care of patient with traction

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By: kenrjam (36 month(s) ago)

Very well done and informative. Thank you for sharing.

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CARE OF THE PATIENT WITH TRACTION:

CARE OF THE PATIENT WITH TRACTION PRESENTED BY: KIRAN RANDHAWA ARMY COLLEGE OF NURSING

INTRODUCTION:

INTRODUCTION Traction is the application of a pulling force to a part of the body. It is used primarily as a short term interventions. Traction produces physical & emotional frustration.

DEFINITION:

DEFINITION Traction means that a pulling force is applied to a part of the body or an extremity while a countertraction pulls in the opposite direction.

PURPOSES:

PURPOSES Provide alignment. Reduce muscle spasms. Prevent deformities. Provide immobilization. Increase space between opposing surfaces.

PRINCIPLES:

PRINCIPLES Have an opposite pull or traction. Free from friction. Continous. Good body alignment. Line of pull.

PRINCIPLES OF TRACTION:

PRINCIPLES OF TRACTION

NURSING ASSESSMENT RELATIVE TO PRINCIPLES:

NURSING ASSESSMENT RELATIVE TO PRINCIPLES COUNTER TRACTION-Is a force that counteracts the pull of traction. Keep the bed flat. Foot& bed should be elevated. Change the position of the patient . Assist the patient in lifting himself.

CONTD…:

CONTD… FRICTION Check the - Weight applied. Knots Footplates &splints. Bed- linen.

KNOTS & WEIGHTS:

KNOTS & WEIGHTS

CONTD..:

CONTD.. LINE OF PULL Patient position should be checked to see that his body is resting in line or not. Care should be taken when changing the position.

CONTD..:

CONTD.. CONTIOUSNESS Tapes should not be slipping . Check contiousness of the traction frequently.

CONTD..:

CONTD .. POSITIONING Provide good body alignment . Provide support . Elevate head end of the bed.

NURSING RESPONSIBILITIES:

NURSING RESPONSIBILITIES PRIOR TO APPLICATION OF TRACTION - ASSESSMENT PHYSICAL ASSESSMENT- History taking. Inspection of skin area. Assess the neurovascular status. Identify any pain.

CONTD..:

CONTD.. PSYCHOLOGICAL ASSESSMENT- Explain about the procedure ,it’s purposes. Reassure the patient . Be with the patient during the procedure.

CONTD…:

CONTD… ASSISTING WITH TRACTION APPLICATION - All equipments should be kept ready. Maintain aseptic technique . Reassure the patient . Be sure to hang the weight in a slow manner.

CLASSIFICATION:

CLASSIFICATION STRAIGHT TRACTION SUSPENSION TRACTION

STRAIGHT TRACTION:

STRAIGHT TRACTION CALLED AS RUNNING TRACTION. POSITIONS USED- FLAT TILTED AWAY ELEVATING HEAD OR KNEE.

SUSPENSION TRACTION:

SUSPENSION TRACTION CALLED AS BALANCED TRACTION DEVICES USED- SLINGS HAMMOCKS SPLINTS

BALANCED TRACTION:

BALANCED TRACTION

SPLINTS & SLINGS:

SPLINTS & SLINGS

CLASSIFICATION CONTD…:

CLASSIFICATION CONTD… SKIN TRACTION SKELETAL TRACTION MANUAL TRACTION

SKIN TRACTION:

SKIN TRACTION It is the application of a pulling force to the skin & soft tissues. MATERIALS USED- Wrapping bandages Tapes Slings Halters

Contd…:

Contd… Uses- Applied to skin & soft tissues. Used to control muscle spasms. Weight applied- 2 – 3.5 kg. For pelvic traction- Depends on body weight Usually 4.5-9 kg.

TYPES OF SKIN TRACTION:

TYPES OF SKIN TRACTION BUCK’S TRACTION CERVICAL HEAD HALTER PELVIC BELT

BUCK’S EXTENSION TRACTION:

BUCK’S EXTENSION TRACTION

PELVIC BELT:

PELVIC BELT

CONTD..:

CONTD.. ADVANTAGES Prevent source of infection. No device is introduced into skeleton. DIS- ADVANTAGE Causes skin irritation. Pressure problems.

CONTD..:

CONTD.. CONTRA-INDICATIONS Patient who have Dermatitis Diabetes Varicose ulcers Skin & soft tissue injury. COMPLICATIONS Skin break down Nerve pressure Circulatory impairment

NURSING MANAGEMENT:

NURSING MANAGEMENT GOAL- To prevent skin or neuro vascular problems. To prevent from potential complications.

