Transcript chapter 21 - Princeton ISD

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The Musculoskeletal System
1. Define important words in this chapter
abduction
moving a body part away from the midline of the body.
adduction
moving a body part toward the midline of the body.
amputation
the surgical removal of an extremity.
arthritis
a general term that refers to inflammation of the joints.
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The Musculoskeletal System
1. Define important words in this chapter
bones
rigid connective tissues that make up the skeleton, lend
support to body structures, allow the body to move, and
protect the organs.
bursae
tiny sacs of fluid that are located near joints and help reduce
friction.
bursitis
a condition in which the bursae become inflamed and painful.
cartilage
the protective substance that covers the ends of bones and
makes up the discs that are found between vertebrae.
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The Musculoskeletal System
1. Define important words in this chapter
flexion
bending a body part.
fracture
a broken bone.
full weight-bearing (FWB)
a doctor’s order stating that a person has the ability to support
full body weight on both legs and has no weight-bearing
limitations.
joints
the points where two bones meet; provide movement and
flexibility.
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The Musculoskeletal System
1. Define important words in this chapter
ligaments
strong bands of fibrous connective tissue that connect bones or
cartilage and support the joints and joint movement.
muscles
groups of tissues that contract and relax, allowing motion,
supporting the body, protecting organs, and creating heat.
muscular dystrophy
an inherited, progressive disease that causes a gradual wasting
of muscle, weakness, and deformity.
non-weight-bearing (NWB)
a doctor’s order stating that a person is unable to touch the
floor or support any weight on one or both legs.
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The Musculoskeletal System
1. Define important words in this chapter
osteoarthritis
a type of arthritis that usually affects weight-bearing joints,
especially the hips and knees; also called degenerative joint
disease.
osteoporosis
a condition in which the bones become brittle and weak; may
be due to age, lack of hormones, not enough calcium in bones,
or lack of exercise.
partial weight-bearing (PWB)
a doctor’s order stating that a person is able to support some
body weight on one or both legs.
phantom limb pain
pain in a limb (or extremity) that has been amputated.
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The Musculoskeletal System
1. Define important words in this chapter
phantom sensation
warmth, itching, or tingling from a body part that has been
amputated.
prosthesis
an artificial device that replaces a body part, such as an eye,
hip, arm, leg, tooth, or heart valve; helps improve function
and/or appearance.
rheumatoid arthritis
a type of arthritis in which joints become red, swollen, and very
painful; movement is restricted and deformities of the hands
are common.
sling
a bandage or piece of material that is suspended from the neck
for the purpose of holding and supporting a forearm.
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The Musculoskeletal System
1. Define important words in this chapter
tendons
tough fibrous bands that connect muscle to bone.
total hip replacement (THR)
a surgical replacement of the head of the femur (long bone of
the leg) and the socket it fits into where it joins the hip with
artificial materials.
total knee replacement (TKR)
a surgical replacement of a damaged or painful knee with
artificial materials.
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The Musculoskeletal System
2. Explain the structure and function of the musculoskeletal
system
Define the following terms:
muscles
groups of tissues that contract and relax, allowing motion,
supporting the body, protecting organs, and creating heat.
bones
rigid connective tissues that make up the skeleton, lend
support to body structures, allow the body to move, and
protect the organs.
joints
the points where two bones meet; provide movement and
flexibility.
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The Musculoskeletal System
2. Explain the structure and function of the musculoskeletal
system
Define the following terms:
cartilage
the protective substance that covers the ends of bones and
makes up the discs that are found between vertebrae.
bursae
tiny sacs of fluid that are located near joints and help reduce
friction.
tendons
tough fibrous bands that connect muscle to bone.
ligaments
strong bands of fibrous connective tissue that connect bones
or cartilage and support the joints and joint movement.
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Transparency 21-1: The Musculoskeletal System
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The Musculoskeletal System
2. Explain the structure and function of the musculoskeletal
system
Know the three types of muscles:
• Skeletal muscles
Also called voluntary muscles, these muscles control body
movements by contracting and relaxing. A voluntary
muscle is a muscle that can be controlled voluntarily, or at
will.
