Traction PDF

Preview

Summary

Professor Martinez, traction...

Description

What is it?  



Principles of Effective Traction

It is the application of pulling force to a part of the body. It is used to minimize muscle spasms; to reduce align, and immobilize fractures and to reduce deformities. Traction is used primarily as a short term intervention until other modalities, such as external or internal fixation, are possible

Types of Tractions:  

Skin Traction – traction applied to skin Skeletal Traction – traction directly applied to the bony skeleton

Skin Traction

Counter traction must be applied to ensure proper traction (usually, the patient’s body weight and bed position adjustments supply the needed counter traction)

When caring for patient with traction, follow these:        

Traction must be continuous in order for it to be effective in reducing and immobilizing fractures Skeletal traction is never Interrupted Weights are not removed unless intermittent traction is prescribed Any factor that might reduce the effective pull or alter its resultant of pull must be eliminated Good body alignment in the center of the bed Ropes must be unobstructed Weights must hang freely not resting on anything Knots must not touch pulleys

  

Skin traction is used to control muscle spasms and to immobilize an area before surgery. Skin traction uses weights to pull on traction tape or a foam boot attached to the skin. The amount of weight used is not to exceed the tolerance of the skin.



Types of skin traction used for adults o o o

Straight traction  Bucks extension which is applied to the lower leg Cervical head halter (to treat neck pain) Pelvic belt (sometimes used to treat back pain)

Bucks extension traction(skin traction for femoral)   

Unilateral or bilateral, and temporarily used Pull is exerted for partial or temporary immobilization is desired Before traction is applied nurse must assess skin(for abrasions) and circulatory disturbances o Ensure skin is clean and dry before applying traction When applying one nurse hold the extremity and other nurse puts on the foam boot Excessive pressure is avoided over the malleolus and proximal fibula during application to prevent pressure ulcers

 

Skin Traction Nursing Intervention’s

Ensuring Effective Traction  avoid wrinkles and slipping of the traction bandage and maintain counter traction must be maintained  proper positioning  refrain from patient moving side to side to keep bone fragments from moving(patient may shift position slightly with assistance)  monitor and manage potential complications  skin breakdown (during initial assessment, nurse identifies sensitive, fragile skin(common in older adults) and monitors skin in close contact with tape or foam to ensure that shearing forces are avoided.

Monitor and manage potential complications Skin Breakdown 



skin breakdown(during initial assessment, nurse identifies sensitive, fragile skin(common in older adults) and monitors skin in close contact with tape or foam to ensure that shearing forces are avoided. Procedure to monitor and prevent breakdown o Remove devices to inspect skin around ankles and Achilles tendon 3 times a day a second nurse is needed to support extremity during inspection o Palpate area of traction tapes daily to detect tenderness o Provide back care at least Q2hrs to prevent pressure ulcers. Uses special mattress to prevent pressure ulcers.

Nerve damage needs to be assessed 

 

   

 

Pressure on the peroneal nerve can be cause by applying to much pressure to the boot or tape. Assessing for sensation and movement on a daily basis is recommended Skin traction can place pressure on peripheral nerves. When traction is applied to the lower extremities care must be taken to avoid pressure on the peroneal nerve just below the knee (can cause foot drop) Check CMS regularly Investigate any burning sensation under traction bandage of boot Dorsi-flexion demonstrates peroneal nerve function Weakness of dorsi-flexion or foot movement and inversion of the foot might indicate pressure of peroneal nerve Plantar-flexion demonstrates function of the tibial nerve Promptly report alter sensation or impaired motor function

Circulatory Impairment     

After skin traction is applied, the nurse assess circulation of foot within 15-30 min and then Q1-2hrs Circulatory assessment consist of Peripheral pulses, color, capillary refill and temp of the fingers and toes Asses for DVT Encourage active foot exercises q1hr while awake



Skeletal Traction

Skeletal traction is applied directly to the bone. o This method of traction is used occasionally to treat fractures of the femur, the tibia, and the cervical spine. o The traction is applied directly to the bone by use of a metal pin or wire. o Installed to bone distal (below) to the fracture, avoiding nerves, blood vessels, muscles, tendons and joints. The orthopedic surgeon applies skeletal traction, using surgical asepsis o The surgeon drills pin or wire through the bone o The patient is anesthetics o Patient feels pressure and may feel some slight pain Weights are attached to the pin or wire by rope pulleys for effective traction As muscle spasms and muscle relax, the traction weights are reduced as per to prevent fracture dislocation and promote healing. When skeletal traction and pins are removed by physician, an internal fixation, cast or splint is used to immobilized and support the healing bone.



