nursing diagnosis for femur fracture

Fractured Femur Nursing Diagnosis & Care Plan

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A femur fracture is a severe injury involving a break in the thigh bone (femur), the longest and strongest bone in the human body. This nursing diagnosis focuses on managing pain, preventing complications, and promoting optimal healing while ensuring patient safety and comfort during recovery.

Causes (Related to)

Femur fractures can occur due to various mechanisms, with several factors influencing their severity and healing potential:

  • High-energy trauma (motor vehicle accidents, falls from height)
  • Pathological fractures due to:
    • Osteoporosis
    • Bone tumors
    • Metastatic disease
    • Sports-related injuries
    • Direct blow to the thigh
  • Patient Risk Factors including:
    • Advanced age
    • Osteoporosis
    • Poor nutrition
    • Chronic conditions
    • Medication use (long-term steroids)

Signs and Symptoms (As evidenced by)

Femur fractures present with distinctive signs and symptoms that nurses must recognize for proper assessment and intervention.

Subjective: (Patient reports)

  • Severe pain in the thigh area
  • Inability to bear weight
  • Pain with attempted movement
  • Numbness or tingling sensation
  • The feeling of instability in the leg

Objective: (Nurse assesses)

  • Visible deformity of the thigh
  • Swelling and bruising
  • Shortened or rotated affected limb
  • Limited range of motion
  • Crepitus upon examination
  • Neurovascular compromise
  • Muscle spasms
  • Decreased peripheral pulses

Expected Outcomes

The following outcomes indicate successful management of a femur fracture:

  • The patient will report adequate pain control
  • The patient will maintain proper alignment of the affected limb
  • The patient will demonstrate proper use of prescribed mobility aids
  • The patient will maintain adequate circulation to the affected limb
  • The patient will show no signs of complications
  • The patient will achieve optimal bone healing
  • The patient will regain functional mobility
  • Patient will verbalize understanding of treatment plan

Nursing Assessment

Monitor Pain Status

  • Assess pain level using the appropriate scale
  • Document pain characteristics
  • Evaluate the effectiveness of pain management
  • Note non-verbal pain indicators
  • Monitor for breakthrough pain

Assess Neurovascular Status

  • Check peripheral pulses
  • Monitor sensation and movement
  • Assess skin color and temperature
  • Document capillary refill
  • Note any changes in neurological status

Evaluate Mobility Status

  • Assess the ability to move safely
  • Document range of motion
  • Monitor weight-bearing status
  • Evaluate transfer abilities
  • Check the proper use of mobility aids

Monitor for Complications

  • Check for signs of compartment syndrome
  • Assess for deep vein thrombosis
  • Monitor for fat embolism
  • Watch for signs of infection
  • Document wound healing progress

Review Risk Factors

  • Assess bone health status
  • Document medical history
  • Review medication profile
  • Check nutritional status
  • Evaluate fall risk

Nursing Care Plans

Nursing Care Plan 1: Acute Pain

Nursing Diagnosis Statement:
Acute Pain related to tissue trauma and bone fracture as evidenced by verbal reports of severe pain (8/10), guarding behavior, and facial grimacing.

Related Factors:

  • Tissue trauma
  • Bone fracture
  • Muscle spasms
  • Movement of fractured bone
  • Inflammatory response

Nursing Interventions and Rationales:

  1. Administer prescribed pain medications on schedule
    Rationale: Maintains therapeutic pain control levels
  2. Position the affected limb properly with support
    Rationale: Reduces pain and promotes proper alignment
  3. Apply ice packs as ordered
    Rationale: Reduces swelling and provides pain relief
  4. Assess pain levels regularly
    Rationale: Enables timely intervention and evaluation of treatment effectiveness

Desired Outcomes:

  • The patient will report pain level at 3/10 or less
  • The patient will demonstrate improved comfort
  • The patient will maintain the prescribed position
  • The patient will utilize effective pain management strategies

Nursing Care Plan 2: Impaired Physical Mobility

Nursing Diagnosis Statement:
Impaired Physical Mobility related to prescribed immobilization and pain as evidenced by the inability to move purposefully within the physical environment.