• Smooth muscles
Also called involuntary muscles, these muscles make up the
walls of organs, such as the bladder and uterus.
Involuntary muscles are controlled automatically and are
not under a person’s conscious control.
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The Musculoskeletal System
2. Explain the structure and function of the musculoskeletal
system
Three types of muscles (cont’d.):
• Cardiac muscles
Another type of involuntary muscles, these muscles are
found only in the heart. The cardiac muscles contract and
relax anywhere from 60 to 100 times each minute.
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The Musculoskeletal System
2. Explain the structure and function of the musculoskeletal
system
Know the four types of bones:
• Long bones: e.g. the humerus (upper arm bone), the femur
(upper leg or thigh bone)
• Short bones: e.g. carpals (wrist bones), tarsals (ankle bones)
• Flat bones: the sternum (breastbone) and scapula (shoulder
blade)
• Irregular bones: bones of the vertebrae (spine)
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2. Explain the structure and function of the musculoskeletal
system
Know the three types of joints:
• Immovable joints: Examples of immovable joints are the
bones of the cranium (skull).
• Slightly movable joints: An example of a slightly movable
joint is the joint between the pubic bones.
• Movable joints: The joint between the scapula and the
humerus is an example of a freely movable joint. Other types
of movable joints are the hip and shoulder joints, which are
ball-and-socket joints, and the elbow and knee joints, which
are types of hinge joints.
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The Musculoskeletal System
2. Explain the structure and function of the musculoskeletal
system
Functions of the musculoskeletal system:
• Gives shape and form to the body
• Maintains posture
• Permits movement
• Protects internal organs
• Stores calcium and phosphorus
• Produces heat
• Produces some blood cells
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3. Discuss changes in the musculoskeletal system due to aging
Normal changes of aging in the musculoskeletal system:
• Muscles weaken and lose tone.
• Bones lose calcium, causing them to become porous and
brittle.
• Height is gradually lost due to shrinkage of space between the
vertebrae in the spine.
• Loss of muscle mass in the body causes weight loss.
• Joints are less flexible and stiffer, which slows normal body
movements and decreases range of motion.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Define the following term:
muscular dystrophy
an inherited, progressive disease that causes a gradual wasting
of muscle, weakness, and deformity.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about muscular dystrophy:
• Hereditary, progressive disease in which muscle tissue is
destroyed and muscles atrophy
• Symptoms: muscle weakness, stiffness, twitching of the
hands and arms
• Cause: specific gene in the body
• Generally appears at birth or during childhood
• There is currently no cure.
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4. Discuss common disorders of the musculoskeletal system
Remember these care guidelines for muscular dystrophy:
• Allow time for movement.
• Give frequent skin care to prevent pressure
ulcers.
• Reposition residents often to prevent contractures.
• Perform ROM exercises as directed.
• Assist with ADLs. Encourage independence.
• Report red skin; pale skin; signs of the beginning of a
pressure ulcer; stiffening of muscles; pain, swelling, or
burning in a leg; symptoms of UTI; or signs of pneumonia.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Define the following term:
osteoporosis
a condition in which the bones become brittle and weak; may
be due to age, lack of hormones, not enough calcium in bones,
or lack of exercise.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about osteoporosis:
• Bones lose mass, causing them to become brittle.
• Causes: lack of calcium in diet, loss of estrogen, lack of
regular exercise, reduced mobility, age
• More common in women, especially after menopause
• Symptoms: low back pain, loss of height, fractures, stooped
posture
• Treatment: medication, exercise, calcium supplements
• Be patient and reposition residents carefully.
• Report any decline in activity or movement.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Define the following terms:
arthritis
a general term that refers to inflammation of the joints.
osteoarthritis
a type of arthritis that usually affects weight-bearing joints,
especially the hips and knees; also called degenerative joint
disease.
rheumatoid arthritis
a type of arthritis in which joints become red, swollen, and very
painful; movement is restricted and deformities of the hands
are common.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about arthritis:
• General term for inflammation of joints that cause pain,
stiffness and swelling
• May cause decreased mobility
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about osteoarthritis:
• Condition in which cartilage between bones and the pads at
the ends of bones begins to erode.
