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Mechanical Mobilization
Fundamental Nursing Skills and Concepts
Chapter 25
Cheryl Proffitt RN, MSN
October, 2015
Mechanical Mobilization
• Learning Objectives
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
Mechanical Immobilization
• Learning Objectives Cont’d
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
Mechanical Immobilization
• Introduction
Mechanical immobilizations are used for
clients with impaired mobility as a result
from trauma or debilitating condition.
Orthoses – orthopedic devices that support
or align body parts and prevent or correct
deformities. Examples of orthoses are
splints, immobilizers, and braces.
Purposes of Mechanical
Immobilization
• Mechanical immobilization is usually used to
treat musculoskeletal trauma in order to:
 Reduce pain and muscle spasms; support
and align skeletal injuries
 Restrict movement and maintain functional
position while injuries heal; allow activity
while restricting movement of injured area
 Prevents structural damage and Deformity
Mechanical Immobilizing Devices
• Splints- immobilizes and protects an injured
body parts. Used before or instead of a cast
• Splint types include:
– Emergency
– Commercial
Inflatable
Traction
Emergency Splints
Inflatable Splints
Traction Splints
Other Splints
• Commercial splints
– More effective than improvised splints
– Include:
o Immobilizers , Inflatable splints
o Molded splints, traction splints
o Cervical collars
Mechanical Immobilizers
Inflatable Splints or pneumatic splint,
becomes rigid when filled with air.
• They control bleeding and swelling
Traction Splint are metal devices that
immobilize and pull on contracted muscles.
An example Thomas splint (fig 25-3)
Immobilizers made from cloth and foam
and held in place by adjustable hook and
loop tape. Such as velcro strap ( fig 25-4).
Mechanical Immobilizers Cont’d
 Molded splints used for chronic injuries or diseases.
 They provide support and limit movement to prevent
further injury and pain, and also maintain the body part
in a functional position, preventing contractures.

 Cervical Collars is a foam or rigid splint around
the neck, treatment for neck sprains or strains.
Worn continuously, , removed for gentle ROM
exercises.
Mechanical Immobilizing Devices
Cont’d
• Slings- a cloth device that elevates, cradles
and support parts of the body, applied to
arms, legs
• Braces- custom made devices designed to
support weakened muscles.
• Types of braces
– Prophylactic- reduces severity of joint
injury. Rehabilitative protects operative
joint during movement. Functional
provides stability
Rehabilitative Brace & A sling
Casts
• Casts are rigid molds used to immobilize
injured body structures after alignment.
Applied to fractured bones. POP is used
(Plaster of Paris)
– Types of casts
o Cylinder (may be bi-valved)
o Body (may be bi-valved)
o Spica
Casts Cont’d
• Cylinder Casts- covers the arms and legs, but
leaves the toes or fingers exposed.
• Body Cast- encircles the trunk of the body, from
the nipple line to the hips
• Bi-Valve Cast- cast is cut into two pieces
lengthwise. Done when there is swelling, interfering
with circulation, there is pain or the client is being
weaned from the cast
• Spica Cast- encircles one or both the arms and legs
and the chest or trunk. Upper body is called
shoulder spica, lower body is called hip spica.
examples of Cast
Cast Materials
Cast Application
This procedure requires more than one
person
Nurse prepares the client, assembles the
client, assembles cast supplies, making
appropriate assessments to prevent
complications
(Refer to Skill 25-2 in the textbook.( Page 551552)
Basic Casts Care (cont’d)
• Cast Removal
• Cast are removed when they need to be
changed and reapplied, or when the injury has
healed sufficiently that the cast is no longer
necessary. Casts are removed
– Electric cast cutter may frighten clients due
to noise
– Skin care important after cast removal
Cast Removal
Basic Cast Care
Traction
• Traction: pulling effect exerted on a part of
the skeletal system. It is a treatment
measure for musculoskeletal trauma and
disorders
• It is Used
– Reduce muscle spasms; Realign bones
– Relieve pain; Prevent deformities
– Traction is from the clients own body wt.
Traction (cont’d)
• Traction types include:
– Manual-pulling on the body using muscular
strength, to realign broken bone.(f-25-14
– Skin- pulling effect on the skeletal system
by applying devices to the skin
– Skeletal-means pull exerted directly on the
skeletal system by attaching wires,pins, or
tongs into a bone
Examples of tractions
Mauual traction
Skin traction, Pelvic
belt& cervical Halter
Traction (cont’d)
• Traction care
– External fixator– Pin site care to prevent infection
• Effective traction depends on consistent
application of traction principles
Skin Traction
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
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 sun exposure for vitamin D
absorption
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
References
Timby, B. (2009). Fundamental nursing skills and concepts (10th
ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Google pictures. (2015, August 10). Retrieved from
http://www.google.com