CONTD..:

CONTD.. ENSURING EFFECTIVE TRACTION Avoid wrinkling & slipping of the traction bandage. Provide proper positioning. Bandages & tapes & other “soft goods’’are applied in a correct way.

CONTD..:

CONTD.. MONITORING & MANAGING POTENTIAL COMPLICATIONS SKIN BREAK DOWN - Monitor the reaction of the skin. Assist patient in personal hygiene procedures. Palpate the area of traction tapes daily.. Inspect the skin, ankle,achilles tendon three times a day.

CONTD..:

CONTD .. Provide back care every two hourly . Inspect skin specially pressure points. Provide comfort devices . Change the position of the patient frequently.

PREVENT FROM PRESSURE ULCERS:

PREVENT FROM PRESSURE ULCERS

CONTD..:

CONTD .. NERVE – PRESSURE Avoid pressure on peroneal nerve. Check sensation & movement . Immediately investigate any complaint of the patient. Report altered sensation or motor function.

CONTD…:

CONTD … CIRCULATORY IMPAIRMENT Assess the circulation of foot or hand. Check for- Peripheral pulses Color & capillary refill & temperature. Indicators of deep vein thrombosis. Encourages the patient to perform active foot exercises.

SKELETAL TRACTION:

SKELETAL TRACTION It is applied directly to the bone by use of a metal pin or wire that is inserted through the bone distal to the fracture . USES Fractures of femur, cervical spine. Displaced fractures of pelvis & proximal end of tibia, calcaneus, proximal ulna.

SKELETAL TRACTION:

SKELETAL TRACTION

CONTD..:

CONTD.. DEVICES USED - Steinmann pin Kirschner wire Crutchfield tong. INSERTION OF DEVICE - Preparation of skin. Use aseptic technique. Prevent from complcations. Prepare the articles required .

SKELETAL TRACTION:

SKELETAL TRACTION

NURSING MANAGEMENT:

NURSING MANAGEMENT GOALS- To prevent from infection. To improve the general condition of the patient. To prevent from injury. INTERVENTIONS - MAINTAINING EFFECTIVE TRACTION Check position, ropes , apparatus.

CONTD..:

CONTD.. MAINTAINING POSITIONING Maintain alignment of patient’s body. Support the patient’s foot in a neutral position. Avoid footdrop,inward movement,outward rotation.

CONTD…:

CONTD… PREVENTING SKIN BREAKDOWN Protect elbows & heels from injury. Inspect for preessure ulcers. Encourage movement of body part. Provide back care frequently. Special precaution should be taken while doing procedure. Provide special comfortable devices.

CONTD…:

CONTD… MONITORING NEUROVASCULAR STATUS Check neurovascular status every hour. Encourage to do exercise. Check for DVT. Anticoagulant therapy Provide elastic stockings,compression devices.

CONTD…:

CONTD… PROVIDING PIN SITE CARE Use aseptic technique while dressing. Check for complications. Avoid infection& development of osteomyelitis. Check the insertion site.

CONTD…:

CONTD… PROMOTING EXERCISE Encourage movement of unaffected part. Explain range of motion exercises. Provide conducive environment to the patient. Teach isometric exercises to the patient.

MANUAL TRACTION:

MANUAL TRACTION It is used to tying to mobilize soft tissues& to treat hypomobility. It is applied with hands. It is a temporarily measure used in neck- injury . It is also used to apply the necessary pull to an extremity when cast is applied.

COMPLICATIONS:

COMPLICATIONS PRESSURE ULCERS HYPOSTATIC PNEUMONIA THROMBOPHLEBITIS OSTEOPOROSIS ANOREXIA URINARY STASIS & INFECTION DEEP VEIN THROMBOSIS

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NURSING PROCESS

NURSING MANAGEMENT:

NURSING MANAGEMENT ASSESSMENT PHYSICAL ASSESSMENT Assess & monitor the movement . Assess neurovascular status. Assess skin integrity. Assess for potential complications.

CONTD..:

CONTD.. PSYCHOLOGICAL ASSESSMENT Assess level of anxiety & response to traction. Explain about the procedure. Assess the economic status . Assess the coping mechanisms used by the patient.

NURSING MANAGEMENT:

NURSING MANAGEMENT NURSING DIAGNOSIS Acute pain r/t musculo skeletal disorder as evidenced by facial expression of the patient. GOAL- To relief from pain. To make the patient comfortable.

