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Presentation for skin traction

Skin Traction types plus nursing care plan

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Presentation for skin traction

  1. 1. SKIN TRACTION Prepared by: Jacqueline Bacayo; RN Jayson Teruel; RN
  2. 2. Definition • Traction - Is the application of a pulling force to a part of the body with counter traction a pull in the opposite direction. More specifically, orthopaedic traction occurs when “ A pulling force is exerted on a part or parts of the body”(Davis, 1996).
  3. 3. Purpose of traction • To reduce a fracture and realign bone fragments by overcoming muscle spasms. • To maintain skeletal length and alignment. • To reduce and treat dislocations. • To immobilize and to prevent further tissue damage.
  4. 4. Purpose of Traction • To relieve muscle spasms that occur as a reaction to musculoskeletal trauma in the absence of a fracture such as cervical sprain or low back pain. • To lesson deformities, such as with arthritis. • To rest a diseased joint.
  6. 6. Skin Traction Is attached directly to the patient’s skin to immobilize a body part continuously or intermittently over a short or extended period. The direct application of a pulling force to the patients skin and soft tissues may be accomplished by using adhesive or non adhesive traction tape or other skin traction devices such as a cast, a boot, a belt or a halter. - (Schoen 2000)
  7. 7. Buck’s Traction or Extension  Used in temporary management of fractures of  Femoral neck  Femoral shaft in older children  Undisplaced fractures of the acetabulum  After reduction of a hip dislocation  To correct minor flexed deformities of the hip or knee  In place of pelvic traction in management of low back pain  Can use tape or pre- made boot  Not more than 4.5 kgs  Not used to obtain or hold reduction
  8. 8. Hamilton Russell Traction  Buck’s with sling  May be used in more distal femur fracture in children  Can be modified to hip and knee exerciser
  9. 9. Bryant’s Traction  Useful for treatment of femoral shaft fracture in infant or small child  Combines gallows traction and Buck’s traction  Raise mattress for counter traction  Rarely used currently
  10. 10. Forearm Skin Traction  Adhesive strip with Ace wrap  Useful for elevation in any injury  Can treat difficult clavicle fractures with excellent cosmetic result  Risk is skin loss
  11. 11. Double Skin Traction  Used for greater tuberosity or proximal humeral shaft fracture  Arm abducted 30 degrees  Elbow flexed 90 degrees  Risk of ischemia at antecubital fossa a
  12. 12. Dunlop’s Traction  Used for supracondylar and transcondylar fractures in children  Used when closed reduction difficult or traumatic  Forearm skin traction with weight on upper arm  Elbow flexed at 45 degrees
  13. 13. Finger traps  Used for distal forearm reductions  Changing fingers imparts radial/ulnar angulation  Can get skin loss/necrosis  Recommend no more than 20 minutes
  14. 14. Head Halter traction  Simple type cervical traction  Management of neck pain  Weight should not exceed 2.3 kg  Can only be used a few hours at a time
  15. 15. Contraindications  Abrasions and lacerations of skin in the area to which traction is to be applied  Impairment of circulation - Varicose veins, impending gangrene  Dermatitis  When there is marked shortening of the bony fragments, the traction weight required will be more then 6.7 kg which cannot be applied through the skin
  16. 16. Complications  Allergic reactions to adhesive  Excortication of skin  Pressure sores around the malleoli and over the tendo calcaneus  Common peroneal nerve palsy
  17. 17. Action/Responsibility Action Knowledge Deficit. Explain the purpose of traction related to injury and healing process. Explain the traction apparatus. For skeletal traction explain pin insertion and removal procedures and care of pin-sites. Maintaining activities of daily living while in traction. Pain Management. Assess the patient’s level of pain and administer analgesia as prescribed. Explain that traction decreases muscle spasms and will gradually help lessen pain. Rationale. · Providing information helps alleviate anxiety and enables the patient to retain further information and instructions. · To monitor the effectiveness of the prescribed analgesia · Patient’s treated in traction have pain due to soft tissue and bone Trauma.
