Incidence Rate for Fractured Lower Leg: approximately 1 in 1,304 in the

Philippines. Extrapolated incidence (annual) of fractured lower leg in the country,

Philippines is 66, 097 from 86,241,697 of estimated population used. (Right
Diagnosis, 2015)
Reference:
Statistics by Country for Fractured Lower Leg. Right Diagnosis, 2015.
Retrieved from http://www.rightdiagnosis.com/f/fractured_lower_leg/statscountry.htm
Assessment
Subjective:
Reports of pain
in the affected or
surrounding
area (left lower
leg)
Objective:
Destruction of
skin layers
Broken tibia in
the lower left
extremity sticks
out through the
skin.
(Compound
Fracture)

Diagnosis
Impaired Skin
Integrity related to
traumatic injury
secondary to open
fracture as
evidenced by
destruction of skin
layers

Planning

Intervention

After series of
Identify
nursing
underlying
interventions, the
condition or
patient will verbalize
pathology
relief of discomfort;
involved.
Demonstrate
Determine
behaviors/techniques
clients age and
to facilitate healing
developmental
as indicated;
factors or ability
maintain optimal
to care for self.
nutrition and physical
well-being;
participate in
Evaluate clients
prevention measures
skin care
and treatment
practices and
program and
hygiene issues.
verbalize feelings of
increased selfesteem and ability to
manage situation.
Determine
nutritional status
and potential for
delayed healing

Rationale
To assess
causative or
contributing
factors.

To determine
risks, sensitivi
of skin and lev
of
responsivenes
to pain
sensations
Ineffective
hygiene can
result in seriou
skin impairme
and discomfor

To assess if
malnutrition
is/could be a
contributing
factor
To identify risk
for injury and
safety
requirements.

Evaluate client
with impaired
cognition,
developmental
delay, need for
or use of
restraints, longterm immobility.
Note presence of May impact
clients self-ca
compromised
as relates to s
mobility,

sensation,
vision, hearing or
speech.
Assess blood
supply and
sensation of skin
surfaces and
affected area on
a regular basis.

Review
laboratory
results pertinent
to causative
factors.

Perform routine
skin inspections
describing
observed
changes.
Determine
degree and
depth of injury or
damage to
integumentary
system.
Photograph the
affected area, as
appropriate.

Determine
clients level of
discomfort.
Ascertain
attitudes of
individual or
significant others
about condition.
Note

care.

To provide
comparative
baseline and
opportunity fo
timely
intervention
when problem
are noted.
Albumin less
than 3.5
correlates to
decreased
wound healing
and increased
frequency of
pressure ulcer
For determinin
the need for
change of
interventions.

To assess ext
of involvemen

To document
status and
provide visual
baseline for
future
comparisons.
To clarify
intervention
needs and
priorities.
Identifies area
to be address
in teaching pla
and potential
referral needs

misconceptions.
Inspect skin on a
daily basis,
describing
characteristics
and changes in
the affected
area.
Periodically
measure and
photograph the
affected area
and observe for
complications.
Avoid or limit use
of plastic
material.
Remove wet and
wrinkled-linens
promptly.
Reposition client
on regular
schedule,
involving client in
reasons for and
decisions about
times and
positions.
Encourage early
ambulation or
mobilization.
Provide optimum
nutrition,
including
vitamins and
protein.

Review
importance of
health, intact
skin, as well as
measures to
maintain proper

To assist clien
with correcting
minimizing
condition and
promote heali

To monitor
progress of
healing.

Moisture
potentiates
breakdown.

To enhance
understanding
and cooperati
Lessens constant
pressure on same
areas and minimiz
risk of skin
breakdown.
Promotes
circulation and
reduces risks
associated wit
immobility.
To provide a
positive nitrog
balance to aid
skin and tissu
healing and to
maintain gene
good health.
The
integumentary
system is the
largest
multifunctiona
organ of the
body.

skin functioning.
Assist the client
or significant
others in
understanding
and following
medical regimen
and developing
program of
preventive care
and daily
maintenance.

Enhances
commitment to
plan, optimizin
outcomes.

Assessment

Diagnosis

Planning

Intervention

Subjective:
Reports of pain
and discomfort
on the affected
lower extremity
Objective:
With
musculoskeletal
impairment on
left lower leg
Impaired
physical
mobility
Environmental
barrier;
[mechanical
restriction
skeletal traction]

Self Care Deficit

in bathing,
dressing and
toileting related to
impaired
immobility as
evidenced by
traction application

After series of
nursing
interventions, the
patient will identify
individual areas of
weakness or
needs; verbalize
knowledge of
healthcare
practices;
demonstrate
techniques and
lifestyle changes to
meet self-care
needs; perform
self-care activities
within level of own
ability and identify
personal and
community
resources that can
provide
assistance.

Note
concomitant
medical
problems or
existing
conditions that
may be factors
for care.
Identify degree
of individual
impairment and
functional level
according to
scale.
Note whether
deficit is
temporary or
permanent,
should
decrease or
increase with
time.
Provide
accurate and
relevant
information
regarding
current and
future needs.
Promote clients
or significant
others
participation in
problem
identification
and desired
goals and
decision
making.
Active listen
clients and
significant
others
concerns.

Rationale
To identify
causative or
contributing
factors.

