Transcript Mechanical Immobilization Nursing Fundamentals Chapter 25

Mechanical Immobilization
Nursing Fundamentals
Chapter 25
Orthoses
• Orthopedic devices that support or align a
body part and prevent or correct
deformities
Examples of orthoses
• Splints
• Immobilizers
• Braces
Wrist Immobilizer(AV)
Shoulder Immobilizer(AV)
Airboot Immobilizer(AV)
Sling(AV)
Purposes of Mechanical
Immobilization
• Most people who need mechanical
immobilization have suffered trauma to the
musculoskeletal system
• These type of injuries are painful and heal
less rapidly than injuries to skin or soft
tissue
Mechanical Immobilization
• Pt who are recovering from injury require a
period of inactivity to allow new cells to
restore integrity to the damaged area
General Purposes for
Mechanical Immobilization
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*Relieves pain and muscle spasm
*Supports and aligns skeletal injuries
*Restricts movement while injury heals
*Aids in maintaining a functional position until
healing is complete
• *Allows activity while restricting movement of an
injured area
• *Prevents further structural damage and
deformity
Examples of Immobilizing
Devices
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WE WILL DISCUSS:
Splints
Slings
Braces
Casts
Traction
Splints
• This device immobilizes and protects an
injured body part
• Splints are used before or instead of
application of casts or traction
Emergency Splints
• These are applied as a first aid measure
for suspected sprains or fractures
• These are placed on the pt by the
paramedic or while at the E.R.
Commercial Splints
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These are available in various designs
Examples:
*Inflatable splints
*Traction splints
*Immobilizers
*Molded splints
*Cervical collar
Inflatable Splints
• These are also called pneumatic splints
• These become rigid when filled with air
• In addition to limiting motion, they control
bleeding and swelling
Inflatable Splint
• You place the injured part in the
deflated portion of the splint.
When air is infused, the splint molds to the
contour of the injured part, preventing movement
• Once this type of splint is placed on a pt, the
injury should be examined and treated within 3045 minutes after application , otherwise,
circulation may be affected
Traction Splints
• These splints are usually made of metal
• They are applied to immobilize and pull on
muscles that are in a state of contraction
• This type of splint is meant to be
temporary
Immobilizers
These are usually made of cloth and foam
and are usually held in place with
adjustable Velcro straps
• These are used to limit motion in the area
of healing the injury
Immobilizers
• These limit motion in the area of a painful
but healing injury such as the neck and
knee
• Immobilizers are removed for brief periods
during hygiene and dressing
Molded Splints
• These are made of rigid plastic and are
used for chronic injuries or diseases
• They may be appropriate for pts with
repetitive motion disorders such as carpal
tunnel syndrome
Molded Splints
• These provide prolonged support and limit
movement to prevent further injury and
pain
• These maintain the body part in a
functional position to prevent contractures
and muscle atrophy during immobility
Cervical Collar
• Is a foam or rigid splint that is placed
around the neck
• It is usually used to treat athletic neck
injuries or other trauma that results in a
neck sprain or strain
Neck Strain
• Is sometimes referred to as “whiplash”
• Whiplash in athletics has decreased
mainly d/t better supportive equipment.
