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What is traction?
*application of a pulling force to a part of the body to provide reduction, alignment, and rest
*used to decrease muscle spasms (relieving pain) and prevent/correct deformity and tissue damage
What is the difference between running traction and balanced suspension?
*Running traction-the pulling force is in one direction and the pt's body acts as countertraction. If bed or pt is moved, the counteraction force is altered.
*Balanced suspension-provides the coutertraction so that the pulling force or the traction is not altered when the bed or pt is moved. Allows for increased movement and facilitates care
What are the two most common types of traction?
- skin- involves a boot called buck's traction;
- primary function is to decrease muscle spasms; weight is 5-10lbs to prevent injury to skin
skeletal-pins/screws in bone, allow longer use of traction time and weight of 15-30lbs; bone relaignment
What is Russell traction
-knee is suspended in sling 20 degrees above bed
-upward and forward pulley system
-allows for slight turning movement to change linens, bedpan
What is Bryants traction?
-used for developmental dislocated hips in children
-keeps femor in hip socket
-bandages, weights, both legs in the air
What is pelvic traction?
-treats back and hip pain
-snug belt around hips attached to a spreader bar that has weights perscribed by physician
What is the nurses role in the management of traction? (6)
-inspect q 8-12hrs, ropes, pulleys and knots for loosening, fraying, and positioning
-check weight w perscription order
-keep weights off of floor
-if pt reports severe pain weights may be too heavy or pt may need realigned
-monitor circulation q hr for 24 hrs then q 4 hrs thereafter
-inspect skin q 8 hrs
What are some relief measures for pt's in traction/
-opiod (pain) NSAIDS (inflammation)
-ice/elevation for swelling/pressure
-heat/massage for muscle spasms
Common charateristics of amputation
-elective: complications of peripheral disease (diabetes, arteriosclerosis), lower extremity, more common
-traumatic: result from accident, more common in upper extremeties
What are some complications of amputations?
- Phantom limb pain
- Flexion contractures
what is the difference between an open (guillotine) amputation and a closed amputation
-open amputation is when the dead tissue is removed and the surgeon leaves the skin and nerves pulled back from the amputation site for 10-14 days to ensure there is not infection
-closed amputation is when the skin flaps are sewn together over the amputation site after the 10-14 day period or if the surgeon is sure of a decreased risk for infection
What is Phontom Limb Pain and name some charactertistics?
-sensation is felt is the amputation part immediately after sx and usually diminishes over time; more ocmmon in chronic limb pain
-pt c/o burning, crushing, cramping, uncomfortable position, numbness and tingling, pain
-pain can be triggered from touching the residual limb, changes in temperature, stress, fatigue, anxiety, touching any body part(stimulation)
-tx pain as though it is real
What is neuroma?
-a sensitive tumor consisting of damaged nerve cells-forms most often in amputations of the upper extremeties but can occur anywhere
-dx with ultrasound, tx surgically but often grows back and is more painful; non-sx steroid injections, nerve blocks, hypnosis
how can you avoid flexion contractions in an amputation pt?
-often in hip/knee amputation
-proper positioning, and active ROM exercises help prevent
What types of circulations assesments need to be checked for an amputation pt?
-neurovascular assessment (if pt has peripheral vascular disease check both legs)
-Assess skin color, temp, sensation, pulses, capillary refill(least effective)
what is the emergency care to provide for a traumatic amputation?
-assess for airway/breathing
-examine site, apply direct pressure w layers of dry guaze, clean gloves
-elevate extremity above pt heart to decrease bleeding
-do not remove dressing to prevent dislodging the clot
what do you do with a amputated finger (limb)?
- -wrap in dry sterile gauze/clean cloth
- -put is watertight, sealed plastic bag
- -place bag in ice water never directly on ice (1 part ice to 3 parts water)
- -part goes with pt to hospital
what is the nurses primary focus for an amputation pt?
-monitor for signs indicating tissue perfusion but no hemorrhage
-residual limb should be pink, warm, assess closest proximal pulse
-pain management for PLP, opiods not as effective calcitonin will reduce plp pain; beta-blockers for burning, antipileptic for sharp pain and antispasmodics for spasms
what therapies can be percribed for amputaiton pts
- ultrasound therapy
- relaxation therapy
- TENS (transcutaneous electrical nerve stimulation)
what can the pt be taught for amputation/prosthesis
-practice prior to sx for easier ambulation after sx
-how to perform ROM exercises, turn q 2 hrs
-firm mattress q 3-4 hrs for 20-30 mins in prone position
-pull residual limb close to other leg and squeeze buttocks for muscle strengthening
-push residaul limb towards bed with soft pillow, then firm pillow, then hard surface to decrease PLP
what are some ways to reduce the size of residual limb for prosthesis
-Rigid, removeable dressings: decrease edema, rotect shape, easy access for wound inspection
-Elastic bandages: reapply q 4-6 hrs, use figure eight, decrease tightness when wrapping residual end