• Symptoms: pain, redness, swelling, stiffness, limited motion
• Generally occurs due to aging and may be due to joint injury
• Cold, damp weather can increase pain and stiffness.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about rheumatoid arthritis:
• Form of arthritis that may become crippling
• Symptoms: stiffness, swelling, severe pain, deformities which
may be severe and disabling, fever, fatigue, weight loss
• Cause: autoimmune illness
• Treatment: rest, controlled exercise, ROM exercises,
medication, weight loss, heat applications, joint replacement
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Remember these care guidelines for arthritis:
• Assist with exercise program.
• Perform ROM exercises as directed.
• Let nurse know, before exercise, if pain medication is needed.
• Assist with ADLs as needed.
• Encourage use of handrails and safety bars in bathroom.
• Be positive and supportive; listen if resident wants to talk.
• Report stiffness, swelling, pain, reduced ability to perform
ROM exercises, or decline in activity.
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4. Discuss common disorders of the musculoskeletal system
Define the following term:
bursitis
a condition in which the bursae become inflamed and painful.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about bursitis:
• Condition in which bursae become inflamed
• Symptoms: tissue around joint may become painful, swollen,
and tender
• Treatment: application of ice, immobilization to rest joint,
medication, removal of fluid from joint, and cortisone
injections
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Define the following terms:
amputation
the surgical removal of an extremity.
prosthesis
an artificial device that replaces a body part, such as an eye,
hip, arm, leg, tooth, or heart valve; helps improve function
and/or appearance.
phantom sensation
warmth, itching, or tingling from a body part that has been
amputated.
phantom limb pain
pain in a limb (or extremity) that has been amputated.
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4. Discuss common disorders of the musculoskeletal system
Define the following term:
flexion
bending a body part.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about amputations:
• Surgical removal of an extremity
• Causes: disease, cancer, injury, accidents
• Person may have prosthesis or transplant.
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4. Discuss common disorders of the musculoskeletal system
REMEMBER:
Phantom sensation, phantom limb pain, and stump pain are
real and should not be ignored or ridiculed.
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4. Discuss common disorders of the musculoskeletal system
Know these guidelines for amputation and prosthesis care:
• Be supportive during process of adjustment.
• Follow orders for bed elevation or positioning.
• Follow orders for positioning of the leg.
• Assist with ADLs.
• Encourage activity.
• Perform range of motion exercises as directed.
• Physical therapists will assist resident in learning to bear
weight on prosthesis.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Guidelines for amputation and prosthesis care (cont’d.):
• Be careful when handling prostheses.
• Follow instructions to apply or remove prostheses.
• Apply special compression bandages and/or stump shrinkers
as ordered.
• Change socks often and place seams on the sock to the
outside to prevent abrasions.
• Give regular, careful skin care to avoid complications with the
stump and the prosthesis.
• Bathe and rinse the stump.
• Clean and dry the socket of the prosthesis when it is removed.
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4. Discuss common disorders of the musculoskeletal system
Guidelines for amputation and prosthesis care (cont’d.):
• Before applying a prosthesis, make sure the area is
completely dry.
• Provide support for phantom pain, phantom sensation, or
stump pain. The pain or sensation is real and should be
treated that way.
• Do not react negatively to the stump or the prosthesis during
care.
• Report redness or swelling; drainage, bleeding or sores;
stump pain, phantom pain, or phantom sensation; reduced
ability to move extremity; cyanosis; or problems with the
prosthesis.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Define the following terms:
fracture
a broken bone.
sling
a bandage or piece of material that is suspended from the neck
for the purpose of holding and supporting a forearm.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Know these points about fractures:
• A fracture is a broken bone.
• Causes: trauma or accidents; falling is a common cause
• Symptoms: pain, swelling, bruising
• Generally diagnosed with x-ray
• Treatment: bone must be set and allowed to heal in normal
alignment
• Can take four to eight weeks to heal; longer in elderly people
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4. Discuss common disorders of the musculoskeletal system
Know these types of fractures:
• Closed or simple fracture
The skin is closed. Bone is in proper position, and has not
dislocated.
