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Verbal expression of negative feelings about injury, unhappiness, fear of rejection, unwillingness to meet peopleĭisturbed body image #6 Fear May be related to Self-care deficit #5 Disturbed body image May be related toįracture(s), presence of immobilizing devices, amputation, tubes and drains Inability to perform activities of daily living (ADLs) independently, difficulty in putting on and removing clothes, difficulty in using assistive device, difficulty in walking Immobilization, pain, limited range of motion (ROM) Impaired skin integrity #4 Self-care deficit (Dressing/Bathing/Toileting) May be related to Open wound, surgical incision site, paresthesia, presence of pressure ulcers on bony prominences
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Open fractures, internal/external fixation devices, traumatic injury, surgical intervention, prolonged immobilization Impaired physical mobility #3 Impaired skin integrity May be related to Report of pain as severe on a standardized pain scale, crying, facial grimace, guarding behavior, diaphoresis, tachycardia, tachypnea, increased blood pressureĪcute pain #2 Impaired physical mobility May be related toĪltered bone integrity, immobilization, traction device, decrease in muscle strength and control, neuromuscular impairmentĭecreased range of motion, poor muscle control, muscle pull/spasm, reduced muscle strength, need for restriction of movement, postural instability NANDA nursing diagnoses for Fracture (Actual)įracture Nursing Diagnosis (Part 1) #1 Acute pain May be related toįracture, movement of bone fragments, soft tissue injury, vascular trauma, nerve injury, traction device, muscle spasms, tendon injury Risk for ineffective cerebral tissue perfusion.
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