  18. 18. Eliminate additional sources of pain by providing comfort measures. Assess for correct positioning of traction and alignment of affected extremity. Risk for Impaired Skin Integrity The patient’s Waterlow Score is assessed. Assess skin over bony prominences (sacrum, trochanters, scapulae, elbows, heels, inner and outer malleolus, inner and outer knees and back of head). Areas where skin is stretched tautly over bony prominences are at a greater risk for breakdown because the possibility of ischeamia to skin is high due to compression of skin capillaries between a hard surface (mattress, chair,) and the bone. -Diversionary activities (books, games, television etc), heat or cold treatments and position changes. -Incorrect positioning and malalignment can be sources of pain. · Frequent repositioning is required to alleviate pressure pain and discomfort. A thorough skin assessment should be carried out each time the patient is repositioned.
  19. 19. The decision to nurse the patient on a pressure-relieving mattress depends on the nurse’s clinical judgment. Maintain correct padding for affected extremity in traction, keep bed-linen wrinkle free and dry. Assess for fecal or urinary incontinence, clean and dry skin daily. -These measures help to minimize the risk of complications of skin breakdown. · Pressure areas and skin irritation can develop under or at the edge of traction device. · The urea in urine turns into ammonia within minutes, and is caustic to the skin. Feces may contain enzymes that cause skin breakdown.
  20. 20. Impaired Physical Mobility. Instruct in the use of assistance devices i.e. Monkey pole. Teach strengthening exercises to affected limb and other limbs as appropriate. Encourage activities of selfcare and the use of the trapeze if the patient’s arms will allow. -To promote independence. -Exercises should be active to prevent muscle atrophy and joint stiffness, which occur quickly in the situation of reduced mobility. · To promote independence.
  21. 21. High risk of injury. Traction Device: -Keep weights hanging freely, tighten all traction equipment and secure all knots. -Cords should be checked daily for fraying, particularly where they pass over pulleys. -Monitor the patient for signs and symptoms of neurovascular compromise, comparing findings to the unaffected limb. a) Check for diminished or absent pedal pulses. b) Check for capillary refill time >3 seconds. The traction system should be checked thoroughly at least daily and always after interventions such as physiotherapy and x-ray. · To maintain a safe environment. - Careful monitoring enables early detection. The traction equipment may through increased pressure on nerves and blood vessels cause temporary or permanent damage. -Surgical trauma causes swelling and oedema, which can compromise circulation and compress nerves. - Prolonged capillary refill time points to diminished capillary perfusion.
  22. 22. c) Observe for pallor, blanching, cyanosis and coolness of extremity. d) Check for complaints of abnormal sensations, e.g. tingling and numbness. e) Observe for increased pain not controlled by medication. Assess the affected extremity for signs and symptoms of altered perfusion of compartment syndrome. (See guideline on Compartment Syndrome.) - These signs may indicate compromised circulation. - These symptoms may result from nerve compression. - Tissue and nerve ischemia produces a deep, throbbing unrelenting pain. Compartment syndrome results from severe tissue swelling that decreases blood flow, causes ischemia and may cause permanent motor/sensory damage.
  23. 23. Risk for Deep venous thrombosis/Pulmonary embolus. - Ensure anti-embolic stockings are fitted on both limbs. - Continuously assess the patient for signs and symptoms Of: Deep Venous Thrombosis * Positive Homan’s Sign ( Forced dorsiflexion of the foot causing discomfort in the upper calf.) • Swelling of leg, • Tenderness in calf. Pulmonary Embolus. Dyspnea, Chest pain, Tachycardia, Hemoptysis, Cyanosis, Anxiety, Pyrexia of unknown origin. Give anti-coagulant i.e.Clexane s/c Daily Elastic stockings have been shown to reduce the risk of D.V.T. by about 25% (Todd&Sitzman 1998). Compression stockings must be used correctly, otherwise they may become a cause rather than a deterrent of D.V.T. (Evans, 1991). · Early detection and treatment. -To prevent complications of deep venous thrombosis or pulmonary embolus.
  24. 24. References Apley, A.G., Solomon, L. (1993) Apley’s System of Orthopaedics and Fractures. 7th Edition.Butterworth Heinemann. Black, Matassarin, Jacobs (1993). An Introduction to Orthopaedic Nursing 2nd Edition. Naon Productions Davis, P.S. (1996) Nursing the Orthopaedic Patient. Churchill Livingstone. Evans A. (1991) Sensible Stockings. Nursing Times 87 (51) 40-41. Todd B.,Sitzman M.D. (1998) Prevention of Perioperative Deep Vein Thrombosis and Pulmonary Embolism. Schoen D.C. (2000). Adult Orthopaedic Nursing.1st Publication Philadelphia Lippincott.