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SAN JOSE STATE UNIVERSITY
School of Nursing
Nursing 155
Care of the Client with a Cast or Traction
KEY
Learning Resources
1.
Elkin, M., Perry, A., & Potter, P. (2004). Nursing interventions and clinical skills (3rd ed.) St. Louis, MO:
Mosby. (pp. 646-674)
2.
Lewis, S.M., Heitkemper, M.M.., & Dirksen, S. R. (2005) Medical-surgical nursing: Assessment and
management of clinical problems (6th ed.). St. Louis: Mosby. (pp. 1657-1678, 1685-1689)
3.
VT #15, Part 2: Nursing care of patients with a cast.
4.
VT #172: Caring for patients in traction.
5.
CD-ROM #CD001: Immobilization.
Independent Learning Activities
Learning Outcomes
1.
State four purposes of traction.
2.
Define traction force and countertraction force.
3.
Describe how skin traction is applied.
4.
List three examples of skin traction.
5.
Describe how skeletal traction is applied.
6.
List three examples of skeletal traction.
7.
Compare Buck’s, Bryants, Russell’s, pelvic/cervical, and balanced suspension traction.
8.
List four nursing measures specific to a patient with skin traction.
9.
List four nursing measures specific to a patient with skeletal traction.
10.
Describe 3 types of casts.
11.
State the purpose of “petaling” a cast.
12.
List teaching needs of a client going home with a cast.
13.
Define compartment syndrome.
14.
List early and late signs and symptoms of compartment syndrome.
15.
List four things the nurse can do to reduce the effects of compartment syndrome.
16.
Identify anatomical structures that are replaced when a ‘total hip replacement’ is performed.
17.
Describe the positioning of a patient who has just had a total hip replacement.
18.
Identify an abductor pillow.
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Learning Activities
1.
State 4 purposes of traction.
a.
reduction, immobilization, and alignment of a fractured or injured bone
b.
prevent or reduce muscle spasm, therefore pain.
c.
prevent, lessen, or correct deformities
d.
prevent additional soft tissue damage
e.
resting a diseased joint
2.
Define traction force and countertraction force.
Traction is the pulling force applied either directly (skeletal traction) or indirectly (skin
traction) to an injured bone or joint. Countertraction is the force pulling in the opposite
direction as the traction force. In some circumstances, countertraction is applied via
weights, and sometimes the patient’s own body provides the countertraction.
3.
How is skin traction applied?
Skin traction is a pulling force applied indirectly to the injured part via the skin. Skin
traction is applied using padded boots, slings, tape, or halters.
4.
5.
Give 3 examples of skin traction.
a.
cervical traction as in a cervical halter used to reduce muscle spasm
b.
Buck’s and Bryant’s traction
c.
pelvic traction
How is skeletal traction applied?
Skeletal traction is a pulling force applied directly to the bone using pins, wires, screws,
or tongs. An incision is made through the skin to apply hardware directly to the bone.
6.
Give 3 examples of skeletal traction.
a.
balanced suspension
b.
lateral arm
c.
overhead arm
d.
cervical with tongs
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7.
Compare the following types of traction by completing the table.
Type of
Traction
Skin or
Skeletal
Purpose of the
Traction
Length of Time
Applied
Amount of
Countertractio
n
Buck’s
Skin
Used for temporary
A few days; 7-10
immobilization and
stabilization of
fractured hips or
fractures of femoral
shaft. Can also be used
to correct knee and hip
joint contractures
Patient’s body
usually serves as
the
countertraction
force
Bryant’s
Skin
Used to immobilize
fractures of the femur
in children weighing
less than 40 lb. Also
used to treat congenital
hip dysplasia in
infants.
7-10 days for
fractures of the
femur. Weeks
for congenital
hip dysplasia.
Patient’s body
usually serves as
the
countertraction
force
Pelvic belt or
girdle
Skin
Used for muscle spasm
in the low back,
sciatica, and minor
fractures of the lower
spine
Days or weeks
Knees of bed
are usually
elevated, and
the patient’s
body also acts
as
countertraction
Russell’s
Skin
Used for fractures of
femur or hip
A few days; 7-10 Patient’s body
usually serves as
the
countertraction
force. Keep in
mind that this
type of traction
involves
elevating the
affected limb, as
well.
Used for arthritis of
cervical vertebrae, as
well as soft tissue
disorders and
degenerative disk
disease. This is not
used for unstable
May be days to
weeks. Can be
removed
intermittently.
Cervical for
Skin
muscle
spasm and
radiculopathy
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HOB is
elevated.
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cervical fractures.
Cervical for
c-spine
fracture
Skeletal
Tongs are applied to
the skull to reduce and
immobilize fractures of
the cervical vertebrae
Weeks or
months
A system of
traction weights
is attached to
the skull tongs
via ropes and
pulleys
Balanced
suspension
traction
Skeletal
Used for injury or
fracture of the femoral
shaft, acetabulum, hip,
tibia, or any
combination of these
Usually 6-8
weeks
The force of
traction equals
the force of
countertraction.
