Interventions and preventative management related to skeletal traction

Interventions and pr blushtative circumspection related to osseous traveling bagList lactate interventions and preventative management related to skeletal clutch.As what we had discussed, travelling bag is the application of soak u oarlockg force to a part of the soundbox. There atomic number 18 two types of clutches, the strip down traction and the skeletal traction.In skeletal traction, the traction is directly applied to the bone by the engross up of metal pin or wire.To maintain an effective traction, the cling to moldiness check the traction apparatus. attain sure that the ropes argon positioned properly in the aspirateey track, ropes are not ragged, the weights hang freely and the knots in the rope are tied securely and make sure that the skeletal traction equipment are tight. inhibit the pins to be sure they are secure and tight, and insert the sm all figure or the index finger between the vest and the affected roles discase to be sure the vest if comfortab le and not too tight. The nurse essential likewise maintain the position of the uncomplaining. Inspect the diligents proper body alignment every 2 hrs. A malarkey floor drop, inward rotation and outward rotation. The foot of the long-suffering whitethorn be back up in a sluggish position.Monitor neurovascular status of the enduring at least every 4 hours. The long-suffering must report to the nurse if there are any changes in his sensation or movement. The immobilized patient of of is risk for DVT. So, encourage the patient to do active flexion and extension of the extremities and isometric abbreviation of the calf. Also, anti-embolism stockings, anti-coagulant therapy may also be employ to prevent thrombus formation. Instruct the patient to exercise to maintain medium and tone of his muscle. Also, this bequeath help in patients rehabilitation.Pin at the insertion site may be risk for infection or the development of osteomyelitis. Pin deal should be performed 1 or 2 times a day. Clean the site with chlorhexidine solution or water and saline. The nurse must natter the pin every 8 hours for infection. When pins are stable for 48- 72 hours, weekly pin site boot is suggested.The nurse must prevent skin breakdown by watching the elbows and heels for compact ulcers. A trapeze preempt be used to help the patient move about in the bed without the use of elbows and heels. The nurse must entertain the bed run dry and free from crumbs and wrinkle for patient who is unable to change positions.Discuss a component of send away care for the pediatric client or adult client. Identify manifestations of compartment syndrome.General line care includes cancel dieting cast wet, especially padding downstairs cast- coiffe skin breakdown as plaster casts become soft. Moisture damps plaster and damp padding next to the skin can cause irritation. Advise the patients that do not c everywhere a leg cast with elastic or sorry boots, as this causes condens ation and wetting of the cast. Also, avoid weight bearing or stress on shaping cast for 24 hours. Report to the medico if the cast cracks or breaks, instructs the patient not to fix it himself. To rifle the cast, remove surface soil with slightly damp cloth, rub soiled field of operationss with household scouring powder, and wife off residual moisture.For pediatric patient there are some additional cast cares. The babe is normally more troubled by immobilization than the adult. A special attempt should be make to ensure that his activities are as normal as possible and that full use is made of his unimpressed joints and muscles. The younger child may not be able to understand why the cast is necessary. He may attempt to remove it. Allow the child to work through his question and feelings via play interchangeable giving her a doll with a cast. Children may be frightened by the removal of the cast. They much think of cast as part of their body and may be helped by analogies o f having fingers nails or hair cut. Age- appropriate explanations and demonstrations should be pass ond. Parents should be instructed in care following cast removal. Daily soaking of the area may be necessary to remove desquamated skin and secretions. Oil or lotion may provide comfort to the child. Exercise should be done as bring downd to increase strength and function.Manifestations of compartment syndromeIn dandy compartment syndromeThe classic sign is distract in the injury site. Stretching the muscles increases the pain.There will be prickling or importunate sensation in the skin.The muscle will feel tight.The late sign of compartment syndrome is paralysis indicating permanent tissue damage.In chronic compartment syndromeThere is pain and cramping during exercise. The pain usually subsides when the activity stops. phlegmDifficulty moving the footVisible muscle bulgingCompare the nursing needs of a total hip replacement patient with those of a total stifle replacement p atient.In patient who had undergone hip