FUNDAMENTALS OF NURSING

LESSON 7SPECIAL BEDS,

TRACTION, CASTS, AND ASSISTIVE DEVICES

SUPPORT SURFACE MATTRESSES

USES– PRESSURE REDUCTION– PRESSURE RELIEF– ROTATION– SUPPORT OF THE MORBIDLY OBESE

REDUCE PRESSURE– PRIMARY FACTOR IS TO RELIEVE PRESSURE

HIGH NURSING CONCERN FOR THE NURSE– IF PATIENT IS IMMOBILE AND UNABLE TO

REPOSITION SELF PREVENT DECUBITUS ULCERS

– #1 NURSING ISSUE

CAUSES OF PRESSURE ULCERSAND RISK FACTORS

PRESSURE ULCERS CAUSED BY PRESSURE OVER BONY PROMINENCES

CAUSED BY:1. PRESSURE = GRAVITY2. FRICTION = FORCE ON PARALLEL SKIN3. SHEARING FORCE + GRAVITY + FUNCTION

INCREASED RISK:– MOISURE (URINE, SWEAT)– NUTRITIONAL FACTORS– BODY HEAT– ANEMIA (↓ OXYGEN TO CELLS)

SPECIAL TYPES OF MATTRESSES

EGGRATE OR FOAM OVERLAY – (Least effective)

FOAM REPLACEMENT MATTRESSAIR MATTRESS OVERLAYAIR MATTRESS

ALL OF THESE REDUCE PRESSURE ONLY

SPECIAL TYPES OF MATTRESSES

NURSING INTERVENTIONS:– REPOSITION PT Q 2 HOURS– INSPECT SKIN REGULARLY– DO NOT MASSAGE REDDENED

AREAS (MAY ↑SKIN BREAKDOWN)– KEEP SKIN CLEAN AND DRY– ROM EXERCISES Q 8 HOURS

AIR SUPSPENSION BEDS

USES– ↓SHEARING– ↓FRICTION– ↓MACERATION– ↓PRESSURE– ↑SKIN INTEGRITY

NURSING IMPLICATIONS ARE THE SAME

AIR SUPSPENSION BEDS

AIR FLUIDIZED BED

USES– ↓SHEARING – ↓FRICTION

BENEFITS– KEEPS PT DRY– LOW CAPILLARY PRESSURE

DISADVANTAGES– AWKWARD– NO HOB CHANGES– TRANSPORT DIFFICULT

AIR FLUIDIZED BED

NURSING INTERVENTIONS– POSITION AND ROM– ASSESS FOR CONTRACTURES AND

PULMONARY COMPLICATIONS– FLUID AND ELECTROLYTES– ASSESS SKIN– ASSESS EMOTIONAL RESPONSE

AIR FLUIDIZED BED

ROTOKINETIC BEDS

USES– SKELETAL ALIGNMENT– MOVEMENT– USED FOR SPINAL CORD INJ

ADVANTAGES– ↓PRESSURE– STIMULATE BODY SYSTEMS

ROTOKINETIC BEDS

DISADVANTAGES– >20 HRS DAILY– SENSORY DISTRESS, DISEQUILIBRIUM– LIMITED VISUAL FIELD– STOP BED NO MORE THAN 30

MINUTES NURSING INTERVENTIONS

– MONITOR FOR OTHOSTATIC HYPOTENSION

– MONITOR FOR DISORIENTATION

ROTOKINETIC BEDS

BARIATRIC BED

USES– MORBIDLY OBESE UP TO

850 POUNDSADVANTAGES

– WIDER, STURDIER– IN BED SCALE– SAFER

BARIATRIC BED

DISADVANTAGES– LACK OF DECREASED PRESSURE– DR ORDER NEEDED

BARIATRIC BED

NURSING INTERVENTIONS

ASSESS SKIN

CHANGE POSITION

FREQUENTLY

USE TRAPEZE ENCOURAGE MOBILITY

POSSIBLE NURSING DIAGNOSIS

IMPAIRED PHYSICAL MOBILITY IMPAIRED SKIN INTEGRITY RISK FOR INFECTION ANXIETY FEAR HOPELESSNESS

TRACTION

DEFINITION– PULLING FORCE AND A COUNTERTRACTION– TOO MUCH FORCE=NERVE AND TISSUE DAMAGE– TOO LITTLE=MUSCLE SPASM AND ↓HEALING

