occur on one line of the
bone, splitting it into two, while the injured bone splitting into many different
pieces characterizes multi-fragmentary fractures. Doctors find it easier to treat a
simple closed fracture, as this kind of bone injury presents a better prognosis
compared to an open or compound multi-fragmented fracture that is likely to be
exposed to contamination

A compression fracture is a kind of fracture that occurs in the bones of the spine,
or the vertebrae. Due in part to osteoporosis, the front portion of a person’s
vertebra may collapse due to the brittleness of the bones and despite the absence
of any trauma. Complete fractures are another type of fracture wherein bone
segments separate completely from one another, while an incomplete fracture
characterizes a type of fracture where fragments of the bone remain partially
joined.

Other types of bone fractures are linear fractures that occur parallel to the long
axis of a bone, and a transverse fracture occurs at right angles to the long axis of
a bone. On the other hand, fractures that are diagonal to the bone’s long axis are
called oblique fractures. A spiral fracture is characterized a twisted bone, and a
compacted fracture occurs when bone fragments are wedged into one another
due to a forceful impact.

A person who has a fracture will exhibit a misshapen limb or a joint that may
look out-of-place. There may be swelling, bleeding, or bruising on area of the
skin surrounding the fracture, and the affected person may experience intense
pain. Numbness and tingling may also accompany this injury, as well as a
limited scope of motion or the inability to fully move the affected limb.

Osteoporosis is a disease that causes bones to weaken, become brittle and more easily
breakable
Symptoms of Fractures
Local pain Local bleeding Local swelling Deformity or dislocation Symptoms of
associated nerve damage:

Fractures: Types list

The list of types of Fractures mentioned in various sources includes:

• Subtype by type of fracture:

• Simple fracture - does not break the skin.

• Χο µ π ο υ ν δ φρα χ τ υ ρ ε - a fracture breaking the skin;

also called "open fracture".

• Greenstick fracture - a bend-like fracture in children.

• Stress fracture - a fracture caused by repeated stress to the bone.

• Πα τ η ο λ ο γ ι χ α λ φρα χ τ υ ρ ε - a fracture caused by

underlying diseases.

• Complicated fracture - also damaging nearby tissues.

• Depressed fracture - skull fracture with bone forced inwards.

• Comminuted fracture - multiple fractures and associated tissue damage to

a single bone.
 • Subtype by location of fracture:

• Skull fracture

• Φα χ ε βον ε φρα χ τ υ ρ ε

• Ριβ φρα χ τ υ ρ ε

• Pelvis fracture

• Ση ο υ λ δ ε ρ φρα χ τ υ ρ ε

• Αρ µ φρα χ τ υ ρ ε

• Ηιπ φρα χ τ υ ρ ε

• Ηα ν δ φρα χ τ υ ρ ε

• Φρα χ τ υ ρ ε δ Φεµ υ ρ

• Αν κ λ ε φρα χ τ υ ρ ε

• Λοω ε ρ λε γ φρα χ τ υ ρ ε

• Φο ο τ φρα χ τ υ ρ ε

• Φα χ ι α λ φρα χ τ υ ρ ε

Definition
A fracture is a complete or incomplete break in a bone resulting from the application of
excessive force.The act or process of breaking.
A break, rupture, or crack, especially in bone or cartilage.

Fracture: A break in bone or cartilage. Although usually the result of trauma, a fracture
can be caused by an acquired disease of bone such as osteoporosis or by abnormal
formation of bone in a disease such as osteogenesis imperfecta ("brittle bone disease").
Fractures are classified according to their character and location as, for example, a
greenstick fracture of the radius.

