Traction Care



Traction Care









CHILD AND FAMILY ASSESSMENT AND PREPARATION



  • Review the medical record to determine the following:



    • Diagnosis and type of fracture/surgery the child has sustained


    • Physical condition and integrity of the skeletal system


    • Purpose and type of traction being used (Tables 105-1 and 105-2)


    • Age and weight of the child


    • Traction weights ordered by the healthcare prescriber


    • The presence of possible adhesive or latex allergies


  • Assess the child’s vital signs to determine presence of fever, increased respiratory rate, and/or increased heart rate that may indicate presence of infection.


  • Assess the child for pain and muscle spasms and provide interventions as indicated (see Chapter 7).


  • Administer pain medication when indicated, at least 30 minutes before moving or assessing the child.


  • Use diversional activities and other nonpharmacological interventions (e.g., music, stroking of unaffected extremities) to distract the child and assist in pain management during the procedure. Collaborate with the child-life specialist to provide diversional activities.


  • Perform range-of-motion exercises to all extremities, unless contraindicated, every shift. (see Chapter 95).


  • Explain to the child and family the care you will be providing.


  • Encourage family members to stay with the child during traction care.









TABLE 105-1 Types of Skin Tractiona


















































Type


Illustration


Uses


Nursing Considerations


Cervical skin


image


Neck sprains or strains


Torticollis


Cervical nerve trauma


Nerve root compression


There is a 5-7 pound limit of weights


Avoid compressing the throat or ears with the chin strap


Side-arm 90-90


image


Fractures and dislocations of the upper arm or shoulder


Hand may feel cool because of its elevation. Hand can be covered with sock or mitten if desired


Dunlop


image


Supracondylar elbow fracture of the humerus


Avoid pressure over bony prominences or nerves


Pelvis sling


image


Pelvic fractures


There is a 10-25 pound limit of weights Ensure proper size of belt and apply it just over iliac crest


Bryant’s traction


image


Infant with a femur fracture or developmental dislocated hip


Supply plenty of diversional activities If the child flips over, a sheet or Posey restraint may be used; avoid pressure over dorsum of foot and heel


Buck’s traction


image


Hip and knee contracture


Legg-Calvé-Perthes disease


Slipped capital femur epiphysis (SCFE)


Remove boot every 8 hour and assess the skin


Leg may be slightly abducted


Russell’s traction


image


Supracondylar femur fracture


Hip and knee contracture


Sling may need to be repositioned often; mark the leg to ensure proper placement


Split Russell’s


image


Femur fracture SCFE


Legg-Calvé-Perthes disease


Avoid pressure over bony prominences or nerves


Weights are not added or removed without a physician’s order


aSkin traction refers to any traction apparatus where the pull force is applied to the affected body part via the soft tissue. Traction is applied to the skin by using skin adherents, ace wraps, commercial traction tapes, or special foam boots. Weights applied to skin traction should not exceed 3.5 kg or 8 lb.










TABLE 105-2 Types of Skeletal Tractiona



































Type


Illustration


Uses


Nursing Considerations


Cervical skeletal tongs


image


Preoperative spine distraction


Fractures or dislocations of cervical or high thoracic vertebrae


A special bed may be used to assist with turning patient


Logroll patient


Halo cast or vest


image


Postoperative immobilization after cervical fusion


Fracture or dislocation of cervical or high thoracic vertebrae


A small wrench is taped to the front of the brace to remove front panel in case of emergency


If patient is in halo cast, a cast saw must be with her or him in case of emergency. Balance is altered with a halo cast; patients ambulating need close supervision


Dunlop’s side-arm 00-90


image


Fractures of upper arm


Turn the patient toward the affected side only


Hand may feel cool despite intact neurovascular status; cover hand with mitten or sock if desired


Knee 90-90


image


Femur fractures


Encourage the child to dorsiflex foot often to prevent foot drop; apply splint if necessary


Ensure that weights do not catch on bottom of the bed


Thomas ring with Pearson attachment (balanced suspension)


image


Femur fracture


Hip fracture


Tibial fracture


Avoid pressure to the area behind the knee, which could cause popliteal nerve injury


If the system is truly balanced, the splint can be placed at any height and it will remain there


aSkeletal fracture refers to any traction apparatus where the pull force is applied directly to the skeleton via pins, wires, screws, and/or tongs that are inserted into the appropriate area of bone. Weights applied can be 4.5 kg or 10 lb, up to 11.5 kg or 25 lb. Skeletal traction is beneficial for unstable or fragmented fractures that are not amenable to surgical intervention. Skeletal traction would also be used if there were skin damage associated with the fracture.

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Jul 9, 2020 | Posted by in NURSING | Comments Off on Traction Care
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