Care of patient with traction ppt

Unformatted text preview: Focused Intervention Care of the Patient in Traction 1 Traction Defined Application of a __PULLING _______ force to extremities or part of body at same time opposing pull (__________) is applied 2 Countertraction Opposing force Often patient’s own ___BODY____or bed ___POSITIONING_________ can provide countertraction 3 Frequency of Use The use of traction in the US has ___DECREASED ______ due to the increased use of surgical internal and external fixation 4 Purposes Reduce __FRACTURE________ – Reduction: repositioning bones to normal anatomical position Maintain __ALIGNMENT________ of bone fragments Reduce muscle ___SPASMS_______ Relieve ___PAIN_____ 5 Traction Types Manual Skin Skeletal 6 Manual Traction Applied by using _HANDS______to exert a pulling force on joint/limb to be re-aligned Used: – During __APPLICATION OF CAST_____________ – To decrease fracture while mechanical __TRACTION___________ being applied Must be applied __SMOOTHLY_______ and firmly 7 Skin Traction Application of pulling force directly to _SKIN____ thru use of tape, belts, halters, boots Short term: __<2 WEEKS_______ __TEMPORARY_____before surgery __5-8 POUNDS_____of weight applied Example: __BUCK’S_______; used with __HIP___ __FRACTURE________ Should be removed at least __DAILY____ for limb washing & skin assessment 8 Skin Traction 9 Skeletal Traction Pins, wires, tongs inserted thru __SKELETON_______ to apply ____CONTINUOUS________ force directly to __BONE______ For _LONG-TERM_________immobilization; often in this type tx for several mths ___15-40_______wgt can be used Allows: – Joint movement – Exercise of non-affected muscles – Isometric exercises of affected muscles 10 Skeletal Traction (Cont’d) Skeletal tx can be applied to: Skull Proximal end of ulna Distal end of femur Proximal & distal ends of tibia Heel bone Released only if life-threatening event – Premature release leads to strong muscle contractions – Can disrupt bone fragments Pts taught not to touch __PINS OR PIN SITES____________ Avoid __LIFTING OR REMOVING______________ weights 11 Skeletal Traction 12 Traction Mechanics Straight line traction – Pulling force is applied in only _1 DIRECTION________ – Oldest & __SIMPLEST_________form – Bucks traction is example – Body wgt serves as countertraction Balanced suspension traction – System of __WEIGHTS_______ & __PULLEYS________ – Allows injured limb to float over bed in elevated position 13 Maintaining Effective Traction ___PULL OF TRACTION_________is important principle to maintain in order for tx to be effective The pull of traction __DECREASES__________ when friction increases Prevent friction: – No bed linens tucked tightly around traction cords – Do not allow spreader/footplate to rest against foot of bed – Wgts must ___HANG FREELY___________ and away from bed – Knots should be ___CLEAR OF PULLEYS____________ – Pulleys working properly; ropes run in middle of pulleys 14 Maintaining Effective Traction (Cont’d) Maintain line of pull: – Generally ensure that traction is on __CONTINUOUSLY___________ – Maintain correct anatomical __ALIGNMENT________ – Remove traction or wgt only with __ORDER____ – Angles of ropes and pulleys should create a pull along the __LONG AXIS_________of the bone 15 Traction Complications Neurovascular changes __DISTAL TO TRACTION_____________ Skin damage Infection – At pin sites with skeletal traction – Osteomyelitis possible DVT Respiratory problems – Pneumonia – Fat emboli Release of fat globules from bone marrow Signs = resp distress & confusion 16 Traction Complications (Cont’d) Compartment Syndrome – Emergency situation – Arteries & nerves compressed by _SWELLING ________ __TISSUE___________ – Signs= _5 P’S_______ Unrelieved pain (Early) Pallor of extremity (Early) Paresthesias (Early) Decreased pulses (Late) Paralysis (Late) Some books add 6th--- Polar (cool skin temp--Late) 17 Assessment Neurovascular check – On admission and pre-op for baseline Check both __SENSATION__________and ___MOVEMENT_______ Client turns head to side; lightly touch area; ask client if sensation felt; check tingling; does the sensation feel same as on opposite side? 18 Nerve Assessment __RADIAL____nerve – Motor: Have client extend wrist – Sensation: Check at web of skin between thumb & index finger & back of hand __MEDIAN____nerve – Motor: Have client touch thumb to another finger on same hand (Thumb opposition) – Sensation: Check at pad of index finger __ULNAR____nerve – Motor: Have client spread fingers apart (finger abduction) – Sensation: Check at pad of little finger 19 Nerve Assessment KNOW ALL OF THIS FOR NEXT EXAM __SCIATIC____nerve femoral branch – Motor: Have client straighten knee – Sensation: Check at anterior thigh __SCIATIC____nerve peroneal nerve branch – Motor: Have client dorsiflex ankle – Sensation: Check at web space between 1st and 2nd toes – ***This nerve is especially vulnerable to injury when traction devices press on outside of leg __SCIATIC____nerve tibial branch – Motor: Have client extend ankle (plantar flexion) – Sensation: Check at bottom of foot (warn client) 20 Vascular Assessment Color Temp Cap refill Pulses 21 Skin Assessment Always check skin covered by or attached to traction Skeletal traction: – Note pin sites and wounds around pins – Notify MD if bright blood/purulent drainage at pins – Pin site care done according to policy or MD orders When ordered generally Hydrogen Peroxide or povodine iodine One cotton-tip swab per pin (prevent cross-contamination) q 8 hrs 22 Other Care Interventions Elimination – – – – ___________,roughage, fluids Stool softeners, bulk agents (metamucil), laxatives Use fracture pan Adequate _____________ Respirations – Cough, deep breathe, incentive spirometer Pain – Always assess carefully – Could be sign of complications (compartment syndrome) 23 Psychosocial Depression, claustrophobia, bored, lonely Plan diversions; support CAUTION: __CAREFULLY ASSESS ANXIETY______________ – Could be hypoxia from release of a fat emboli (generally 12-72 hrs post injury; but up to 2 wks) – Signs of PE: Anxious, restless, dyspneic, tachypnea, tachycardia – If travels to brain: confusion,, HA, increased temp 24 External Fixators Used when significant __BONE LOSS_________or extensive soft tissue damage External fixation provides realignment, __WOUND ACCESS____________, fracture stabilization Fixator holds bone and fragments by __METAL_____ __PINS____ attached to an external frame Pin site care done according to policy 25 External Fixators (Cont’d) Assess site at least daily Many __BODY IMAGE_________ issues Often in place for many ___MONTHS _______ Same attention to neurovascular assessments Generally allows for ___EARLY MOBILIZATION_____________ and ambulation 26 External Fixators 27 External Fixators 28 ...
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