• Hairline fracture
The skin is closed. Bone has fine-line crack noted on X-ray,
and has not dislocated.
• Open or compound fracture
The skin is open. Bone may come through the skin. The
person has an increased risk of infection.
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4. Discuss common disorders of the musculoskeletal system
Types of fractures (cont’d.):
• Greenstick fracture
The skin is usually closed. The fracture is incomplete. Only
one side of the bone is broken; the other side is bent.
Greenstick fractures are more common in children.
• Comminuted fracture
The skin is open or closed. Bone has fractured in two or more
places.
• Compression fracture
The fracture occurs in the spine. The skin is usually closed.
Bone may break with trauma or without significant trauma.
This fracture can be due to osteoporosis, tumor, or other
condition. It is commonly seen in the elderly.
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4. Discuss common disorders of the musculoskeletal system
Remember these guidelines for cast care:
• Allow time for movement.
• Follow orders on moving and repositioning.
• Help with ROM exercises as ordered.
• Extremity may need to be elevated.
• Pad cast edges, as needed.
• Assist with use of cane, walker, or crutches.
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4. Discuss common disorders of the musculoskeletal system
Guidelines for cast care (cont’d.):
• Do not get cast wet.
• Use bed cradles to reduce pressure from bed linens.
• Keep cast clean.
• Report numbness, tingling, or increased swelling; cyanosis or
pale skin; redness, drainage, bleeding or sores; changes in
temperature of skin; complaints that cast is too tight; pain,
burning, or pressure; wetness in or around cast; odor, or
resident placing sharp objects inside cast.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Define the following terms:
total hip replacement (THR)
a surgical replacement of the head of the femur (long bone of
the leg) and the socket it fits into where it joins the hip with
artificial materials.
partial weight-bearing (PWB)
a doctor’s order stating that a person is able to support some
body weight on one or both legs.
non-weight-bearing (NWB)
a doctor’s order stating that a person is unable to touch the
floor or support any weight on one or both legs.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Define the following terms:
full weight-bearing (FWB)
a doctor’s order stating that a person has the ability to support
full body weight on both legs and has no weight-bearing
limitations.
abduction
moving a body part away from the midline of the body.
adduction
moving a body part toward the midline of the body.
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4. Discuss common disorders of the musculoskeletal system
Remember these care guidelines for total hip replacement
(THR):
• Keep often-used items in easy reach.
• Follow care plan exactly.
• Follow orders regarding positioning and elevation of head of
bed.
• Assist with dressing, starting with weaker side.
• Use adaptive devices.
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4. Discuss common disorders of the musculoskeletal system
Care guidelines for THR (cont’d.):
• Ask resident to use handrails in shower.
• Encourage fluids.
• Assist with coughing and deep breathing exercises.
• Apply anti-embolic stockings as ordered.
• Never rush resident.
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4. Discuss common disorders of the musculoskeletal system
Care guidelines for THR (cont’d.):
• Never perform ROM exercises on side of hip replacement
without orders from nurse.
• Caution resident not to cross legs.
• Ask nurse for pain medication prior to moving and positioning.
• Report incisions that are red, draining, bleeding or warm;
numbness or tingling; cyanosis or pale skin; increase in pain;
burning sensation; edema of the legs; fever or other change
in vital signs; constipation; problems with appetite; or
resident not following doctor’s orders.
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4. Discuss common disorders of the musculoskeletal system
Define the following term:
total knee replacement (TKR)
a surgical replacement of a damaged or painful knee with
artificial materials.
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The Musculoskeletal System
4. Discuss common disorders of the musculoskeletal system
Remember these care guidelines for total knee replacement
(TKR):
• Apply special stockings to prevent blood clots.
• Do not perform special exercises unless trained and ordered.
• Assist with coughing and deep breathing exercises, as
ordered.
• Encourage fluids.
• Ask nurse for pain medication prior to moving and positioning.
• Report incisions that are red, draining, bleeding or warm;
numbness or tingling; cyanosis or pale skin; increase in pain;
burning sensation; reduced mobility in the extremity; fever or
other change in vital signs; constipation; problems with
appetite; or resident not following doctor’s orders.