Diagnosis
Diagnosis begins immediately with an individual's own observation of symptoms. A
thorough medical history and physical exam by a physician often reveals the presence of
a fracture. An x ray of the injured area is the most common test used to determine the
presence of a bone fracture. Any x-ray series performed involves at least two views of the
area to confirm the presence of the fracture because not all fractures are apparent on a
single x ray. Some fractures are often difficult to see and may require several views at
different angles to see clear fracture lines. In some cases, CT, MRI, or other imaging tests
are required to demonstrate fracture. Sometimes, especially with children, the initial x ray
may not show any fractures, but if it is repeated seven to 14 days later, the x ray may
show changes in the bone(s) of the affected area. If a fracture is open and occurs in
conjunction with soft tissue injury, further laboratory studies are often conducted to
determine if blood loss has occurred.
In the event of exercise-related stress fractures (micro-fractures due to excessive stress), a
tuning fork can provide a simple, inexpensive test. The tuning fork is a metal instrument
with a stem and two prongs that vibrate when struck. If an individual has increased pain
when the tuning fork is placed on a bone, such as the tibia or shinbone, the likelihood of a
stress fracture is high. Bone scans also are helpful in detecting stress fractures. In this
diagnostic procedure, a radioactive tracer is injected into the bloodstream and images are
taken of specific areas or the entire skeleton by CT or MRI.
Treatment
Treatment depends on the type of fracture, its severity, the individual's age, and the
person's general health. The first priority in treating any fracture is to address the entire
medical status of the patient. Medical personnel are trained not to allow a painful,
deformed limb to distract them from potentially life-threatening injury elsewhere or
shock. If an open fracture is accompanied by serious soft tissue injury, it may be
necessary to control bleeding and the shock that can accompany loss of blood.
First aid is the appropriate initial treatment in emergency situations. It includes proper
splinting, control of blood loss, and monitoring vital signs such as breathing and
circulation.
Prognosis
Fractures involving joint surfaces almost always lead to some degree of arthritis of the
joint. Fractures can normally be cured with proper first aid and appropriate aftercare. If
determined necessary by a physician, the fractured site should be manipulated, realigned,
and immobilized as soon as possible. Realignment has been shown to be much more
difficult after six hours. Healing time varies from person to person with the elderly
generally needing more time to heal completely. A non-union fracture may result when a
fracture does not heal, such as in the case of an elderly person or an individual with
medical complications. Recovery is complete when there is no bone motion at the
fracture site, and x-rays indicate complete healing. Open fractures may lead to bone
infections, which delay the healing process. Another possible complication is
compartment syndrome, a painful condition resulting from the expansion of enclosed
tissue and that may occur when a body part is immobilized in a cast.
Prevention
Fractures can be prevented if safety measures are taken seriously. These measures
include using seat belts in cars and encouraging children to wear protective sports gear.
Weight-bearing exercise also helps to strengthen bones.
Type: It is important to note whether the fracture is simple or multifragmentary and
whether it is closed or open: A=simple fracture, B=wedge fracture, C=complex
fractureOther classification systems

There are other systems used to classify different types of bone fractures:

• "Denis classification": spineHYPERLINK \l "cite_note-4"[5]

• "Frykman classification": radius and ulna

• "Gustilo open fracture classification"[6]

• "Letournel and Judet Classification": Acetabular FracturesHYPERLINK \l

"cite_note-Fractures_of_the_Acetabulum-6"[7]

• "Neer classification": humerusHYPERLINK \l "cite_note-pmid9155417-

7"[8]HYPERLINK \l "cite_note-titleeMedicine_-
_Proximal_Humerus_Fractures:_Article_by_Mark_Frankle.2C_MD-8"[9]
"Seinsheimer's Classification": femurHYPERLINK \l "cite_note-
Seinsheimer.27s_Classification_of_Subtrochanteric_Frxs_-
_Wheeless.27_Textbook_of_Orthopaedics-9"[10]

[edit] Signs and symptoms

Although bone tissue itself contains no nociceptors, bone fracture is very painful for
several reasons:[11]
 • Breaking in the continuity of the periosteum, with or without similar discontinuity
in endosteum, as both contain multiple nociceptors.

• Ε δ ε µ α of nearby soft tissues caused by bleeding of torn periosteal blood

vessels evokes pressure pain.

• Μυ σ χ λ ε σπα σ µ σ trying to hold bone fragments in place

[edit] Pathophysiology
Main article: Bone healing
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.[12]

[edit] Diagnosis
A bone fracture can be diagnosed clinically, based on the history given and the physical
examination performed by a healthcare professional. Usually there will be an area of
swelling, abrasion, bruising and/or tenderness at the suspected fracture site.
Open fractures may be obvious if bone is exposed but small wounds may need surgical
exploration to determine if they are only superficial or connected to the fracture.
X-ray radiographs can be requested to view the bone suspected of being fractured.
In situations where x-ray alone is insufficient, a computed tomograph (CT scan) may be
performed.

[edit] Treatment
X-ray showing the proximal portion of a fractured tibia with an intramedullary nail.
X-ray showing the distal portion of a fractured tibia and intramedular nail.