replacement, nursing intervention focuses on preventing dislocation of hip prosthesis. The nurse must instruct the patient to position his leg in abduction because this may prevent dislocation of the prosthesis. A wedge pillow is usually placed between the legs to remain the legs abducted. Also, the hip of the patient should never be flexed for more than 90 degrees. When the patient sits, adv screwball him than his hips should be higher that his knees. The patients affected leg should not be elevated and the knee may be flexed. Emphasize to the patient that he should maintain his legs in abducted position, to avoid internal and external rotation, hyperextension and acute flexion. collectable to incursive procedure, there will be fluid and blood being accumulated. The nurse must telephone that drainage is still normal if 200-500 ml of fluid were drained for the initiatory 24 hours and after 48 hours it usually decreases to 30 ml or less. R eport to the physician if the volume of the drainage is greater than expected. encounter for deep stain thrombosis is common after the hip replacement because of immobility. Anti-embolic stockings, anti-thrombolytic medication can be used as preventive measures. Advise the patient to report any signs of calf pain, ostentation and tenderness because it may indicate DVT. One of the serious complicatednesss after hip replacement is infection it may occur at heart 3 months after surgery and associated with hematomas. Use of aseptic technique for dressing changes should be observed and utilise to avoid introducing organisms. Severe infections may require surgical debridement or removal of the prosthesis.In patient who had undergone knee replacement, nursing intervention should focus on mobilizing the patient. While in hip replacement the patients legs should be abducted, in knee replacement the patient is encourage to do active flexion of the foot every hour when the patient is al ert. Like in hip replacement, knee replacement is also risk for deep vein thrombosis. Active range of doubtfulness, anti- embolic stocking and anti-coagulant can be used to prevent DVT. Also, knee replacement is an invasive procedure and its fluid had accumulated in the joint. Drainage of this replacement may ranges from 200-400 ml during the first 24 hours and less than 35 ml by 48 hours. If extensive bleeding happens, an autotransfusion drainage system may be used during postoperatively. Change in the characteristics and amount of drainage is promptly reported to the physician. Encourage the patient to use a continuous passive motion device with physical therapy to improve patients knee mobility, reduced hospital stay and minimize the intake of analgesic agents. The nurse must assist the patient to get out of the bed on the second postoperative day and start ambulating as tolerated.Discuss methods to avoid dislocation after hip replacement surgery.Dislocation of the hip is a seri ous complication of surgery that causes pain and necessitates reoperation to correct the dislocation. The desirable positions such as abduction neutral rotation and flexion of less than 90 degrees must be emphasized during the patient teaching. Instruct the patient to keep the knees apart at all times by putting a pillow between the legs to keeps hip in abduction and in neutral position to prevent dislocation. The patient should never cross his/ her legs firearm sitting. Avoid bending forward plot of land sitting in a chair. The patient should not flex the hip to put on article of clothing such as pants, stockings or socks. Use a high-seated chair and a raised toilet seat.You are caring for a patient who has had skeletal traction placed to treat a fractures femur. Discuss nursing interventions and assessment techniques related to this type of treatment.Fracture of the femur usually is treated with some form of traction to prevent deformities and soft- tissue damage. Skeletal trac tion is used to align the fracture in the preparation for the next reduction. Traction restricts patients mobility and independence therefore the nurse must assess and monitor the patients anxiety level and mental responses to traction.Since the patient requires assistance with self-care activities, the nurse must help the patient to eat, bathe, dress and toilet. Assess the patient and the traction set-up to determine the best method for changing the bed linen. Eliminate any instruments that reduce the traction pull or alter its direction. Ropes and pulleys should be in straight alignment and the ropes should be unobstructed. The nurse must inspect the body part that is placed in traction and its neurovascular status to determine if there is sign of inflammation. Because the patient is confined to bed, the nurse must implement measures to prevent complications of immobility and inactivity.One of the complications in patient to skeletal traction is atelectasis and pneumonia due to immobility. To assess respiratory status, the nurse auscultates the patients lungs every 4-8 hours. Teach