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NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

APPLICATION BALANCED SKELETAL TRACTION


INDICATION:

1. To prevent or correct deformity


2. To maintain good body alignment
3. To provide pain immobilization
4. To reduce pain and muscle spasm, reduce fracture.

5. To support the affected area

PREPARATION PHASE:

1. Check for the doctor’s order


2. Inform and explain the purpose and procedure to the patient for easy installation and
cooperation
3. Assemble all equipment

• Thomas splint with Pearson attachment

• Rest splint

• 5 Slings (variable sizes)

• 5 Paper Clips or Safety pins


• Cord Sash (different length)
• Short – for thigh

• Long – for traction

• Longest – for suspension

• Weight’s and bags

• Traction wt. 10% of patient’s weight

• Suspension wt. (50% or ½ lighter than traction bag)

• Foot support – (prevent foot drop)


Parts of an Orthopedic Bed
1. Firm Mattress
2. Fracture Board
3. Bed Elevator or Shock Block
4. Balkan Frame
o 4 Vertical bars

o 2 Horizontal bars

o 1 diagonal bar

o 1 Straight bar or cross bar


1 JOSEPH MANUEL RADAM DIVINE WORD COLLEGE OF BANGUED College of
Nursing
NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

o 1 Curve bar (optional)

5. 3 Pulleys with the clamps (hold place)


6. Overhead Trapeze
PROCEDURE PHASE:

1. Mount Thomas splint to Pearson’s attachment

• Upper part is Thomas splint, which support the thigh


• Lower part is the Pearson’s attachment, which will support the leg

• Check alignment of screw of Pearson’s with knee joint


2. Attach / apply Rest splint to Thomas splint and Pearson attachment

3. Apply slings to Thomas splint and Pearson attachment

• Start from thigh area (Thomas splint) then to leg area (Pearson attachment)

• From medial to lateral upright

• Wider and long slings at thigh area

• Smooth / right side should be touching or in contract the patient’s skin

• Provide space or 1 inch apart between the slings for ventilation and prevent irritation

• Popliteal and heel / sole of the foot should be free sling

• Apply not to lose or not too tight to support and follow contour of leg
4. Tie the short rope (thigh rope) to medial portion of the Thomas splint with Slip Knot

• Provide privacy
5. Apply the prepared set-up to the patient

• 3 Manpower Apply manual traction

• Apply manual traction

• Lifting the affected leg removing the Braun Bohler

• Insert the prepared set-up

• At the count of 3 do simultaneously

• Instruct the patient to flex the unaffected leg

• Hold on to the overhead trapeze

• Lift the buttocks


6. Tie the longer rope to the Steinmann’s pin (slip knot), pass the 3rd pulley then hang and
tie the traction weight bag (any kind of knot will do, securely tied and will not fall)
7. Finish or tie the other end of the short rope to the lateral aspect of the Thomas splint
8. Tie the longest rope to the middle of the short rope (slip knot)
• Insert to the 1st pulley

• Hang the suspension weight bag and anchor to the clamp


2 JOSEPH MANUEL RADAM DIVINE WORD COLLEGE OF BANGUED College of
Nursing
NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

• insert the rope to the 2nd pulley


9. Tie to the Tomas splint using the clove hitch knot then to Pearson attachment.

• Be sure the rope is outside the traction rope

• Outside / under the rest splint (removed later)


10. Release suspension weight bag

• Check alignment of the traction


• 1st pulley – in line with inguinal area
• 2nd pulley – in line with the knee
• 3rd pulley – in line with the 1st and 2nd
11. Apply foot support using Ribbon Knot
12. Remove the Rest splint

13. Check the efficiency of the traction

• Flex the unaffected side

• Hold on the overhead trapeze

• Swing the affect leg

PRINCIPLES OF TRACTION APPLICATION

• Have an opposite pull or counter traction

• Line of pull should be in line of deformity

• Traction should be continuous


• Position of the point should be dorsal recumbent or supine

• Avoidance of friction
a) Weight should be hanging freely
b) Observe for signs of wear and tear on the ropes and bag
c) Rope should run freely along the grove of the pulley

NURSING CARE

1.) General hygiene and comfort

• Skin care

• Hair care

• Nail care

• Oral and perineal care

• Sponging of affected leg

3 JOSEPH MANUEL RADAM DIVINE WORD COLLEGE OF BANGUED College of


Nursing
NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

2.) Conditioning exercises

• Deep breathing
• Coning exercise

• Address ROM exercise


• Static quadricep exercise

• Dorsiflexion and plantar flexion of leg


3.) Provide diversional activities –increase coping mechanics for boredom

4.) Meeting nutritional needs – protein, vitamin c, calcium


5.) Working pertinent observation

COMPLICATION AND NURSING MANAGEMENT

a) Hypostatic pneumonia
Deep breathing
Keep back dry
b) Bed sore /decubitus ulcer

