Transcript External fixator

Chapter 25
Mechanical Immobilization
OBJECTIVES






1.
2.
3.
4.
5.
6.




7.
8.
9.
10.
 11.
 12.
List at least three purposes of mechanical immobilization.
Name four types of splints.
Discuss why slings and braces are used.
Explain the purpose of a cast.
Name three types of casts.
Describe at least five nursing actions that are appropriate when
caring for clients with casts.
Discuss how casts are removed.
Explain what traction implies.
List three types of traction.
Name seven principles that apply to maintaining effective
traction.
Describe the purpose of an external fixator.
Identify the rationale for performing pin site care.
DEFINITION
 Impaired mobility as result of:
-overall debilitating condition
-trauma or its treatment
 Orthoses:
-orthopedic devices that support or align a body
part and prevent or correct deformities
 Examples include: splints, braces, immobilizers,
slings, casts, traction, external fixators
Purposes of Mechanical Immobilization
 Mechanical immobilization is usually used to treat
musculoskeletal trauma in order to:
1. Reduces/relieves pain and muscle spasms
2. Allow activity while restricting movement of
injured area
3. Prevents further structural damage and
deformity
Purposes of Mechanical Immobilization-cont’d
4. Support and align skeletal injuries
5. Restricts movement while injuries heal
6. Maintains functional position until healing is
complete
Question
 Is the following statement true or false?
Mechanical immobilization of a body part
can relieve muscular pain.
Answer
True.
Most clients who require mechanical
immobilization have suffered trauma to the
musculoskeletal system. Mechanical
immobilization relieves muscular pain and
spasms.
Splints
 Splint types include:
 Emergency-applied
as a first aid measure
for sprains or fractures
 Commercial
Inflatable or pneumatic (air)
Traction-metal (Thomas splint)
Question
 Is the following statement true or false?
A splint is a device that mobilizes and protects
an injured body part.
Answer
False.
A splint is a device that immobilizes and
protects an injured body part. Splints are used
before or instead of casts or traction.
Emergency Splints
Inflatable Splints
AKA “PNEUMATIC SPLINTS”
FILLED WITH AIR
LIMIT MOTION, CONTROL BLEEDING,
AND SWELLING
Traction Splints
Other Splints
 Commercial splints


More effective than improvised splints
Include:
o Immobilizers-limit motion in painful
but healing injury (neck, hip)
o Molded splints- limit motion in
chronic injuries or diseases (carpal
tunnel syndrome)
o Cervical collars-limit motionsed in
trauma (foam or rigid); neck strain or
“whiplash”
Mechanical Immobilizing Devices cont’d
• Slings
• Braces (support weakened structures)
• Types of braces
– Prophylactic-prevent or reduce severity
– Rehabilitative-allow protected motion
– Functional-provide stability
Slings
 Cloth devices
 Used to:
 Elevate
 Cradle
 Support
 Most
common areas: arm, leg, pelvis
GA#1
Group Assignment #1
Divide into four groups and discuss:
a. The definition and use of slings
b. The definition and use of braces
c. The types of braces
d. The materials that braces are made of, with an
example of a back brace
e. The consequences of an improperly applied or illfitting brace
Question
 Is the following statement true or false?
Braces that allow protected motion of an injured
joint that has been treated operatively are called
rehabilitative braces.
Answer
True.
Braces that allow protected motion of an injured joint
that has been treated operatively belong to the
category of rehabilitative braces.
Rehabilitative Brace
Casts
• Purpose:

Casts are used to immobilize injured body
structures (fractured bones)
Types of casts
o Cylinder (may be bi-valved)
o Body (may be bi-valved)
o Spica
Bivalved cast
Spica Casts
Why Bi-valved?
 Cut into two pieces lengthwise (creates a front and
back)
 Body cast-to facilitate bathing and skin care
 Cylinder (on an extremity)
-when swelling compresses tissue (circulation)
-being weaned
-sharper xray image needed
-temporary immobilization for painful joints
Cast Materials
DT #1
Discussion Topic #1
 . A client has had multiple fractures in a motor vehicle
accident affecting the trunk and limbs. The accident has
also caused spinal trauma. After the client’s body has been
restored to correct anatomic alignment, a cast has to be
placed around the injured body parts.
 a. What type of cast will the physician recommend?
 b. How will the nurse care for the cast and make
appropriate assessments to prevent complications?
Cast Application
(Refer to Skill 25-2 in the textbook.)
Casts (cont’d)
 Cast application and care
 Cast removal-when needing changed and
reapplied or when injury has healed
 Electric cast cutter may frighten clients due to
noise
 Skin care important after cast removal
 Joints may have limited range of motion
 Unexercised muscle is smaller & weaker
DT#2
Discussion Topic #2
 A client who has fractured her leg has to have her
cast removed. Upon removal of her cast, she is very
upset at the sight of her leg, which looks smaller and
weaker. The skin texture looks sickly as well.
 a. How should the nurse assure the client that such
occurrences are within the scope of normal
developments?
 b. What nursing interventions will the nurse employ
in this situation?
Basic Cast Care
Traction
 Traction: pulling effect exerted on a part of the
skeletal system
 Uses:
 Reduce

muscle spasms
Realign bones
 Relieve
pain
 Prevent
deformities
Traction (cont’d)
• Traction types include:
–
Manual-pulling on the body (often used
with dislocated bone) using a person’s
hands and muscular strength
–
Skin-pulling on the skeletal system
w/devices on the skin (Buck’s)
–
Skeletal-pulling directly on skeletal system
with pins, wires, or tongs into or through
the bone
Traction (cont’d)
• Traction care
• Effective traction depends on consistent
application of traction principles (Box 25-1,
page 544)
Skin Traction
Buck’s traction
Russell’s traction
DT #3
Discussion Topic #3
 . A client who had an accident on his motorcycle and
has lost consciousness is being given preliminary
treatment at the site of the accident. The examining
paramedic suspects a bad fracture in the right leg.
The leg has to be immobilized immediately using a
splint.
 a. What type of splint will be most appropriate and
how will the nurse apply the splint? What follow-up
assessments will the nurse conduct after the
application of the splint?
Traction Care
(Refer to Skill 25-4 in the textbook.)
Principles for Maintaining
Effective Traction
External Fixators
–
–
Metal devices surgically inserted into or
through one or more broken bones to
stabilize during healing
External fixator:
Pin site care to prevent infection (Skill
25-5, page 558)
Question
 An external fixator is inserted through which body
part?
a. Muscles
b. Broken bones
c. Mouth
d. A gaping wound in the leg
Answer
b. Broken bones
An external fixator is a metal device inserted into
and through one or more broken bones to stabilize
fragments during healing.
Nursing Implications
 Nursing diagnoses include:
 Acute
pain; impaired physical mobility or bed
mobility
 Risk for disuse syndrome, peripheral
neurovascular dysfunction, impaired skin
integrity, ineffective tissue perfusion
 Self-care deficit: bathing/hygiene
Risk for Peripheral Neurovascular Dysfunction
General Gerontologic Considerations
 Common causes of hip fractures in older adults
 Longer healing time due to brittle bones
 Stiffer joints due to decreased synovial joint fluid
General Gerontologic Considerations (cont’d)
 Due to diminished tactile sensation, older
adults may be unaware of skin pressure from
cast, brace, etc.
 Remove indwelling catheters as soon as
possible after surgery to prevent incontinence
and urinary tract infections
 Cautious use of narcotics for pain management
to avoid adverse effects
General Gerontologic Considerations (cont’d)
 Implement measures to increase bone density in
older adults to prevent fractures:
 Drink
liquid supplements high in nutrients;
include protein, calcium, and zinc in diet to
promote healing in a musculoskeletal injury
 Encourage
absorption
sun exposure for vitamin D
General Gerontologic Considerations (cont’d)
 Post-orthopedic surgery interventions for older
adults
 Bladder training schedules to maintain or
regain continence
 Appropriate rolling technique when using
fracture-style bedpan
General Gerontologic Considerations (cont’d)
 Nonsurgical treatment of fractures of the
upper extremities includes:
 Immobilization
 Occupational
and physical therapy to regain
function and range of motion
Q#1
,CS#1
A 75-year-old adult who fractured the femur in a fall
on some ice in the driveway is in an external fixator
on an orthopedic floor in an acute care facility. The
nurse has to perform pin site care. (Learning
Objectives 8, 11, and 12)
a, What are the purposes for traction?
b. What are the key steps and rationale for
providing pin site care?