[edit] Pain management

In arm fractures in children, ibuprofen has been found to be equally effective as the
combination of acetaminophen and codeine.[13]

[edit] Immobilization
Since bone healing is a natural process which will most often occur, fracture treatment
aims to ensure the best possible function of the injured part after healing. Bone fractures
are typically treated by restoring the fractured pieces of bone to their natural positions (if
necessary), and maintaining those positions while the bone heals. Often, aligning the
bone, called reduction, in good position and verifying the improved alignment with an X-
ray is all that is needed. This process is extremely painful without anesthesia, about as
painful as breaking the bone itself. To this end, a fractured limb is usually immobilized
with a plaster or fiberglass cast or splint which holds the bones in position and
immobilizes the joints above and below the fracture. When the initial post-fracture edema
or swelling goes down, the fracture may be placed in a removable brace or orthosis. If
being treated with surgery, surgical nails, screws, plates and wires are used to hold the
fractured bone together more directly. Alternatively, fractured bones may be treated by
the Ilizarov method which is a form of external fixator.
Occasionally smaller bones, such as phalanges of the toes and fingers, may be treated
without the cast, by buddy wrapping them, which serves a similar function to making a
cast. By allowing only limited movement, fixation helps preserve anatomical alignment
while enabling callus formation, towards the target of achieving union.

[edit] Surgery
Surgical methods of treating fractures have their own risks and benefits, but usually
surgery is done only if conservative treatment has failed or is very likely to fail. With
some fractures such as hip fractures (usually caused by osteoporosis or osteogenesis
Imperfecta), surgery is offered routinely, because the complications of non-operative
treatment include deep vein thrombosis (DVT) and pulmonary embolism, which are more
dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also
commonly recommended to make an accurate anatomical reduction and restore the
smoothness of the joint. Infection is especially dangerous in bones, due to their limited
blood flow. Bone tissue is predominantly extracellular matrix, rather than living cells,
and the few blood vessels needed to support this low metabolism are only able to bring a
limited number of immune cells to an injury to fight infection. For this reason, open
fractures and osteotomies call for very careful antiseptic procedures and prophylactic
antibiotics.
Occasionally bone grafting is used to treat a fracture.
Sometimes bones are reinforced with metal. These implants must be designed and
installed with care. Stress shielding occurs when plates or screws carry too large of a
portion of the bone's load, causing atrophy. This problem is reduced, but not eliminated,
by the use of low-modulus materials, including titanium and its alloys. The heat
generated by the friction of installing hardware can easily accumulate and damage bone
tissue, reducing the strength of the connections. If dissimilar metals are installed in
contact with one another (i.e., a titanium plate with cobalt-chromium alloy or stainless
steel screws), galvanic corrosion will result. The metal ions produced can damage the
bone locally and may cause systemic effects as well.
Electrical bone growth stimulation or osteostimulation has been attempted to speed or
improve bone healing. Results however do not support its effectiveness.[14]

[edit] Complications

An old fracture with nonunion of the fracture fragments.

Some fractures can lead to serious complications including a condition known as
compartment syndrome. If not treated, compartment syndrome can result in amputation
of the affected limb. Other complications may include non-union, where the fractured
bone fails to heal or mal-union, where the fractured bone heals in a deformed manner.

In orthopedic medicine, fractures are classified in various ways. Historically they are
named after the doctor who first described the fracture conditions. However, there are
more systematic classifications in place currently.
All fractures can be broadly described as:

• Closed (simple) fractures are those in which the skin is intact, while open
(compound) fractures involve wounds that communicate with the fracture, or
where fracture hematoma is exposed, and may thus expose bone to contamination.
Open injuries carry a higher risk of infection.
Other considerations in fracture care are displacement (fracture gap) and angulation. If
angulation or displacement is large, reduction (manipulation) of the bone may be
required and, in adults, frequently requires surgical care. These injuries may take longer
to heal than injuries without displacement or angulation.
Another type of bone fracture is a compression fracture. It usually occurs in the
vertebrae, for example when the front portion of a vertebra in the spine collapses due to
osteoporosis (a medical condition which causes bones to become brittle and susceptible
to fracture, with or without trauma).
Other types of fracture are:

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

• Ινχο µ π λ ε τ ε φρα χ τ υ ρ ε : A fracture in which the bone

fragments are still partially joined.