Linen free from wrinkles/ creases


Keep back dry, lift buttock
c) Joint contractor and muscleatrophy

• Active exercise (unaffected)

• Isometric (affected)
d) Constipation

• Fluid intake

• High roughage diet

• Exercise
• Offer bedpan
e) Infection

• Meticulous wound care


REMOVAL

1) Attach the rest splint

2) Anchor the suspension weight to the pulley

3) Remove the suspension rope

4) Apply manual traction


5) Remove traction weight. Tie the rope the rest splint, Thomas splint and Pearson’s
attachment using the clove hitch knot. (READY TO TRANSFER)

4 JOSEPH MANUEL RADAM DIVINE WORD COLLEGE OF BANGUED College of


Nursing
NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

TRACTIONS
TYPES INDICATION
1. BALANCE SKELETAL TRACTION Fracture of hip and femur
2. BOOST CAST TRACTION Post polio with residual paralysis
3. BRYANT TRACTION Fracture of hip and femur. For Congenital Hip
Dislocation
4. BUCK’S EXTENSION TRACTION Fracture of hip and femur
5. COTREL TRACTION For Scoliosis
6. CRUTCHFIELD ONG Fracture of cervical spine
7. DUNLOP TRACTION Fracture of the supracodylar of the humerus
8. HALO-FEMORAL TRACTION For Scoliosis
9. HALO-PELVIC TRACTION For Scoliosis (severe)
10. HAMMOCK SUSPENSION Fracture of the pelvis
TRACTION
11. HEAD HALTER TRACTION Fracture of the cervical spine
12. 90 90 DEGREES TRACTION Fracture of the subtrochanteric
13. OVERHEAD TRACTION Fracture of the supracondyle of humerus
14. PELVIC GIRDLE Fracture of the lumbar spine. For Herniated
nucleus Polposus
15. VINKE’S CALLIPER Fracture of the cervical spine
16. ZERO DEGREE TRACTION Fracture of the surgical humerus
17. Stove in chest Multiple rib fractures

BRACES
TYPES INDICATOR
1. BANJO SPLINT Peripehral nerve injury
2. BILATERAL LEG BRACE Post polio with residual paralysis,
3. CHAIR BACK BRACE Lumbo-sacral affection
4. COCKED-UP SPLINT Prevention of wrist drop
5. DENNIS BROWN SPLINT Club foot deformity
6. FORESTER BRACE Cervico-thoraco-lumbar spine affection
7. FOUR POSTER BRACE Cervical spine affection
8. JEWETTE BRACE Dorso-lumbar spine fracture
9. KNIGHT/TAYLOR BRACE Upper spine fracture
10. MILWAUKEE BRACE Scoliosis
11. OPPEN HEIMER SPLINT/LIVELY Peripheral nerve injury
FINGER
12. PHILADELPHIA COLLAR Cervical spine affection (thick)
13. SHANTZ COLLAR Cervical spine affection (soft)
14. UNILATERAL LEG BRACE Post polio with residual paralysis
15. YAMAMOTO BRACE scoliosis

GADGETS HARDWARE
TYPES INDICATOR
Crutch field Tong Cervical Spine
Circlage Wiring Patella
Gigli saw For amputations
Antibiotic bead Osteomyelitis
5 JOSEPH MANUEL RADAM DIVINE WORD COLLEGE OF BANGUED College of
Nursing
NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

X pinning/Y bone pinning Supracondylar fx of the humerus


Roger Anderson External Fixator (RAEF) Comminuted fracture of long bones
Total knee Arthroplasty (TKA) Tibial & Femoral components Degenerative joint
disease (osteoarthritis)
Harrington Rod Instrumentation Scoliosis
Hybrid External Fixator Periarticular injuries such as your knee & ankle
joints
Ilizarov external Fixator Mal-union, bone loss & bone lengthening
Total replacement Hip Arthroplasty Femoral head, femoral neck including acetabulum
(TRHA)
Partial replacement Hip Prosthesis Femoral head and neck fracture
(PRHP)
Compression Hip screw Fixation (CHSF) Intertrochanteric fracture
Tower/Interdental Wiring Fracture of mandible
Intramedullary Nailing Fracture middle 3rd femur
Tibidal Femural component Degenerative uses
T-plate or buttress planting Proximal tibia
Planting with Screw Radius ulna fracture
Hoffmann external fixator Fracture of pelvis
Spacer antibiotic Infected hip prosthesis
Delta frame Periarticular injuries such as your knee & ankle
joints

3 PRINCIPLES IN MANAGEMENT OF FRACTURE:

1. Close or Open Surgery – reduction


2. Immobilization – Traction, brace, cast
3. Rehabilitation – restoration of function, Physical Therapy exercise OT & Surgery

6 JOSEPH MANUEL RADAM DIVINE WORD COLLEGE OF BANGUED College of


Nursing