- Acute Pain related to bone displacement, muscle spasms and edema as evidenced by verbalization of pain, guarding behavior and facial grimacing
- Impaired Physical mobility related to loss of integrity of bone structure and pain as evidenced by reports of pain and unwillingness to move
- Risk for constipation related to immobility, Opioid use and change in eating pattern as evidenced by signs and symptoms
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Expressions of pain, such as crying Unpleasant feeling (such as a prick, burn, or ache) Objective Data: -Significant changes in vital signs -Changes in appetite or eating patterns -Changes in sleep patterns -Guarding or protective behaviors | Acute Pain related to bone displacement, Muscle spasms and edema as evidenced by verbalization of pain, guarding behavior and facial grimacing | Patient will report pain of 2/10 or less by discharge Patient will display signs of comfort as evidenced by resting with eyes closed and vital signs within normal limits Patient will utilize nonpharmacologic pain relief measures | 1. Administer analgesics. Acute fractures usually warrant narcotic pain relief which may be oral or IV. NSAIDs such as Ibuprofen or Naproxen treat inflammation and are often given in conjunction with narcotics. 2. Provide alternative comfort measures. Patients should not rely solely on medication. Implement alternative measures that alleviate the patient’s pain such as ice packs, heat, massage, distraction, and controlled breathing. 3. Support the injured area. A fractured extremity should remain elevated to reduce swelling. Utilize splints or traction devices as ordered. Immobilize the fractured area and follow weight-bearing instructions to promote healing. 4. Instruct on medications at discharge. Patients should be instructed to not take pain medications more frequently than prescribed. If the dose ordered is not controlling their pain they should contact their provider. Instruct on other precautions with narcotics such as not operating vehicles, and possible side effects such as drowsiness, dizziness, nausea, and constipation. | Patient reported relief of pain. Patient rated the pain scale lower than the initial rate at a level that is acceptable to them or 0/10. Patient manifested vital signs within normal limits. Patient verbalized regaining appetite and sleep. |
| Subjective Data: Expression of pain and discomfort with movement Refusal to move Objective Data: -Limited range of motion -Uncoordinated movements -Poor balance -Inability to turn in bed, transfer, or ambulate -Postural instability -Gait disturbances -Reliance on assistive devices -Contractures -Decreased muscle strength | Impaired Physical mobility related to loss of integrity of bone structure and pain as evidenced by reports of pain and unwillingness to move | Patient will increase ambulation distance and participation in ADLs as tolerated Patient will demonstrate techniques to support movement Patient will remain free from falls or injury while ambulating | 1. Encourage independence. The patient should be encouraged to do as much for themselves as possible. Even patients confined to a bed can assist with turning themselves and should be encouraged to perform ADLs such as feeding or washing their face if possible. 2. Premedicate before movement. The nurse should anticipate pain and premedicate before potentially painful activities such as PT sessions or complete bed baths. This will help relax the patient and improve their ability to perform exercises. 3. Collaborate with PT/OT. Hip fractures, spinal fractures, or other serious fractures may require PT or OT to assist with safe movement. These specialists can teach patients how to use canes, crutches, and other devices as well as instruct on exercises to strengthen muscles. 4. Encourage the use of assistive devices and equipment. Any equipment that will support safe movement such as bedside commodes, grab bars, walkers, or scooters should be utilized. | Patient participated in their activities of daily life (ADLs) and prescribed therapies. Patient displayed improvement in physical mobility by transferring from bed to wheelchair independently (if this is a realistic goal). Patient remained free of contractures and decubitus ulcers from impaired mobility. Patient demonstrated exercises to improve physical mobility. |
| Subjective Data: Complaints of straining at stooling, incomplete evacuation, abdominal bloating, or pain -Abdominal pain Objective Data: -Large, dry stools that are difficult to pass -Less than three bowel movements per week -Bright red blood on surface of stool | Risk for constipation related to immobility, Opioid use and Change in eating pattern as evidenced by signs and symptoms | Patient will have a solid bowel movement at least every 3 days Patient will report no straining or discomfort with defecation Patient will implement 2 measures to prevent constipation | 1. Administer stool softeners or laxatives. The most common side effect of opioid medications is constipation. When prescribed these medications a stool softener should be used prophylactically in conjunction. For severe constipation, enemas may be required. 2. Educate on the risk and prevention of constipation. Educate that patient that constipation is increased due to their immobility and use of opioids (if taking). Stool softeners should be taken before constipation occurs to prevent impaction or serious complications such as a bowel obstruction. 3. Increase fluids. Fluids keep stools soft and easier to pass. Patients should drink plenty of water (if not contraindicated) as well as juices such as prune juice. Hot beverages like tea also stimulate bowel movements. 4. Increase mobility as tolerated. Immobility from fractures can also slow down peristalsis. While the patient must first follow activity instructions, once the patient may safely ambulate or exercise, this should be encouraged. | Patient has solid bowel movement at least every 3 days Patient reported no straining or discomfort with defecation Patient will implement 2 measures to prevent constipation |