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  1. 1. BANDAGINGDEFINITION: Bandaging is the process of covering a wound oran injured part.USES:Bandages are used for following purposes: To prevent contamination of wound by holdingdressings in position. To provide support to the part that is injured,sprained or dislocated joint. To provide rest to the part that is injured. To prevent & control hemorrhage.
  2. 2.  To restrict movement / immobilize afracture or a dislocation. To correct deformity. To maintain pressure e.g. elastic bandagesapplied to the improve venous return. TYPES OF BANDAGES: Triangular Bandage. Roller Bandage. Special Bandage. E.g. Many tail bandage,T-
  3. 3. MATERIALS COMMONLY USED FORBANDAGES: Flannel Cotton Cotton gauze Jute Wool Special materials like crape bandage,elastic bandage & Domestic material etc.PARTS ROLLAR OF BANDAGE: Head Free End or
  5. 5. SIZES OF BANDAGE: The size of the bandage varies according tothe part it is supposed to bandagePart To be Bandaged Width(Cm)Length (Mts)HeadTrunkLegArmFingersHandWrist510 to 156 to 85 to 62.554 to 66 to 843 to
  6. 6. GENERAL PRINCIPLES: - Select a bandage of proper size & suitablematerial. Put the patient in a comfortable position. Support the injured area while bandaging. If a joint is involved, flex it slightly. Face the patient while applying thebandage, except when applying it to thehead. Pad bony
  7. 7.  Hold the roll of the bandage in the righthand when applying bandage on the leftside, Hold the bandage with the rolluppermost & apply the outer surface to theskin, unrolling a few centimeters of thebandage at a time. Put some cotton wool on the part to bebandaged so that the bandage does notslip or cause cutting into the skinunderneath. Bandage from below upward, & fromwithin
  8. 8.  Hold the end of the of the bandage overthe outer aspect of the injured area & windthe bandage around the part twice to fix it. When bandaging a limb start with anoblique turn to keep the bandage inposition, as an alternative method. Cover two thirds of the bandage by thenext one, while covering a large area bywinding the roller bandage around thepart. Keep the edges parallel. Keep even & not too tight pressure whileapplying bandage, too tight bandageinterferes with circulation.
  9. 9.  Finish with a straight turn & fix the end with asafety pin, sticking plaster or by dividing theterminal portion of the bandage longitudinally &tying the two ends around the bandaged part. If possible, leave fingers & toes exposed to checkcirculation. Do not bandage the part too tightly or tooloosely. Observe the extremities carefully for any signs ofswelling or blueness due to interference withcirculation by a bandage that is too tight. When removing a bandage, pass it from one handto the other, so that it is collected in a
  10. 10. FOLLOWING TERMS ARE USED INROLLER BANDAGING. Simple spiral Reverse spiral Figure of eight. Spica1. Simple Spiral : This type of bandage is used for uniformthickness part i.e. wrist or finger. Each turnof the bandage overlaps the previous
  11. 11. 2.Reverse Spiral: This bandage is used for the parts wherethe thickness varies e.g. legs & forearms.It is applied in the same way as thegeneral spiral bandage, but each turn isreversed as necessary to prevent gaping &to make the bandage smooth.3.Figure of Eight: This bandage is used for elbow & kneejoints. This bandage is made by formingtwo loops or oblique turns over a joint. Theturns alternately ascend & descend tocover the part.