• Λιν ε α ρ φρα χ τ υ ρ ε : A fracture that is parallel to the bone's long

axis.

• Τρα ν σ ϖ ε ρ σ ε φρα χ τ υ ρ ε : A fracture that is at a right angle

to the bone's long axis.

• Οβ λ ι θ υ ε φρα χ τ υ ρ ε : A fracture that is diagonal to a bone's long

axis.

• Σπ ι ρ α λ φρα χ τ υ ρ ε : A fracture where at least one part of the

bone has been twisted.

• Χο µ µ ι ν υ τ ε δ φρα χ τ υ ρ ε : A fracture in which the bone has

broken into a number of pieces.

• Ιµπα χ τ ε δ φρα χ τ υ ρ ε : A fracture caused when bone fragments

are driven into each other.

[edit] OTA classification

The Orthopaedic Trauma Association, an association for orthopaedic surgeons, adopted
and then extended the classification of Müller and the AO foundation [1] ("The
Comprehensive Classification of the Long Bones") an elaborate classification system to
describe the injury accurately and guide treatment.[2]HYPERLINK \l "cite_note-2"[3]
There are five parts to the code:

• Bone: Description of a fracture starts by coding for the bone involved:}}

(1) Humerus, (2) Radius/Ulna, (3) Femur, (4) Tibia/Fibula, (5) Spine, (6) Pelvis, (24)
Carpus, (25) Metacarpals, (26) Phalanx (Hand), (72) Talus, (73) Calcaneus, (74)
Navicular, (75) Cuneiform, (76) Cuboid, (80) LisFranc, (81) Metatarsals, (82) Phalanx
(Foot), (45) Patella, (06) Clavicle, (09) Scapula

• Location: a code for the part of the bone involved (e.g. shaft of the femur):
proximal=1, diaphyseal=2, distal=3 (at the ankle the malleolar region is
considered separately due to the pre-existing Weber classification and coded as
4[4]). Except at the proximal femur the distal and proximal regions of the bone
are defined by a square that is as wide as the as the distance between the condyles.
 The diaphysis is considered to be the rest of the bone between these two squares.

• Type: It is important to note whether the fracture is simple or multifragmentary

and whether it is closed or open: A=simple fracture, B=wedge fracture,
C=complex fracture

• Group: The geometry of the fracture is also described by terms such as transverse,
oblique, spiral, or segmental.

• Subgroup: Other features of the fracture are described in terms of displacement,

angulation and shortening. A stable fracture is one which is likely to stay in a
good (functional) position while it heals; an unstable one is likely to shorten,
angulate or rotate before healing and lead to poor function in the long term.

[edit] Other classification systems

There are other systems used to classify different types of bone fractures:

• "Denis classification": spineHYPERLINK \l "cite_note-4"[5]

• "Frykman classification": radius and ulna

• "Gustilo open fracture classification"[6]

• "Letournel and Judet Classification": Acetabular FracturesHYPERLINK \l

"cite_note-Fractures_of_the_Acetabulum-6"[7]

• "Neer classification": humerusHYPERLINK \l "cite_note-pmid9155417-

7"[8]HYPERLINK \l "cite_note-titleeMedicine_-
_Proximal_Humerus_Fractures:_Article_by_Mark_Frankle.2C_MD-8"[9]
"Seinsheimer's Classification": femurHYPERLINK \l "cite_note-
Seinsheimer.27s_Classification_of_Subtrochanteric_Frxs_-
_Wheeless.27_Textbook_of_Orthopaedics-9"[10]

[edit] Signs and symptoms

Although bone tissue itself contains no nociceptors, bone fracture is very painful for
several reasons:[11]

• Breaking in the continuity of the periosteum, with or without similar discontinuity

in endosteum, as both contain multiple nociceptors.

• Ε δ ε µ α of nearby soft tissues caused by bleeding of torn periosteal blood

vessels evokes pressure pain.

• Μυ σ χ λ ε σπα σ µ σ trying to hold bone fragments in place

[edit] Pathophysiology
Main article: Bone healing
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.[12]

[edit] Diagnosis
A bone fracture can be diagnosed clinically, based on the history given and the physical
examination performed by a healthcare professional. Usually there will be an area of
swelling, abrasion, bruising and/or tenderness at the suspected fracture site.
Open fractures may be obvious if bone is exposed but small wounds may need surgical
exploration to determine if they are only superficial or connected to the fracture.
X-ray radiographs can be requested to view the bone suspected of being fractured.
In situations where x-ray alone is insufficient, a computed tomograph (CT scan) may be
performed.