  

Maintain Effective Traction Nursing  Check the traction apparatus to see that the ropes Intervention for are in the wheel grooves of the pulleys. Skeletal  Ropes are not frayed.  Weights are hanging freely. Traction

Providing pin site care  

Maintaining positioning   

Maintain alignment of patients body as prescribed Position foot to avoid foot drop Maybe some foot support



Preventing skin breakdown    

Elbows can become sore from frequently repositioning by pushing off elbows patients push off heels of unaffected leg what for breakdown Try to get a trapeze to prevent ^^^ If pt can’t move side to side make sure you provide back care and maintain a dry, crumb and wrinkle free bed to prevent breakdown

Monitoring neurovascular status

 





Promoting exercise 

Exercise with in therapeutic limit of traction, assist in maintaining muscle strength and tone. Also good for circulation (exercise includes pulling up on the trapeze, flexing and extending the feet, and ROM  and weight-resistance exercise for non-involved joints.  Isometric exercise of the immobilized extremity is  important to maintain strength and tone of ambulatory muscles. Assessing anxiety traction restricts mobility and independence. Equipment looks threatening. o Confusion, disorientation, and behavioral problems may develop in patients who are confined in a limited space. Assisting with self-care (as patient heals the nurse must encourage independence. o Make sure everything is set up so pt can be independent to improve self-esteem. Check CMS and compare to unaffected extremity to gather a baseline Manage and monitor potential complications. o Atelectasis o Pneumonia o Constipation o Anorexia o Urinary stasis and infection (incomplete emptying of the bladder related to positioning in bed can result in urinary stasis and infection.pt might find bed pan uncomfortable and limit intake of fluids and voiding. Make sure you check I&O and teach client to try to void Q3-4HRS if S/S of UTI are present notify the DR. o Venous thromboembolism  Encouraged to do foot exercise as permitted  Drink fluids to prevent dehydration and associated hemoconcentration which increases stasis  Contact physician for definitive evaluation and therapy Don’t forget the other leg.  

Nursing Management



To prevent infection and development of osteomyelitis. Covered with no-stick bandage for first 48 hrs.(rolled gauze or ace bandage)after this time a loose bandage or no bandage is recommended Pin site care done 1-2x daily(pin care increases if mechanical pins loosen or signs of infection are present.(chlorhexidine solution is usually used but you can use N.S Check pin sites Q8hrs for normal reactions (redness, warmth and serous or slightly sanguineous drainage at the site. Should subside after 72 hrs .Similar to signs of infection, signs of infection also include the presence of purulent drainage, pin loosening and odor. When pins are mechanically stable (after 48-72 hrs.) weekly pin site care is recommended

CMS check Q1H initially then Q4H. Report any change in sensation or movement. DVT significant Risk Factor for immobile Patients. Encourage active flexion-extension on ankle and calf pumping exercise (isometric contraction) 10xQ1hr while awake. Anticoagulant therapy and pressure stalking maybe ordered.

NURSING ALERTS  



NEVER REMOVE WEIGHTS FROM PATIENTS UNLESS LIFE THREATHING SITUATION OCCURS THE NURSE MUST PROMPTLY INVESTIGATE EVERY REPORT OF DISCOMFORT EXPRESSED BY THE PATIENT IN TRACTION. PROMPT RECOGNITION OF A DEVELOPING NEUUROVASCULAR PROBLEM IS ESSENTIAL SO THAT CORRECTIVE MEASURES CAN BE INSTITUTED POMPTLY THE NURSE MUST INSPECT THE PIN SITE AT LEAST EVERY 8HRS FOR SIGNS OF IMFLAMMATION AND EVEDIENCE OF IFECTION....