  12. 12. 4.Spica: It is a form of the figure of eightbandage. The turn is larger than theother. It is used for joints at right anglesto the body, e.g. the shoulder, groin,thumb. 5.Special Bandages:A). Many Tail Bandage: This bandage is usually used forabdominal wounds & chest injuries. It isprepared from a number of strips or tailsof flannel or cotton material. It is 4 to 6inches wide & has sufficient length to
  15. 15. SLINGS Definition:-Slings are used to provide support andprotection for injured arms, wrists andhands or for immobilising an upperlimbwhen there are arm or chest injuries. Types of Slings:-1 . Arm sling2. Elevation sling3. Improvised
  16. 16. 1.Arm Sling :-This is used when there are injuries to theupperlimb and for some chest injuries. It holds the forearm across the chest but itis only effective if the casualty sits orstands. When an arm sling is in the correctposition ,the casualtys hand will be slightlyhigher than the elbow.. The base of thetriangular bandage should lie at the root ofthe little finger leaving the finger
  17. 17.  Method of Application:-1. Ask the casualty to sit down and supportthe forearm on the injured side with thewrist and hand slightly higher than theelbow.2. Using the hollow between the elbow andthe chest slide one end of the triangularbandage between the chest and forearm sothat its point reaches well beyond theelbow.3. Place the upper end over the shoulder onthe sound side and around the back of theneck to the front of the injured
  18. 18. 4. Still supporting the forearm, carry thelower end of the bandage up over the handand forearm and using a reef knot, tie offon the injured side in the hollow above thecollar bone .5. Bring the point forward and secure it to thefront of the bandage with a safety pin.6. Check the circulation. If it is affected adjustthe bandage or the position of the
  19. 19. Support of forearm1: Arm
  20. 20. Forming
  21. 21.  2. Elevation Sling:-This sling is used to support the hand andforearm in a well raised position.-If the hand is bleeding.-There are complicated chest injuries.-There are shoulder injuries.A). Collar and Cuff Sling:-This is used to support the wrist
  22. 22. Method of Application:- 1 . The elbow is bent, the forearm is placedacross the chest in such a way that thefingers touch the opposite shoulder. Nowthe sling is applied 2. A clove-hitch is passed round the wristand the ends tied in the hollow above thecollar bone on the injured side. Clove-hitch is made with a narrow bandage.Two loops are made and laid one on top ofthe
  23. 23. A). Collar and Cuff
  24. 24.  B. Triangular Sling:--This is used in treating a fracture of thecollarbone. It helps to keep the hand raisedhigh up giving relief from pain due to thefracture. Method of Application:-1.Place the forearm across the chest with thefingers pointing towards the oppositeshoulder and the palm over the breastbone.2. Place an open bandage over the chest withone end over the hand and the pointbeyond the
  25. 25.
  26. 26.  3.Improvised Sling:-If no triangular bandages are availableslings may be improvised in several waysto provide support-(a) Turn the free end of a coat and pin it tothe clothing.(b) Pass the hand inside the buttoned coator shirt.(c) Pin the sleeve of the injured limb. toclothing.(d) Use mufflers, scarf, belt, tie or
  27. 27. Improvised
  28. 28. Improvised sling
  29. 29. SPLINTS A splint is a rigid appliance, usually made of wood ormetal, which is tied to a fractured limb to support itand prevent movement from taking place at the siteof fracture. Using a Splint:-If a splint is not used properly, it may cause damage.Therefore, remember the following points whenusing a splint:-1.Make sure that the splint is well padded. This isparticularly important when splints are improvisedfrom pieces of wood which are uneven.2. Make sure that the splint is sufficiently long toimmobilize the joint above and the joint below thefracture.3. Make sure that the bandage used to secure. Thesplint have the knot tied on the splint and not onthe
  30. 30. IMPORTANT SPLINTS IN ORTHOPAEDICOTHER THAN PLASTER SPLINTS Splints occupy a very special place in thetreatment methodologies in orthopaedics.Any material which is reasonably hard like arolled newspaper, card board, woodenplanks, books, etc. can function as a splint.However these are crude and are mostlyuseful during first aid treatment of boneand joint injuries.Refined splints used in orthopaedics are:- plaster of Paris splints, Thomas splints, Bohler-Braun splints, Aeroplane splints.