To assess degree
of disability.

So that client can

incorporate into
self-care plans
while minimizing
problems often
associated with
change.
Enhances
commitment to
plan, optimizing
outcomes, and
supporting
recovery and
health promotion.

Exhibits regard for

clients values and
beliefs, clarifies
barriers to
participation in self
care, provides

 Practice and
promote shortterm goal
setting and
achievement.

Ask client or
significant
others for input
on bathing
habits or
cultural bathing
preferences.
Obtain hygiene
supplies for
specific activity
to be performed
and place in
clients easy
reach.
Provide for
adequate
warmth.

Provide for or
assist with
grooming
activities on a
routine,
consistent
basis.
Encourage
participation,
guiding clients

opportunity to work
on problem-solving
solutions and to
provide
encouragement
and support.
To recognize that
todays success is
as important as
any long-term goal,
accepting ability to
do one thing at a
time and
conceptualization
of self-care in a
broader sense.
Enhances selfesteem, while
respecting
personal and
cultural
preferences.

To provide visual
cues and facilitate
completion of
activity.

Certain individuals
are prone to
hypothermia and
can experience
evaporative cooling
during and after
bathing.
Experiencing the
normal process of
a task through
established routine
and guided
practice facilitates
optimal relearning.

hand through
tasks, as
indicated.
Ascertain that
appropriate
clothing is
available.

Dress client or
assist with
dressing, as
indicated.

Encourage food
and fluid
choices
reflecting
individual likes
and abilities
and that meet
nutritional
needs.
Provide privacy.

Assist with
manipulation of
clothing, if
needed.

Provide or
assist with use
of assistive
equipment.

Review safety
concerns.
Modify activities

Clothing my need
to be modified for
clients particular
medical condition
or physical
limitations.
Client may need
assistance in
putting on or taking
off items of clothing
or may require
partial or complete
assistance with
fasteners.
To maximize food
intake.

That may be
indicative of need
for prompt toileting.
To decrease
incidence of
functional
incontinence
caused by difficulty
removing
clothing/underwear.
To promote
independence and
safety in sitting
down or arising
from toilet or for
aiding elimination
when client is
unable to go the
bathroom.

or environment.
Assist and
support family
with alternative
placements as
necessary.
Be available for
discussion of
feelings about
situation.

To reduce risk of
injury and promote
successful
community
functioning.
Enhances
likelihood of finding
individually
appropriate
situation to meet
clients needs.
Provides
opportunity for
client/family to get
feelings out in the
open and begin to
problem-solve
solutions as
indicated.

Assessment
Subjective:
Reports of pain
and discomfort
on the injured
left lower
extremity.
Objective:
With Skeletal
traction on left
lower extremity
With reduced
muscle
coordination on
the affected left
lower limb
Weakness on
the injured
lower extremity

Diagnosis
Risk for Trauma
related to use of
skeletal traction as
evidenced by loss
of skeletal integrity
of left lower leg

Planning

Intervention

Rationale

After series of
nursing
interventions, the
patient will identify
and correct
potential risk factors
in the environment;
demonstrate
appropriate lifestyle
changes to reduce
risk of injury;
identify resources
to assist in
promoting a safe
environment;
recognize need for
and seek
assistance to
prevent accidents
or injuries.

Determine
factors related
to individual
situation and
extent of risk for
trauma.
Ascertain
knowledge of
safety needs
and injury
prevention, and
motivation to
prevent injury in
home,
community, and
work setting.
Assess
influence of
clients lifestyle
and stress.

Influences
scope and
intensify of
interventions to
manage threat
to safety.
Lack of
appreciation of
significance of
individual
hazards
increases risk of
traumatic injury.

Review history
of accidents,
noting
circumstances.

Review
diagnostic
studies and
laboratory tests
for impairments
or imbalances.
Screen client for
safety
concerns.
Assess for and
report changes
in clients
functional

That can impair

judgment and
greatly increase
clients potential
for injury.
Can provide
clues for clients
risk for
subsequent
events and
potential for
enhanced
safety by a
change in the
people or
environment
involved.
That may result
in or exacerbate
conditions such
as pathological
fracture.
Failure to
accurately
assess and
intervene or
refer regarding
these issues
can place the

status. Perform
thorough
assessments
regarding safety
issues when
planning for
client discharge.
Maintain bed
rest or limb rest
as indicated.
Provide support
of joints above
and below
fracture site,
especially when
moving and
turning.
Support fracture
site with pillows
or folded
blankets.
Maintain neutral
position of
affected part
with sandbags,
splints,
trochanter roll,
and footboard.
Discuss
importance of
self-monitoring
of conditions or
emotions that
can contribute
to occurrence of
injury to self.

Identify
community
resources.

client at
needless risk
and creates
negligence
issues for the
healthcare
practitioner.
Provides
stability,
reducing
possibility of
disturbing
alignment and
muscle spasms,
which enhances
healing.
Prevents
unnecessary
movement and
disruption of
alignment.
Proper
placement of
pillows also can
prevent
pressure
deformities in
the drying cast.
Client or
significant
others may be
able to modify
risk through
monitoring of
actions or
postponement
of certain
actions,
especially
during times
when client is
likely to be
highly stressed.
To assist with
necessary
corrections or

improvements
and purchases.