PRESCRIBED FOR– DEFORMITIES– CONTRACTURES– DISLOCATIONS– FRACTURES– MS DISEASE– PRE/POST-OP POSITION– IMMOBILIZATION

TRACTION

PULLING FORCE—ROPES, PULLEYS, WEIGHTS COUNTERTRACTION—ELEVATING FOOT OR HOB TYPES

– BALANCED– SUSPENSION– STRAIGHT

TYPE USED DEPENDS ON– INJURY/CONDITION– PURPOSE– AGE– WT/HEIGHT– SKIN CONDITION– LENGTH OF TIME NECESSARY

BALANCED TRACTION

COUNTERTRACTION

OTHER TRACTION

CERVICAL SKIN TRACTION

DUNLOP SKIN TRACTION

TRACTION

TYPE USED DEPENDS ON– INJURY/CONDITION– PURPOSE– AGE (#1 THOUGHT WHEN CONSIDERING

SAFETY)– WEIGHT/HEIGHT– SKIN CONDITION– LENGTH OF TIME NECESSARY

SKIN TRACTION

FORCE APPLIED TO SKIN AND SOFT TISSUE

CONTINUOUS– HIP OR EXTREMITY– RELIEVES MUSCLE

SPASM

INTERMITTENT– FOR BACK– TO RELIEVE SCIATIC PAIN

BUCKS TRACTION: MOST COMMMON

– *IMMOBILIZATION OF A HIP FRACTURE

SKIN TRACTION

ON 4 SHORTER PERIODS INCREASE SKIN

PROBLEMS CONTRAINDICATED:

– ULCERS– BURNS– DERMATITIS– DIABETES– ELDERLY

SKIN TRACTION

PURPOSE:– DECREASE MUSCLE

SPASMS & MVMT– PROPER ALIGNMENT

CERVICAL DISK DISEASE PELVIC FX SPINAL DEFORMITIES PREOP IMMOBILIZATION

OF HIP FXs

SKELETAL TRACTION

– FORCE APPLIED DIRECTLY TO BONEUSES

– FEMUR & CERVICAL SPINE FX– IMMOBILIZATION– EXTERNAL FIXATION

PURPOSE– IMMOBILIZE FOR LONG PERIODS– ENABLE HEALING

SKELETAL TRACTION

SKELETAL TRACTION

SKELETAL TRACTION

SKELETAL TRACTION

TRACTION

NURSING INTERVENTIONS– PIN CARE – REPOSITIONING – DR GUIDES INTERVENTIONS

TRACTION

EXTERNAL FIXATION – FRAMES WITH SPREADER BAR

HOLDS PINS DRILLED DIRECTLY INTO BONES.

– PATIENT IS USUALLY D/C WITH THEM IN PLACE.

USED FOR– SKULL OR FACIAL FRACTURES– RIBS– ALL BONES OF EXTREMITIES– PELVIS

TRACTION

EXTERNAL FIXATION: NURSING INTERVENTIONS

– PREPARE PATIENT– ASSESS SKIN– ASSESS NEUROVASCULAR STATUS

AND BODY PART TO BE IN TRACTION– SUPPORT ADLS– MAINTAIN SKIN INTEGRITY

TRACTION NURSING INTERVENTIONS

4 P’S POUNDS: CORRECT WEIGHT IN PLACE PULL DIRECTION: ALIGNED WITH LONG AXIS OF BONE PULLEYS: ROPE OVER PULLEY GLIDING SMOOTHLY PRESSURE: EVERY CLAMP AND CONNECTION TIGHT

TRACTION NURSING INTERVENTIONS

NEUROVASCULAR CHECKS SKIN COLOR AND TEMPERATURE CAPILLARY REFILL SENSATION/PULSE MOVEMENT OF PARTS DISTAL TO TRACTION

*NUMBNESS MAY INDICATED COMPROMISED NERVE FUNCTION

TRACTION NURSING INTERVENTIONS

TOILETING– IMMOBILIZED: USE FLAT, FRACTURE BEDPAN– USUALLY NEED STOOL SOFTENERS

TURNING AND POSITIONING– MAINTAIN LINE OF PULL– PREVENT FRICTION– MAINTAIN COUNTERTRACTION– MAINTAIN CONTINUOUS TRACTION– MAINTAIN CORRECT BODY ALIGNMENT

TRACTION NURSING INTERVENTIONS

EQUIPMENT– SPREADER BAR– WEIGHT HOLDER– PELVIC BELT AND SLING

CASTS

ALSO CALLED IMMOBILIZATION DEVICE– APPLIED EXTERNALLY– IMMOBILIZATION: PREVENTS MOVEMENT OF

INJURED TISSUE– CORRECT OR PREVENT MALFORMATION– DECREASE RISK OF SOFT TISSUE DAMAGE

CASTS

MATERIALS USED PLASTER OF PARIS

– USES: UNSTABLE FRACTURE TISSUE EDEMA FREQUENT CAST CHANGE ANTICIPATED.