CONTD…:

CONTD… INTERVENTIONS- Assess the intensity,frequency of pain. Maintain immobilization of affected part. Provide medication as prescribed by physician. Elevate & support the injured extremity.

CONTD….:

CONTD…. Encourage patient to discuss problems. Provide recreational activities. Explain procedures before performing. Avoid use of plastic sheets,pillows. Investigate any reports of pain.

CONTD..:

CONTD.. NURSING DIAGNOSIS Impaired physical mobility r/t application of traction as evidenced by decreased muscle strength,limited ROM. GOAL- To maintain mobility at highest level. To increase function of affected part. To maintain position of body part.

CONTD…:

CONTD… INTERVENTIONS- Assess degree of immobility .& Note patient’s perception of immobility. Encourage participation in diversional activities. Instruct patient in active & passive exercise. Assist the patient in self- care activities.

CONTD…:

CONTD… Assist with mobility by means of assistive devices. Reposition periodically & encourage deep breathing & coughing exercises. Provide comfortable bed & conducive environment.

CONTD…:

CONTD… NURSING DIAGNOSIS Risk for impaired skin integrity R/ T insertion of traction pins,wires, screws as evidenced by reports of itching, disruption of skin surface GOALS- To improve the skin integrity. To prevent the itching. To prevent from pressure ulcers..

CONTD..:

CONTD.. INTERVENTIONS- Examine the skin for rashes, discoloration,itching. Cleanse the skin with warm ,soapy water. Maintain the personal hygiene of the patient. Apply emollients regularly. Change the position of the patient frequently. Provide moist free bed& air mattress..

CONTD..:

CONTD.. Palpate taped tissues daily& document if any tenderness or pain. Remove skin traction every 24 hr inspect & give skin care. Place protective padding under leg & over bony prominences.

CONTD…:

CONTD… NURSING DIAGNOSIS - Self- care deficits r/t application of traction, fracture . GOALS- To make the patient as independent as possible. To enhance the self- esteem of the patient.

CONTD..:

CONTD.. INTERVENTIONS- Assess the general condition of the patient. Assist the patient in self- care activities. Kept all articles near by patient as required by the patient. Maintain an environment in which patient’s independence is maximum.

CONTD..:

CONTD.. NURSING DIAGNOSIS - Anxiety r/t health status & traction devices as evidenced by frustration, frequent asking of questions GOALS- To remove anxiety. To educate about adaptive techniques.

CONTD..:

CONTD.. INTERVENTIONS- Explain each & every procedure before doing. Reassure the patient & family members. Provide diversional therapies to patient. Provide time to patient to ventilate his feelings& explore problems. Provide emotional support to the patient.

CONTD..:

CONTD.. Encourage the patient to participate in activities. Educate the patient to use coping skills & positive thinking.

PATIENT EDUCATION:

PATIENT EDUCATION Explain traction in relation to fracture & plan of treatment. Explain amount of movement permitted & how to achieve it. Explain correct body positioning. Explain about traction devices like splints, weights etc.. Explain about personal hygiene & pressure ulcers.

CONTD…:

CONTD… Explain about complications. Explain about range of motion & isometric exercises. Explain about self- care activities.

SUMMARIZATION:

SUMMARIZATION DEFINITION PURPOSES PRINCIPLES NURSING ASSESSMENT RELATIVE TO PRINCIPLES CLASSIFICATION STRAIGHT TRACTION SUSPENSION TRACTION SKIN TRACTION TYPES OF SKIN TRACTION

CONTD..:

CONTD.. COMPLICATIONS NURSING INTERVENTIONS SKELETAL TRACTION NURSING INTERVENTIONS MANUAL TRACTION NURSING MANAGEMENT PATIENT EDUCATION

BIBLIOGRAPHY:

BIBLIOGRAPHY BRUNNER & SUDDARTH, ‘‘MEDICAL-SURGICAL NURSING,’’10 th ed,LIPPINCOTT,WILLIAMS& WILKINS PUBLISHERS ,Pp-2025-2030. C.D MARILYNNE, ‘‘NURSING CARE PLAN’’,DAVIS COMPANY,PHILADELPHIA,Pp-613-628.

CONTD…:

CONTD… DIANA INTENZO, ‘‘ILLUSTRATED GUIDE TO ORTHOPAEDIC NURSING’’,3 rd ed, LIPPINCOTT PUBLICATIONS, Pp-90-128. BARBARA C. L. ‘‘MEDICAL- SURGICAL NURSING’’,3 rd ed,MOSBY PUBLICATIONS,Pp-1405-1410. WWW.GOOGLE.COM.

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THANKS