The affected
body part is
supported by a
sling, hammock,
or the body, and
partly by a
system of
weights
attached to an
overhead frame
with pulleys and
ropes
8.
9.
List 4 nursing interventions specific to a client with skin traction.
a.
maintain established line of pull
b.
prevent friction on the skin
c.
maintain countertraction
d.
maintain continuous traction unless ordered otherwise
e.
maintain correct body alignment
List 4 nursing interventions specific to a client with skeletal traction.
a.
maintain established line of pull
b.
prevent friction on the skin
c.
maintain countertraction
d.
maintain continuous traction unless ordered otherwise
e.
maintain correct body alignment
f.
perform pin care
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10.
Describe 3 types of casts.
a.
Upper extremity
-short arm cast
*used for stable wrist or metacarpal fractures. Prevents wrist mobility
while allowing for movement of the elbow.
-long arm cast
*used for stable fractures of the forearm or elbow, and unstable wrist
fractures. Restricts motion in both wrist and elbow.
-sugar tong splint
*used for acute wrist injuries
-posterior splint
* splints both the volar and dorsal aspects of the forearm
*splints are used when excessive swelling is expected. They allow more
room than the non-elastic cast
b.
torso
-body jacket
*used to support and immobilize stable spinal fractures of the thoracic or
lumbar spine.
-hip spica
*used to treat femoral fractures, especially in children. Immobilizes the
affected extremity and the trunk
c.
lower extremities
-long leg cast
*used for unstable ankle fractures, soft tissue injuries, fractured tibia, and
knee injuries
-short leg cast
*usually used for stable ankle and foot injuries and fractures
11.
What is the purpose of ‘petaling’ a cast.
“petaling” a cast is a method of using waterproof tape to finish the edges of a cast. Short
strips, 1 inch long are placed around the edge of the cast, each strip slightly overlapping
the previous strip. This provides a smooth edge to the cast, and reduces irritation that
may occur from a rough edge or ‘crumbs’ of plaster falling down inside the cast.
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12.
Megan, a 13-year-old girl who broke her arm when she fell out of a tree, is going home
from the emergency department with a full-arm polyurethane cast. You need to give her
and her parents discharge instructions. In the table, list the things you would tell them to
do, and the things they should not do regarding her cast and injury.
Do’s
Don’ts
-apply ice over the fracture site for 24
hours
-get plaster of paris cast wet
-check w/MD before getting cast wet
-insert any foreign object inside cast
-dry cast thoroughly after exposure to
moisture
-bear weight on new cast for 48 hours—
make sure cast is made for weight
bearing
-elevate extremity above the heart for 48
hours
-move joints above and below cast
regularly
-remove any padding
-cover cast with plastic for prolonged
periods
-report signs of possible problems to MD
-keep appointment to have cast and
fracture checked
13.
What is compartment syndrome?
Compression of structures within closed compartments of the upper or lower extremities
formed by fascial sheaths or bone. A closed compartment may also be caused by an
externally applied circumferential dressing such as a cast or splint.
14.
Compartment syndrome is considered an emergency, but careful assessment can help
prevent problems. In the space below list early and late signs and symptoms of
compartment syndrome.
Early signs and symptoms:
Increased pain unrelieved by analgesics, pain with passive ROM, tingling, numbness
Late signs and symptoms:
Numbness of the extremity, tenseness of the compartment, loss of sensation, loss of
function, coolness of the extremity, pallor of the extremity, and most ominous, absence of
a peripheral pulse.
15.
List 4 things the nurse can do reduce the effects of compartment syndrome until
definitive treatment is done.
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a.
prevention or early recognition is key. Assess neurovascular status frequently in a
new post-surgical patient. If compartment syndrome is suspected, the physician should be
notified immediately
b.
the extremity should not be elevated because this raises venous pressure and
would exacerbate the problem
c.
ice should not be used on the extremity because it causes vasoconstriction and
may exacerbate the problem
d.
usually loosening or removing the cast or splint is necessary. Sometimes a
fasciotomy (surgically incising the fascia surrounding the compartment) is necessary to
relieve pressure in the compartment.
16.
When a client has a ‘total hip replacement’
what structures are actually replaced?
Darken those structures on the diagram.
The term ‘arthroplasty’ refers to the replacement or
joint. In the case of the hip, the trochanter, the femoral
acetabulum, or some combination of the three may be
depending upon the patient circumstances.
17.
revision of a
head, or
replaced,
In addition to routine post-operative care, the client with a hip replacement must be
positioned in a specific way. Describe the positioning of a client who has had a hip
replacement.
The patient is usually positioned in bed with the knees separated. A foam pillow or
bilateral knee immobilizers are often used to prevent adduction. The affected leg should
never cross the midline of the body. 90 degree flexion should be avoided, therefore
chairs, toilets, and commodes should be elevated. The patient should not sit in high
Fowler’s position while in bed, nor should they cross their legs when sitting in a chair.
18.
What is the device shown in the picture below?
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This is an abduction pillow and is used to
separate the knees of the patient who has
had hip replacement surgery. This prevents
adduction, and possible dislocation of the
new joint.
N155: Orthopedic care KEY