Related Factors:

  • Prescribed immobilization
  • Musculoskeletal injury
  • Pain
  • Fear of movement
  • Muscle weakness

Nursing Interventions and Rationales:

  1. Assist with prescribed mobility exercises
    Rationale: Maintains joint function and prevents complications
  2. Teach proper use of mobility aids
    Rationale: Ensures safe movement and prevents falls
  3. Position patient properly q2h
    Rationale: Prevents pressure injuries and promotes comfort

Desired Outcomes:

  • The patient will demonstrate safe transfer techniques
  • The patient will maintain proper body alignment
  • The patient will participate in a prescribed exercise program
  • The patient will use mobility aids correctly

Nursing Care Plan 3: Risk for Peripheral Neurovascular Dysfunction

Nursing Diagnosis Statement:
Risk for Peripheral Neurovascular Dysfunction related to trauma and immobilization as evidenced by femur fracture and required stabilization.

Related Factors:

  • Musculoskeletal trauma
  • Edema
  • Immobilization
  • Vascular compromise
  • Compartment syndrome risk

Nursing Interventions and Rationales:

  1. Assess neurovascular status q4h
    Rationale: Enables early detection of complications
  2. Monitor for signs of compartment syndrome
    Rationale: Allows prompt intervention for this emergency
  3. Maintain proper positioning
    Rationale: Promotes optimal circulation

Desired Outcomes:

  • The patient will maintain adequate peripheral circulation.
  • The patient will demonstrate intact sensation
  • The patient will show no signs of neurovascular compromise

Nursing Care Plan 4: Risk for Falls

Nursing Diagnosis Statement:
Risk for Falls related to altered mobility and balance impairment as evidenced by the use of assistive devices and weakened lower extremity.

Related Factors:

  • Altered mobility
  • Use of assistive devices
  • Muscle weakness
  • Pain
  • Environmental hazards

Nursing Interventions and Rationales:

  1. Implement fall precautions
    Rationale: Prevents additional injury
  2. Educate about environmental safety
    Rationale: Promotes awareness and safe mobility
  3. Ensure proper use of call light
    Rationale: Provides timely assistance when needed

Desired Outcomes:

  • The patient will remain free from falls
  • The patient will demonstrate safe mobility practices
  • The patient will utilize the call light appropriately
  • The patient will identify fall risk factors

Nursing Care Plan 5: Risk for Infection

Nursing Diagnosis Statement:
Risk for Infection related to surgical intervention and presence of internal fixation devices as evidenced by surgical incision and altered tissue integrity.

Related Factors:

  • Surgical procedure
  • Internal fixation devices
  • Altered tissue integrity
  • Decreased mobility
  • Invasive procedures

Nursing Interventions and Rationales:

  1. Monitor surgical site
    Rationale: Enables early detection of infection
  2. Maintain sterile technique
    Rationale: Prevents contamination
  3. Administer prescribed antibiotics
    Rationale: Prevents postoperative infection

Desired Outcomes:

  • The patient will remain free from infection
  • The patient will demonstrate proper wound care
  • The patient will maintain a normal temperature
  • The patient will show no signs of systemic infection

References

  1. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 
  2. Forsh DA, Ferguson TA. Contemporary management of femoral neck fractures: the young and the old. Curr Rev Musculoskelet Med. 2012 Sep;5(3):214-21. doi: 10.1007/s12178-012-9127-x. PMID: 22628175; PMCID: PMC3535087.
  3. Ghayoumi P, Kandemir U, Morshed S. Evidence based update: open versus closed reduction. Injury. 2015 Mar;46(3):467-73. doi: 10.1016/j.injury.2014.10.011. Epub 2014 Oct 14. PMID: 25554424.
  4. Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
  5. Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
  6. Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
  7. Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. 
  8. Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015 Mar;46(3):484-91. doi: 10.1016/j.injury.2014.10.010. Epub 2014 Oct 31. PMID: 25480307.

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Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.
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