[edit] Treatment
The 'prognosis' of Fractures usually refers to the likely outcome of Fractures. The
prognosis of Fractures may include the duration of Fractures, chances of complications of
Fractures, probable outcomes, prospects for recovery, recovery period for Fractures,
survival rates, death rates, and other outcome possibilities in the overall prognosis of
Fractures. Naturally, such forecast issues are by their nature unpredictable.
Incidence: 1,499,999 (USA annual incidence calculated from this data: 1.5 million
osteoporosis-related fractures
Incidence: 1,499,999 (USA annual incidence calculated from this data: 1.5 million
osteoporosis-related fractures
Skull fractures invariably result from a traumatic blow to the head. Motor vehicle
accidents, bad falls, sports injuries, and physical assaults top the list of causes. The brain
can be directly affected by damage to the nervous system and by bleeding.
NURSING CARE PLAN
ASSESSMENT
NURSING
DIAGNOSIS
INFERENCE
PLANNING
INTERVENTION
RATIONALE
EVALUATION
Subjective:
“Hindi ko
maigalaw ung
binti ko ”, as
verbalized by the
patient
Objective:
>limited range of
motion
>slowed
movement
>limited ability to
perform
gross
and fine motor
> with cast on left
leg
>Functional
Level: 3
Impaired physical mobility related to loss of integrity of bone structures (fracture)
Trauma
(Vehicular
accident)
Fracture of the left
leg
bleeding from
damaged ends of
bone and
surrounding tissue
stimulates
inflammatory
response
increased capillary
permeability
fluid and cellular
exudation
pain
impaired physical
At the end 6hrs. of
nurse-patient
interaction and
intervention, the
patient will:
a) Verbalize
understanding
of the situation
and individual
treatment
regimen and
safety
measures.
b) Participate in
ADLs and
desired
activities
c)Maintain
position of
function and
skin integrity
as evidenced
by absence of
decubitus
ulcers
d) Maintain and
increase
strength and
function of
affected part.
> Determine
diagnosis that
contributes to
immobility.
> note situations
such as fractures
> determine the
degree of immobility
in relation to
suggested scale
> determine
presence of
complications
related to immobility
(pneumonia,
elimination
problems,decubitus)
> Assist client
reposition self on a
regular schedule.
> To identify
contributing
factors
> cause it may
restrict movement
> to assess
functional mobility
> to assess
presence of
complications
> to promote
optimum level of
function and
prevent
After 6hrs. of
nurse-patient
interaction and
intervention, the
patient has:
a) Verbalized
understandin
g of the
situation and
individual
treatment
regimen and
safety
measures.
b) Participated in ADLs and desired
activities
c)Maintained
position of
function and
skin integrity
as evidenced
by absence
of decubitus
ulcers
d) Maintained
and
increased
strength and
function of
affected part.

mobility
> Support affected
body part using
pillows.
> Encourage
adequate intake of
fluids/nutritious
foods
complications
> to maintain
position and
function and
reduce risk of
pressure ulcers.
> It promote well-
being and
maximizes energy
production
ASSESSMENT
NURSING
DIAGNOSIS
INFERENCE
PLANNING
INTERVENTION
RATIONALE
EVALUATION
Subjective:
Objective:
(+) presence of
wound
Risk for infection related to wound secondary
to
fracture
Trauma
(Vehicular
accident)
Fracture of the left
leg
bleeding from
damaged ends of
bone and
surrounding tissue
At the end of the
6hr nurse-patient
interaction and
intervention the
patient will:
a)Identify
interventions to prevent/reduce risk of infection
b)Achieve timely
wound healing;
be free of
purulent
>Note risk factor for
occurrence of infection
>Observe for localized
signs of infection
.>Stress proper hand-
hygiene by all
caregivers bet.
Therapies/clients.
>To assess
causative/
contributing
factors
>To assess for
infected sites
>A first line
defense against
healthcare-
associated
infections
After 6hr nurse-
patient interaction
and intervention
the patient has :
a) identified
interventions to prevent/reduce risk of infection
b)Achieved
timely wound
healing; be
free of purulent
drainage or