• In auto accidents, the use of shoulder
harnesses and neck supports has also
caused a decrease in whiplash
• A cervical collar reminds the pt to limit the
movements of the head and neck
• These collars need to be fitted before
application of them
Applying an Emergency Splint
(1-11)
• 1. Keeping the injured parts in place prevents
additional injuries so avoid changing the position
of the injured part even if its grossly deformed
• 2. Leave high top shoes or ski boots in place,
these help to limit movement and reduce pain
and swelling
• 3. Cover open wounds to prevent entrance of
microorganisms
• 4. Select a rigid splinting material such as a flat
board, broomstick or rolled up newspaper, this
will help restrict movement
Applying an emergency splint
• 5. Pad bony prominences with soft material,
padding prevents friction and pressure
• 6. Apply the splint so that it spans the injured
area from the joint above the injury to beyond
the joint below the injury
• 7. Use wide tape or wide strips of fabric to
confine the injured part to the splint. Securing
the body part prevents displacement and
reduces the risk of compromising circulation
Applying an emergency splint
• 8. Loosen the splint or the material used to
attach it if the fingers or toes are pale, blue, or
cold. Loosening the splint allows for better
circulation
• 9. Elevate the immobilized part so the lowest or
end part is higher than the heart, this reduces
venous flow back to the heart
• 10. Keep the pt warm and safe
• 11. Seek assistance in transporting the pt to a
health care facility
Slings
• This is a cloth device used to elevate,
cradle and support parts of the body
• Slings are commonly applied to the arm
• Many pts use a commercial type of arm
sling
Braces
• These are designed to
support weakened
structures during weight
bearing
• Any improperly fitting
brace can cause
discomfort, deformity
and pressure sores
• There are 3 categories
of braces: ………
Braces
• 1. Prophylactic braces – those used to prevent or
reduce the severity of a joint injury
• 2. Rehabilitative braces – those that allow protected
motion of an injured joint that has been treated surgically
• 3. Functional braces – those that provide stability for
an unstable joint
Wearing a brace
• Because pts generally wear a brace during
active periods, they are always made of sturdy
materials such as metal
• Leg braces may be incorporated into a shoe for
added support
• Some back braces are made with fabric or metal
staves or strips for support
Casts
• A cast is a rigid mold that is placed around an injured
body part after it has been restored to correct anatomic
alignment
• The purpose of a cast is to immobilize the injured
structure
• Casts are usually applied to fractured (broken) bones
• Casts are formed using wetted rolls of plaster of Paris or
premoistened rolls of fiberglass
Types of bone fractures
Compound Fracture
• Open fracture
What risk
factors present
with this type of
fracture
Types of Casts
• Cylinder cast
• Body cast
• Spica cast
• Bivalved cast
Cylinder Cast
• Encircles an arm or leg and leaves the
toes and fingers exposed. The cast
extends from the joints above and below
the affected bone. This prevents
movement by maintaining correct
alignment during healing. As healing
progresses, the cast may be trimmed or
shortened
Body Cast
• This is just a larger form of a cylinder cast that
encircles the trunk of the body instead of an
extremity
• A body cast extends from the nipple line to the
hips
• For pts with spinal problems, the body cast
extends from the back of the head and chin area
to the hips with modifications made for exposing
the arms
Spica Cast
• PURPOSE: used to keep the hips and legs from
moving after surgery.
• This type of cast encircles one or both arms or
legs and the chest or trunk
• It is generally strengthened with a reinforcement
bar (never grab the bar)
• When applied to the upper body, its called a
shoulder spica, when applied to the lower
extremity, its called a hip spica
Spica Cast
• Spica casts of the lower extremity are heavy, hot
and frustrating because they severely restrict
movement and activity
• These casts are trimmed in the genital and anal
area to allow for elimination of urine and stool
• These pts cannot sit so the nurse must care for
the cast and the pt frequently
Hip Spica
• What are nursing concerns that you have for this
person?
Reduction of an injury
• If a bone is broken, it must be reduced,
fixed, or put back into place
• Reduction can be :
• Open
• Or
• Closed
MEDLINE PLUS
• You had a fracture (break) in the femur, also called the
thigh bone, in your leg. You may have needed surgery to
repair the bone. You may have had surgery called an
open reduction. Your surgeon used special metal
devices to hold your bones in place while they heal.
These devices are called internal fixators.
• The complete name of this surgery is open reduction and
internal fixation (ORIF).
• In the most common surgery to repair a femur fracture,
the surgeon inserts a rod or large nail into the center of
the bone. This rod helps support the bone until it heals.