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4. Discuss common disorders of the musculoskeletal system
Know these points about continuous passive motion (CPM)
machines:
• May be used for people who have had TKR
• Moves joint through normal range of motion
• Notify nurse if the resident complains of pain or discomfort or
if the extremity moves out of the proper position.
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4. Discuss common disorders of the musculoskeletal system
Remember these points about traction:
• Method of treating fractures that keeps bones in place
• Uses weights and pulleys to keep bones in proper position
• Do not disconnect traction assembly or adjust the weights.
• Keep resident in proper body alignment.
• Report numbness or tingling, cyanosis or pale skin, wetness
on sling, odor around sling or boot, sling or boot becomes
loose or comes off, pain, burning, pressure, swelling, changes
in skin temperature, redness, drainage, bleeding, sores, or
resident moving to the side or sliding down.
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5. Describe elastic bandages
Know these points about elastic bandages:
• Bandages that are wrapped around a body part
• Used to keep dressings in place, hold splints in place, and
provide protection, compression and support for body parts,
decrease swelling from injuries and hold ice in place
• Must be snug enough to provide proper compression and
support but not interfere with circulation
• Report pale, gray, cyanotic, or white skin; skin that is cold to
the touch; swelling; complaints of bandage feeling too tight;
pain or discomfort; numbness or tingling
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5. Describe elastic bandages
Know the “RICE” acronym:
Rest: Rest is important to help an injury heal properly. Putting
any weight on the injury could cause more harm.
Ice: Ice helps to prevent or reduce swelling. The skin should
always be protected when using ice.
Compression: As you have learned, elastic bandages are used
to compress the injured area, hold the extremity in place, and
reduce discomfort. In addition, elastic bandages help decrease
tissue swelling that occurs with an injury.
Elevation: Elevating the extremity also helps prevent or reduce
swelling. When an extremity is elevated above the level of the
heart, swelling may decrease.
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5. Describe elastic bandages
REMEMBER:
Memorize the “RICE” (Rest, Ice, Compression, Elevation)
acronym for care when a person is injured.
Applying elastic bandages
Equipment: elastic bandage
in the correct size, clip, safety
pin, or tape (if using selfadhering bandage, these are
not needed)
1.
Identify yourself by
name. Identify the
resident. Greet the
resident by name.
2.
Wash your hands.
3.
Explain procedure to
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
Applying elastic bandages
4.
Provide for the resident’s
privacy with a curtain,
screen, or door.
5.
Adjust bed to safe
working level, usually
waist high. Lock bed
wheels.
6.
Avoid trauma or pain to
the resident throughout
the procedure.
7.
Assist resident to get
into the supine (flat on
the back) position.
8.
Expose only the part to
be bandaged.
Applying elastic bandages
9.
Hold the rolled bandage
with one hand and, with
the other hand, put the
loose end on top of the
extremity.
10. Wrap extremity,
beginning at the spot
furthest from the heart.
Circulation returns
toward the heart, and
this allows extra fluid to
flow to the heart and
leave the area. (For the
wrist, begin wrapping at
the hand. For the ankle,
begin at the foot.)
Applying elastic bandages
(For the wrist, begin
wrapping at the hand.
For the ankle, begin at
the foot.)
11. Wrap bandage once
around the beginning
spot, and turn over the
tip so that an anchor is
made.
12. Wrap one more time
around the spot where
the anchor lies, and then
begin slowly wrapping in
overlapping spirals up
the extremity.
13. Smooth out entire
bandage, removing any
wrinkles.
Applying elastic bandages
14. Secure bandage with
self-closure, clip, safety
pin, or tape. If using a
pin, be careful not to
pierce the resident’s
skin.
15. Straighten all of the
linens.
16. Remove and re-apply
bandage as directed.
Wash and dry bandages
as necessary.
17. Make resident
comfortable.
Applying elastic bandages
18. Return bed to lowest
position. Remove privacy
measures.
19. Leave call light within
resident’s reach.
20. Wash your hands.
21. Be courteous and
respectful at all times.
