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Modalities of Care (Traction (Nursing intervention (Ensuring effective…

- - - - It is used to control muscle spasms and to immobilize an area before surgery.
      - It is accomplished by using a weight to pull on traction tape or on a foam boot attached to the skin, and the amount of weight must not exceed the tolerance of the skin (no more than 2 to 3.5 kg of traction can be used on an extremity).
      - This traction is used on the lower leg could be unilateral or bilateral and before traction is applied the skin is assessed for abrasions and circulatory disturbances..
      - The pull is exerted in one plane when partial or temporal immobilization is desired na did used to provide immobility after fractures of of the proximal femur before surgical fixation.
      - The skin must be clean and dry before applying the traction, one nurse elevates and supports the extremity under the patient's knee and another places the foam boot under the leg with the patient's heel in the boot heel.
      - The nurse passes the rope affixed to the spreader or footplate over a pulley fastened to the end of the bed and attaches to the weight. Smeltzer (2004)
    - - Skeletal traction is applied directly to the bone by the use of metal pins and wires and is used occasionally to treat fractures of the femur, the tibia, and the cervical spine.
      - The pins or wires are inserted through the bone distal to the fracture, avoiding nerves, blood vessels, muscles, tendons and joints, while tongs (Gardner-Wells or Vinke tongs) are fixed in the skull to apply traction that immobilizes cervical fractures.
      - The surgeon applies the skeletal traction, using surgical asepsis and the site is cleaned with surgical scrub povidone-iodine solution and a local anaesthetic is administered at an insertion site and periosteum.
- - - - This is referred to as fiberglass casts, used on non displaced fractures with minimal swelling, these water-activated polyurethane materials have the versatility of plaster but are lighter in weight, stronger, water resistant and durable.
      - They consist of open-weave, non-absorbent fabric impregnated with cool water-activated hardeners that bond and reach full rigid in minutes.
      - They are porous and therefore reduce skin problems and when wet are dried using hair drier on a cool setting, thorough dryness is necessary to prevent skin breakdown and is for long-term wear.
    - - Rolls of plaster bandage are wet in cool water and applied smoothly to the body, than crystalizing reaction occurs, and heat is given off and a rigid dressing result.
      - It gives off an uncomfortable heat and the patient should be informed to allay anxiety, and cast need to be exposed to allow maximum dissipation of the heat and cools after 15 minutes.
      - After the cast sets, it remains wet and soft for some time and must be protected from hard, sharp objects, and it must be exposed to air, it dries up completely in 24 to 72 hours.
      - A wet plaster appears dull, grey and sounds dull on percussion, feels damp and smells musty and a dry plaster is white and shiny, resonant, odourless and firm. Smeltzer (2004)
  - - - It is used to immobilized patients' arms and patient must readjust to many routine tasks and the unaffected arms must assume all the upper extremity activities.
      - The occupational therapist suggests devices designed to aid one-handed activities and the may patient will experience fatigue due to modified activities and the weight of the cast.
      - The nurse elevates the immobilized arm to control the swelling, and when the patient is lying down the arm is elevated so that the each joint is positioned higher than the preceding proximal joint and the sling can be used when the patient ambulates and elevated immediately after.
      - Check the extremities especially the hands and fingers for warmth, cyanosis, movement, swelling indicating circulatory disturbances. Smeltzer (2004)
      - These include short-arm cast which extend from elbow to the palmar crease, long-arm cast encompasses the whole arm and thumb spica which can cover the thumb.
    - - The application of leg cast imposes a degree of immobility on the patient, and the cast may either be short, extending to the knee or long and extending tot the groin.
      - The nurse must support the patient's leg with pillows to heart level to control swelling and applies ice packs over the fracture site for 1 to 2 days.
      - The patient must assume a recumbent position several times a day with the casted leg elevated to promote venous return and control swelling.
      - The nurse should assess circulation by observing the colour, temperature, and capillary refill of the exposed toes, and nerve function by assessing the abilities to move the toes and the sensation in the foot.
      - Teach the patient on how to transfer and ambulate safely with assistive devices like crutches and walker.
      - These include the short-leg cast that extend from the knee to the base of toes, long-leg cast extends through the whole leg.
    - - These are the casts that encase the trunk and include shoulder spica which enclose the upper trunk and shoulder and elbow and hip spica which encloses the lower trunk and lower extremities.
      - The nurse should prepare and position the patient, assisting with skin care and hygiene and monitoring for cast syndrome.
      - The nurse reassures the patient that several people will provide care during the application, that support for the injured area will be adequate, and that care providers will be as gentle and possible.
      - Administer medication for pain relief and relaxation before the procedure so as the patient cooperates during the application of the cast.
      - Support the patient on a firm mattress and with flexible, waterproof pillows next to each other until it dries since spaces between them allow the damp cast to sag, become weak and possibly break.
      - The patient should be turned as a unit towards the uninjured side every two hours to relieve pressure and to allow the cast to dry and avoid twisting the patient's body within the cast.
      - Place a pillow under the patient's abdomen for comfort, and place one under the dorsa of the feet or allow the toes to hang over the edge of the bed to prevent toes from being forced into the mattress.
      - Inspect the skin around the edges of the cast while bathing and massaging where the fingers can reach and look for signs of irritation and pull the skin taut and using a flashlight.
      - To protect the cast from soiling, the nurse must insert clean dry plastic sheeting under the cast and over the cast edge before elimination by the patient or you can offer fracture bedpans.
      - The nurse needs to recognize the anxiety reaction and provide an environment in which the patient feels secure.
      - The nurse monitors the patient foe cast syndrome, noting the bowel sounds every 4 to 8 hours, and reports distention, nausea, vomiting, to the doctor and also give anti-emetics in case of nausea and vomiting. Smeltzer (2004)