The surgeon may also put a plate next to your bone that
is attached by screws to a frame outside your leg
Open Reduction
• An incision is made near
the affected broken area
and the use of pins to
help keep the part
aligned, are used
• The affected area is then
casted for immobilization
• ORIF – open reduction
internal fixation, no pins
to clean, it’s all inside
Closed Reduction
• There is NO incision,
the affected bone is
repositioned (reduced
back to normal) and
may be held with
screws on the outside
or is casted to keep
bone in place
Care of the Patient with a spica
cast
• Plastic wrap is tucked around any opening
of the cast
• Gauze is also used and the pt must use a
fractional bed pan
Shoulder Spica
Bivalved Cast
• This is a cast that started
out as a cylinder type
cast and it was then cut
into 2 pieces, lengthwise,
so that one layer fits on
the underside of the arm
(for example) and the top
piece fits over the upper
arm
• This type of cast
promotes bathing of the
body part
Who uses a bivalved cast?
• *Pts with a lot of swelling that interferes
with circulation
• *If a pt is being weaned from the cast
• *If many x-rays are needed
• *If pt has painful joints that need to be
immobilized temporarily as in pts with
arthritis
Cast Application
• Requires more than 1 person
• The Dr. repositions the affected bone and then
applies the cast
• The nurse prepares the pt and supplies then
assists the Dr.
• A light-curred fiberglass cast requires exposure
to UV light to harden
Casting (AV)
Cast Removal
• A cast is removed when it needs to be changed
or when the injury has healed sufficiently
• A cast removed prematurely can cause
complications
• Casts are removed with an electric cast cutter
that looks like a saw
• Pts become frightened by the noise of the saw
and the feeling that their limb will be cut in to
Cast Care (AV)
Cast Care part 1(AV)
Cast Care part 2(AV)
Biggest problem that can occur
when casted?
• Compartment
syndrome
• A condition in which
nerves and tendons
under the skin are
constricted due to the
edema that occurs
after injury and
casting. What can
this lead to?
Remove Casting (AV)
Post cast care
• *The unexercised muscle of the affected part is
usually weak and smaller than it used to be
• *The joints have limited range of motion
• *The skin usually appears pale and waxy and
may contain scales or patches of dead skin
• *The area is washed with warm soapy water and
lotion is sometimes applied to add moisture,
eventually, the dead fragments will slough off
Care of the pt with a newly
applied cast
• A pt can bear weight within 15-30 minutes after the
application of a cast
• Plaster casts remain wet for 24-48 hrs depending on the
level of humidity in the air
• The nurse should use the palms of the hand to move the
affected part
• A fan can be used to speed drying
• Do not cover the casted area with linens
• Change positions of the casted area to allow all parts to
dry
• Heat lamp may be used to dry cast
• The casted area is then elevated to avoid swelling
Windowing (AV)
Care of the casted pt
• One of the major problems with the application
of a cast is swelling which affects
circulation…bad
• Once the cast is applied and swelling has
occurred, the Dr. must be notified to “window”
the cast
• A cut is made in the cast to relieve the swelling
Windowed Cast
What to assess when one is
casted
• *Perform the blanch test by pressing on the skin
around the cast
• *Assess nailbeds of affected limb for circulation
• *Keep casted area elevated above the heart
• *Assess the edges of the cast for roughness, if
so, tuck gauze into cast around edges
• * assess pulses if you can
• *Follow Dr. orders for circ checks, starts out to
be Qhr x 24 hrs, then Q4hr for 2-3 days then Q
shift
Cast Assessment
• What are the
important things to
assess related to the
cast?
Drs. Orders
• Follow Drs. Orders at all times
• Certain Drs. Will order particular care or
treatment
• Pedal edges of cast so crumbs won’t get
down into cast
• NEVER ALLOW THE PT TO STICK
ANYTHING INTO CAST TO SCRATCH,
• No coat hangers, pencils, pens, rulers,
forks, knives, mail openers,
straws…NOTHING
• If skin tears or breaks, dark, warm, moist
area inside the cast, what will
happen?????