22. Report any changes in
the resident to the
nurse. Document
procedure using facility
guidelines.
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Exam
Multiple Choice. Choose the correct answer.
1. Which of the following type of muscle is a voluntary muscle?
(A) Skeletal muscle
(B) Smooth muscle
(C) Pulmonary muscle
(D) Cardiac muscle
2. Which of the following is a function of the bones?
(A) Protecting the body from disease
(B) Lending support to body structures
(C) Sending messages throughout the human body
(D) Pumping blood throughout the body
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Exam (cont’d.)
3. Normal age-related changes for the musculoskeletal system include:
(A) Muscles weaken and lose tone
(B) Bones gain calcium
(C) Muscle mass increases, causing weight gain
(D) Joints become more flexible
4. Weakening, wasting away, and decrease in size of a muscle is called:
(A) Dystrophy
(B) Atrophy
(C) Contracture
(D) Dislocation
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Exam (cont’d.)
5. The painful and permanent stiffening of a muscle is called:
(A) Dystrophy
(B) Atrophy
(C) Contracture
(D) Dislocation
6. Osteoporosis is caused by a lack of _______ in the diet.
(A) Sodium
(B) Calcium
(C) Iron
(D) Protein
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Exam (cont’d.)
7. Rheumatoid arthritis is an autoimmune illness. With an autoimmune illness the
body’s ______ system attacks normal tissue.
(A) Endocrine
(B) Lymphatic
(C) Circulatory
(D) Immune
8. Which of the following statements is true of osteoarthritis?
(A) Jaw and neck are usually affected.
(B) Pain and stiffness increase in cold or damp weather.
(C) Antibiotics are usually the first type of medication to treat osteoarthritis.
(D) Residents will not be able to perform any ADLs if they have osteoarthritis.
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Exam (cont’d.)
9. After an amputation, a resident may experience phantom sensation. Phantom
sensation is:
(A) Not real
(B) Sensations where the limb existed
(C) The inability to use a new body part
(D) The desire to get rid of a new body part
10. Which of the following is an example of a prosthesis?
(A) An adaptive device to assist residents with dressing
(B) Handrolls to keep residents’ fingers from curling too tightly
(C) Special shoes to help residents with flat feet
(D) An artificial arm to replace an arm that has been lost
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Exam (cont’d.)
11. Before applying a prosthesis, the area must be:
(A) Dry
(B) Damp
(C) Cold
(D) Warm
12. A fracture in which the skin is open and the bone may come through the skin
is a(n):
(A) Closed fracture
(B) Open fracture
(C) Greenstick fracture
(D) Compression fracture
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Exam (cont’d.)
13. Which of the following statements is true of cast care?
(A) Keep the cast wet or damp.
(B) Use a sharp object to remove items that have fallen inside the cast.
(C) Elevate an extremity that is in a cast.
(D) Use warm water and soap to wash the cast when it gets dirty.
14. A full weight-bearing order for a resident with a total hip replacement means
that:
(A) The resident is able to support some body weight on one or both legs
(B) The resident is unable to support any body weight on one or both legs
(C) The resident can bear full weight on both legs
(D) The affected hip needs to be kept in abduction
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Exam (cont’d.)
15. After a total hip replacement, the hip cannot be bent or flexed more than
______ degrees.
(A) 45
(B) 75
(C) 90
(D) 100
16. Fluids are encouraged for residents who have had a total knee replacement to
help prevent:
(A) Myocardial infarctions
(B) Urinary tract infections
(C) Depression
(D) Side effects of medication
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Exam (cont’d.)
17. Elastic bandages are commonly used to:
(A) Treat reddened skin
(B) Keep dressings in place
(C) Cover cuts in the skin
(D) Stop numbness and tingling
18. Which of the following is a nursing assistant’s responsibilities regarding
traction?
(A) The nursing assistant should adjust weights if the resident’s limb starts to
lower.
(B) The nursing assistant should keep the traction unit’s weights flat on the floor.
(C) The nursing assistant should give pain medication if traction is causing the
resident pain.
(D) The nursing assistant should report to the nurse if the weights move.