Role of Nursing Personnel : Fractures

Role of Nursing Personnel

Registered Nurse (RN)

  • Perform neurovascular assessment on the affected extremity.
  • Assess for manifestations of compartment syndrome.
  • Monitor cast during drying for denting or flattening.
  • Teach patient and caregiver about cast care and complications of casting.
  • Determine correct body alignment to enhance traction.
  • Instruct patient and caregiver about traction and correct body positioning.
  • Teach patient and caregiver ROM exercises.
  • Assess for complications associated with immobility or fracture (e.g., wound infection, constipation, VTE, renal calculi, atelectasis).
  • Develop plan to minimize complications associated with immobility or fracture.

Licensed Practical/Vocational Nurse (LPN/LVN)

  • Check color, temperature, capillary refill, and pulses distal to the cast.
  • Mark circumference of any drainage on the cast.
  • Monitor skin integrity around cast and at traction pin sites.
  • Pad cast edges and traction connections to prevent skin irritation.
  • Monitor pain intensity and administer prescribed analgesics.
  • Notify RN of changes in pain or if pain persists after prescribed analgesics are administered.

Unlicensed Assistive Personnel (UAP)

  • Position casted extremity above heart level as directed by RN.
  • Apply ice to cast as directed by RN.
  • Maintain body position and integrity of traction (after being trained and evaluated in this procedure).
  • Assist patient with passive and active ROM exercises.
  • Notify RN about patient complaints of pain, tingling, or decreased sensation in the affected extremity.

Role of Other Team Members

Physical Therapist

  • Assess patient’s current mobility and need for assistance.
  • Teach safe ambulation with assistive device based on patient’s weight-bearing restrictions.
  • Establish exercise regimen and teach patient to perform exercises safely.
  • Coordinate physical therapy with RN so that patient can receive timely analgesia.
  • Discuss home environment with patient and identify possible modifications to facilitate recovery (e.g., stair training if allowed by patient’s weight-bearing restrictions, bed placement on first level to avoid stairs).

Occupational Therapist

  • Assess impact of patient’s condition on ability to perform ADLs.
  • Instruct patient in use of assistive devices (e.g., long-handled reacher, shoe donner) to facilitate self-care while maintaining activity restrictions.
  • Discuss home environment with patient and identify possible modifications to facilitate recovery (e.g., bed placement on first level for access to bathroom).


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