  31. 31. PLASTER SPLINTS-1.Thomas Splint:- This is one of the very commonly usedsplints in orthopaedics. It was discovered by H.O. Thomas in1876 to assist for ambulatorytreatment of TB knee. It is now widely used for thetreatment of shaft fractures of femur,knee injuries
  32. 32. Metal oval ring2 inch angulation at outer barSide barsDistal -W
  33. 33.  Parts of a Thomas splint :A Thomas splint consists of four parts:- 1. A padded metal oval ring with softleather set at an angle of 1200to theinner bar. 2. Two side bars-one inner and anotherouter bars of equal length. They bisectthe oval ring 3. Distal end-where the two side bars arejoined in the form of a ‘W. 4. Outer side bar is angled 2 inches belowthe padded ring to clear the prominentgreater
  34. 34.  Uses of Thomas splint:-1. To immobilise fracture femur anywhere.2. As a first aid measure to immobilise thelower limb injuries.3. For transportation of an injured patient4. In the treatment of joint diseases like TBknee, septic arthritis
  35. 35. Bohler-Braun (BB) Splint:- This is Bohlers modification of Braunsplint. It consists of a heavy metallic framewith four pulleys:-1. Proximal pulley prevents foot drop.2. Second pulley to apply traction. in the lineof femur.3. Third pulley to apply traction in the line ofsupracondylar area of femur.4. Fourth pulley to apply traction in line of
  36. 36.
  37. 37. Indications Skeletal traction is applied through thisframe for comminuted trochantericfractures of the femur. It is also used for the treatment of fractureshaft femur and supracondylar fractures ofthe femur. Rarely it can be used for the fracture shaftof tibia and fibula. One important precaution which should betaken while using the BB splint is to providesupport at the fracture site and not at theknee joint to prevent angulation especiallyin supracondylar fractures of
  38. 38.  Problems of BB Splint:-1. Makes nursing care difficult2. It is a heavy and cumbersomeframe.3. It is associated with recumbentproblems like bedsores,hypostatic pneumonia, renalcalculi,
  39. 39. PNEUMATIC SPLINTS These are the present generation splintsand are more aesthetic, light and effective. They consist of the splints made up ofpneumatic material and can be easilyapplied to the limbs by inflating it with air. They provide a tight fit and are morecomfortable to the patient. Most of the ambulances today carry thesesplints which are easy to transport unlikethe crude and hard Thomas splints,
  40. 40.
  41. 41.  Care of the Splints by the Nurse-1. Padding- The splint should ,be well paddedat the bony prominences and at the injurysites.2. Bandage- This should be tied with optimumpressure.3. Exercises -Active exercises of the jointsand muscles should be permitted withinthe splints.4. Checking -Daily checking and adjustmentsof the splints are recommended.5. Neurovascular status- Distal neurovascularstatus should be assessed daily.
  42. 42. NURSING CARE FOR PATIENTS TREATEDWITH SPLINTS Nursing care assumes extreme importancein patients treated with splints as most ofthese patients are severely injured and arebed ridden. This can be discussed undertwo headings:-A}-NURSING CARE BEFORE APPLICATIONOF THE SPLINT Take consent. Inform the patient about the procedure. Remove any tight fitting clothes and changethem into easy to wear dresses.
  43. 43.  Clean the affected part. Select right sized splint. Adequately pad the pressure points and theperineum. Apply the splint gently. Check for the tightness of the weight cord. After application check for the peripheralpulses and nerve function. Apply proper weight as per the directions ofthe surgeon. Foot end elevation may be required to givethe counter
  44. 44.  Note: Maximum permissible weight limits:--a. Skin traction-4-5 kgb. Skeletal traction-8.10 kgB}-NURSING CARE AFTER APPLICATIONOF THE SPLINT. Check the pressure points and perineumeveryday for abnormal pressure. Tighten the weight cord arid increase ordecrease the weight as per the advise ofthe
  45. 45.  Bed pan and urinecan has to be given withcare to avoid disturbance to the injuredsite. Care of the back is very important toprevent bedsores . Sponge bath the patient everyday. To prevent soiling of the bed sheets and thebed but proper rubber sheets. Attend to the hair and nails of the patient. Arrange to supply proper diet to thepatients being treated on splints. . Instruct the patient to carry out activeexercises of the unaffected joints.
  46. 46.  Isometric exercises for the immobilisedjoints. Change the splint if the canvas gets soiled. If traction, either skin or skeletal, is appliedthrough the splint then the nursing careshould proceed on the lines described fortreatment on