– DISADVANTAGES: SLOW TO DRY 48 HRS BEFORE WEIGHT BEARING DIFFICULT TO X-RAY CRUMBLES AND FLAKES CANNOT GET WET POSSIBLE ALLERGY

CASTS

MATERIALS USED PLASTER OF PARIS

– ADVANTAGES: SMOOTH SURFACE GREATER MOLDABILITY INEXPENSIVE STRONG

CASTS

SYNTHETIC– USES:

STABLE FRACTURE LONG-TERM USE

– ADVANTAGES: 7-15 MIN DRYING TIME WEIGHT BEARING IN 30 MIN CAN BE X-RAYED DURABLE CAN BE IMMERSED IN WATER STRONGER THAN PLASTER

CASTS

SYNTHETIC– DISADVANTAGES:

ROUGH SURFACE POSSIBLE ALLERGY LIMITED MOLDABILITY MAY NEED SPECIAL CAST SAW NONABSORBANT LINING EXPENSIVE

CASTS

NURSING INTERVENTIONS– SUPPORT JOINTS ABOVE AND BELOW THE CASTED

AREA WHEN LIFTING WET CAST—USE PALMS OF HANDS

– USE FAN TO AID DRYING– KEEP CAST ABOVE LEVEL OF HEART X 48HRS.– COVER WITH PLASTIC BEFORE BATHING – IF SYNTHETIC GETS WET—RINSE WELL, DRY

THOROUGHLY– DO NOT ALLOW OBJECTS UNDER CAST– MAY NEED TO SMOOTH RAW EDGES (PETALING)

CASTS

MANY TYPES

CASTS

APPLICATION– ASSESSMENT

Health status Skin Neurovascular status applying

– MATERIALS– EVALUATION– REPORT TO MD

CASTS

REMOVAL– PREPARE PT– COLD WATER ENZYME WASH– SORENESS OR PAIN– PATIENT TEACHING

ASSISTING WITH AMBULATION

INDICATION MOST COMMON AIDS

– CANES– CRUTCHES– WALKERS

TEMPORARY OR PERMANENT

TYPES OF ASSISTIVE DEVICES

•Canes:•Widens base of support•Increased security

•3 Types:•Standard•T-handled•Quad cane

TYPES OF ASSISTIVE DEVICES

QUAD CANE

TYPES OF ASSISTIVE DEVICES

AXILLARY•Crutches:•Wood or metal

•Ground to axilla

•3 types:

•Axillary

•Loftstrand

•Platform

TYPES OF ASSISTIVE DEVICES

LOFTSTRAND OR CANADIAN

TYPES OF ASSISTIVE DEVICES

PLATFORM CRUTCH

TYPES OF ASSISTIVE DEVICES

AXILLARY•Crutches:•Measurements in 3 areas

•Pt height

•Crutch pad & axilla

•Angle of pt flexion

4 Point Gait

MOST STABLE3 POINTS OF SUPPORT REQUIRES WEIGHT BEARING ON ALL FOURS

3 Point Gait

REQUIRES USE OF

ONE FOOT & 2 ARMS

GAITS

2-POINT SWING-TO SWING-THROUGH STAIRS

WALKERS– 4 LEGS– WIDE BASE OF SUPPORT– GREAT STABILITY FOR FULL/PARTIAL WEIGHT

BEARING– USED FOR PTS WITH WEAKNESS OR BALANCE

ISSUES

TYPES OF ASSISTIVE DEVICES

NURSING INTERVENTIONS FORASSISTIVE DEVICES

ALL SHOULD HAVE RUBBER TIPS SURFACE CLEAN, DRY, WELL LIGHTED

AND LEVEL APPROPRIATE HEIGHT FOR PT

SIGNIFICANT ASSESSMENT DATA

PREVIOUS AND CURRENT HEALTH STATUS

ABILITY TO SAFELY AMBULATE

VISUAL, PERCEPTUAL, SENSORY DEFICITS

APPROPRIATE FOOTWEAR

THE END