the patient deep exercises to in full expand the lungs and to clear out secretions. Constipation is also a complication due to decreased peristalsis, a high fiber diet and fluids may help stimulate gastric motility. Urinary infection is also a common complication because of incomplete emptying the bladder due to the uncomfortable effects of excretion into a bed pan. The nurse must encourage the patient to drink large quantities of water and to void every 3-4 hours. DVT is also a serious complications, nurse must assist the patient in foot and ankle exercise. Also, drinking a lot of fluids makes the patients hydrated and prevents homoconcentration which can contribute to stasis.A patient is being discharged with an external fixator for a fractured humerus. Discuss home care instructions for this patient.These are the instructions that the nurse must teach to the patient forwa rd dischargePatient must inspect each pin site for signs of infection and loosening of pins. Watch for pain, soft tissue swelling and drainage and consult a physician when it occurs.Cleanse around each pin daily, using aseptic technique to prevent contamination of bacteria leading to infection. Do not touch pique with your bare hands.Clean fixator daily to keep it free of dust and contamination.Do not tamper with clamps or nuts because it can alter crush and misalign fracture.Encourage the patient to follow rehabilitation regimen because it is helpful in teaching the patient to use ambulatory aid safely, adjust to weight- bearing limits and altered gait patterns.Identify various types of traction and the principles of effective traction.The first type of traction is the running traction, it is a form of traction in which the pull is exerted in one plane it may be either skin or skeletal traction and Bucks extension traction is an example of running skin traction. The other type o f traction is balanced fault traction, which uses additional weights to counterbalance the traction force and floats the extremity in the traction apparatus. The line of pull on the extremity remains fairly constant despite changes in the patients position.According to our discussion, to achieve an effective traction, countertraction, a force acting to the opposite direction, is applied. The patient body weight and positioning in bed lend the counterforce Traction must be continuous to reduce and immobilize fracture Skeletal traction is never interrupted weight are not removed unless intermittent traction is prescribed any factor that reduces pull must be eliminated ropes must be unobstructed and weight must hang freely and knots or the foot plate must not touch the foot of the bed.Discuss the use of Bucks traction, its uses and the voluminous nursing considerations.Bucks traction is skin traction to the lower leg. It is used to immobilize fractures of the proximal femur before s urgical fixation.It can be use for hip and knee contracture, preoperative and postoperative positioning and immobilization of hip fractures, muscle spasm, joint rest.Nursing managementEnsure skin integrity by avoiding pressure on heel, dorsum of foot, fibular star, or malleolus.Maintain countertraction by elevating foot of the bed or keeping head of bed flat.Encourage independence with use of trapeze.Do not put a pillow under the affected limb.Observe skin by removing traction, with someone holding the leg in alignment with manual traction, at least once every shift.A maximum of 10 lb of traction should be used.Discuss the nursing care for a patient undergoing orthopedic surgery.Preoperative nursing careIn relieving the pain of the patient, elevation of the edematous extremities grows venous return and reduces discomfort. Also, the use of ice lighten ups swelling and reduces discomfort by diminishing nerve stimulation. The physician may order analgesic to control the acute pain of the musculoskeletal injury. The nurse must also maintain adequate neurovascular function by assessing color, temperature, capillary refill, sensation and motion of the extremities. For the nurse to promote health to the patient, th nurse should assist the patient in performing activities that promote health during the perioperative diaphragm. The nurse also assesses nutritional status and hydration. The goal of the nurse in the preoperative period is to focus on helping the client to experienced reduced pain continue to be active, sprightly and injury free and practice measures to reduce the potential for postoperative wounding infection.Postoperative nursing careThe nurse assesses the patients level of pain since pain is common after orthopedic surgery. the use of repositioning, relaxation, distraction and channelise imagery may help in reducing the patients pain. The physician must order patient- controlled analgesia and epidural analgesia to relieve the pain. In maintaining an adequate neurovascular function, the nurse must instruct the patient to perform muscle- setting, ankle, and calf-pumping exercise hourly while awake to enhance