Traction
• Is a pulling effect that is exerted on a part of the
skeletal system
• Traction is used for musculoskeletal trauma
remember that traction is used for:
• Reduce muscle spasms
• Realign bones
• Relieve pain
• Prevent deformities
Traction
• The pull of the traction is offset by the
counterpull from the client’s own body
weight
• Application of traction uses weights
connected to the pt through a system of
ropes, pulleys, slings and other equipment
Types of Traction
• Manual Traction
• Skin Traction
• Skeletal Traction
Manual Traction
• Means pulling on the body using a
person’s hands and muscular strength
• It is most often used briefly to realign a
broken bone
• It is also used to replace a dislocated bone
into its original position within a joint
Skin Traction
• Means a pulling effect on the skeletal
system by applying devices such as a
pelvic belt and a cervical halter, to the skin
• Other names for skin traction is Buck’s
traction and Russell’s traction
Skeletal traction
• Means pull exerted
directly on the
skeletal system by
attaching wires, pins,
or tongs into or
through a bone
• Skeletal traction is
applied continuously
for an extended
period
External Fixation
• Is a metal device inserted into and through
one or more broken bones to stabilize
fragments during healing
• This external fixator immobilizes the area
of injury, the pt is encourages to be active
and mobile
• OREF – open reduction external fixation,
pins to clean
External Fixation
• What are the
special
nursing
needs for
this patient?
External Fixation(AV)
Internal Fixation
• What are your
nursing
concerns?
Pin Care
• Care must be given to the pins that are sticking
out of the skin to prevent infection and to
promote healing
• Usually cotton tip applicators are soaked in
H2O2 – hydrogen peroxide, and the nurse
swabs around the pins to clean them
• We used to place bacitracin around the pin
entrance site, but stagnant bacitracin has been
known to cause growth of bacteria at the pin site
Traction
Skin Traction (AV)
Set up for Traction (AV)
Pin Care for Skeletal Traction
(AV)
Moving with Cast(AV)
Halo traction
Passive Motion Machine(AV)
• Provides a constant
motion of bending
and straightening to
keep joints from
stiffening
• Causes pain to pt,
medicate pt well well
The use of an abductor pillow
ACE WRAPS
What is an ACE wrap?
• A.K.A. compression bandage
• An ace wrap is an elastic bandage that comes in
different sizes.
• The wrap comes in a roll with metal clips, with
tape to fasten it in place, or Velcro™ .
• The bandage may be from 2 to 6 inches (5 to 15
cm) wide and 4 to 6 feet (1.2 to 1.8 m) long.
• Elastic bandages can be bought at any medical
supply or drug store.
• Your caregiver will help you choose the best
bandage for you.
PURPOSE:
• An ace wrap puts gentle pressure on the tissue
around an injury providing support
• To help reduce swelling of an injured area of the
body.
• To hold wound bandages in place.
• To wrap around an arm or leg splint during
healing.
• To improve blood flow to a limb like an arm or
leg.
• To hold cold or hot packs in place on a body
part, such as an arm.
How to put an ACE wrap on…
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Hold the rolled bandage with one hand and with the other hand put the loose end on
top of the foot.
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While holding the loose end, wrap the bandage twice around the foot. Be sure to
overlap the ace wrap.
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After the foot has been wrapped twice, move your hand to the heel.
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Wrap the bandage moving toward the ankle. The bandage should be wrapped in a
spiral way like making a figure 8.
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Leave the heel uncovered.
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Cross the bandage over the foot, moving upward, and pass it behind the ankle.
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Move the bandage down and cross it over the top of the foot.
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Wrap the bandage under the foot to complete the 8 figure. Repeat this one more
time.
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Pass the bandage around your calf and start wrapping it toward the knee.
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Stop wrapping below the knee. You don't need to start coming down again.
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The end of the bandage can be fastened with tape or metal clips.
NANDA Diagnoses
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Acute Pain
Impaired physical mobility
Risk for disuse syndrome
Risk for impaired skin integrity
Risk for ineffective tissue perfusion
Self care deficit
The End