circulation. Encourage the patient to increase intake of foods that is rich in protein and vitamins because it is essential for wound healing. Positioning the patient at least every 2 hours can minimize pressure ulcer and skin break down. The patient may use assistive device for postoperative mobility.There are potential complications that may arise after the surgery. The goal of the nurse is to the patient is to exhibit absence of complication. The patient is risk having pneumonia and atelectasis, the nurse must instruct the patient to deeply snorkel and cough every 2 hours to expand the lungs and mobilize secretions encourage the use of incentive spirometry to increase respiratory effort turning the patient at least every 2 hours to prevent pooling of secretions and auscultate lung sounds every 4 hours to note for brea th sounds. The patient is also risk for infection. When changing the dressing of the patient and performing pin care, the nurse must use aseptic principle to reduce microorganisms that may go into the wound and incision keep the wound drainage system below the level of incision to prevent backflow of the drainage and administer prescribe antibiotics to control the infection. The patient is also risk for deep vein thrombosis. The nurse encourage the patient to use ankle and calf- pumping exercises, anti embolism stockings. To avoid constipation, the nurse encourages the patient to increase fluid intake to 2000 ml/ day unless contraindicated to prevent fecal impaction.SourcesBrunner, Suddarths et al. (2008). Medical- Surgical Nursing 12th edition. Philadelphia, Pennsylvania Lippincott Williams and WilkinsMahler, Salmond et al. (2005). Orthopaedic Nursing. Philadelphia, Pennsylvania W.B Saunders lodgeTimby and Smith (2003). Introductory Medical- Surgical Nursing 8th edition. Philadelp hia, Pennsylvania Lippincott Williams and WilkinsWeb Assignment1. Find a research article addressing health teaching needs for the patient with a cast. Explain your findings in a one-page paper.The nurse must instruct their patient to rest and keep the affected extremity elevated on a one or two pillow as much as possible during the first 24 hours. The use of crutches may be suggested for your patients with a leg cast or a delegate for patients with an arm cast for use during the first 24-48 hours.Remind your patient that the cast must be dry at all times. Advise them that water or any liquids will cause the plaster to weaken and it may lead to skin irritation. While bathing, instruct your patient to cover the cast with a plastic bag, tape the opening shut, and hang the cast outside the tub. Even when covered with plastic, you should not place the cast in water or allow water to run over the area. If the cast becomes wet, your patient can dry it with a hair dryer on the cool settin g. Do not use the doting or hot setting because this can burn the skin. Your patient can also use a vacuum cleaner with a hose attachment to pull air through the cast and stop number drying.To decrease swelling and pain in the first 24-48 hours, your patient should place crushed ice in a plastic bag, covered with a pillow case or towel, on the cast over the injury every 15 minutes per hour while awake. Do not apply ice directly to the skin. Dents or compression of the cast can cause pressure or irritation to the skin beneath the dressing, which may develop sores or ulcers.The nurse must teach the patient to reposition his body every two hours during the first 24 hours to allow even drying of the cast and every two hours when awake thereafter to avoid developing pressure sores on the skin. Do not place anything inside the cast, even for itchy areas. Sticking items inside the cast can injure the skin and lead to infection. Using a hair dryer on the cool setting may help soothe itchi ng. The cast should be inspected regularly. If it develops cracks or soft spots, the physician should be notified.The patient should never attempt to remove the cast. The physician will remove the cast at the appropriate time with a special saw that cuts through the cast of characters material but will not damage skin.Advise the patient that a serious complication can occur after cast application which is known as compartment syndrome. Instruct your patients to call the physician at once if any of the following signs or symptoms appear such as increased pain combined with the feeling that the cast is too tight, numbness and tingling in the hand or foot, burning and stinging sensations, excessive swelling in the part of the limb below the cast and inability to actively move the toes or fingersAdvise your patient to seek for medical help if there are sores areas or a foul odor from the cast, cracks or breaks in the cast, or the cast feels too tight, if there is swelling that causes p ain, if the patients fingers or toes are blue or cold or the cast becomes soaking wet and does not dry with a hair dryer or vacuum.Source http//www.uptodate.com/contents/patient-information-cast-and-splint-care