SKELTEL 2

• Well-padded and wrapped with an elastic bandage

  • Braces
• Braces


  Used to provide support, control movement, and prevent additional injury
• Braces


  • Custom fitted and adjusted for fit, positioning and motion
  • Indicated for longer use than the splint
  • Usually they give you braced if it if they expect long immobilization
• Cast


  A rigid external immobilizing device that is molded to the contour of the body
• Cast


  • Used to immobilize a reduced fracture, to correct a deformity, to apply uniform pressure to underlying soft tissue or to support and stabilize weakened joints
  • Joints proximal and distal to the area immobilized are included in the cast
• Types of Cast


  • Short-arm cast
  • Long-arm cast
  • Short-leg cast
  • Long-leg cast
  • Walking cast
  • Body cast
  • Shoulder spica cast
  • Hip spica cast
• Fiberglass cast


  Exothermic reaction while cast is applied<|>Handled with the palm of the hands and not allowed to rest on hard surfaces or sharp edges can be dented when sitting
• Plaster cast


  Less costly and achieve better mold<|>Not as durable and take longer to dry<|>Also cause an exothermic reaction<|>Requires 24 - 72hrs to dry and complete<|>If dented it imo cast tatanggalon ito
• Splints


  For those that do not that do not require rigid immobilization, for those in which swelling may be anticipated,and and for those that require special skin care<|>Immobilize and support the body part in a functional position
• General Nursing Management


  1. Assess the patient's general condition, status and understanding of the need for the device. Educate the patient on what to expect when on a cast

  2. Physical assessment to include neurovascular status. Because of the risk of nerve injury

  3. Educate patient on pathologic condition and expectation of treatment

  4. Evaluate pain associated with musculoskeletal condition

  5. Encourage mobility of joints that are not immobilized

  6. Observe for signs of complications associated with the device

  7. Monitor circulation, motion and sensation of affected extremity compared to normal

  8. Monitor and manage potential complications
• Compartment syndrome


  Increased tissue pressure within a limited space that compromises the circulation and function of the tissue within the confined area<|>It is a surgical emergency wherein they are going to incise the site to relieve the pressure<|>Cast is cut in half and the extremity is elevated no higher than heart level<|>Fasciotomy may be necessary<|>Nurse: monitors response to management and neurovascular response with prompt reporting
• Pressure Ulcer


  Reports pain and tightness in the area. If there is pain and tightness the cast will be removed and the site will be recast.<|>Erythema or skin breakdown may occurx stain or odor might be noted<|>Nurse: monitor the patient with a cast or brace for pressure ulcer development and report findings to the physician
• Disuse syndrome


  Muscle atrophy and loss of strength due to immobilization<|>Nurse: teach patient isometric contractions to prevent atrophy. Mga tonic contractions la ito hira<|>Isometric exercises should be performed hourly while the patient is awake.
• Nursing Management (Upper extremity immobilization)

  1. Suggest devices designed to aid one-handed activities

  2. Elevate arm to control swelling

  3. Watch out for impaired circulation (Volkmann's Contracture). Volkmann's contracture is a type of compartment syndrome where in the blood flow to fingers and wrist is restricted

  4. Neurovascular checks must be done frequently
• Nursing Management (Lower extremity immobilization)

  1. Patient's leg must be supported on pillows to heart level to control swelling.

  2. Ice packs applied as prescribed over the fracture site for 1-2 days.

  3. Elevate the immobilized leg when seated.

  4. Assess circulation by observing the color, temperature, and capillary refill of the exposed toes.

  5. Assess nerve function
• External Fixator


  Used to manage open fractures with soft tissue damage.<|>Provide stable support for severe comminuted (crush or splintered) fractures while permitting active treatment of damaged soft tissues.<|>Fracture is reduced, aligned, and immobilized by a series of pins inserted in the bone.
• Nursing Management (External Fixator)

  1. Early mobility is anticipated: promotes acceptance of the device

  2. Control or reduce swelling

  3. Control sharp points on the fixator or pins to prevent device-induced injuries

  4. Monitor neurovascular status of the extremity every 2-4hrs. If the patient is already for discharge, educate them about the 5P's

  5. Watch out for potential problems caused by pressure from the device on the skin, nerves or blood vessels and for the development of compartment syndrome

  6. Prevent pin tract infection
• Traction


  The application of a pulling force to a part of the body<|>Used to minimize muscle spasm<|>To reduce, align and immobilize fractures<|>To reduce deformity; and increase space between opposing surfaces<|>Must be applied in the correct direction and magnitude to obtain its therapeutic effects<|>At times, traction needs to be applied in more than one direction to achieve the desired line of pull
• Traction


  • Whenever traction is applied, countertraction must be used to achieve effective traction. Counter traction is to keep one end in place
  • Skeletal traction is never interrupted.
  • Weights are not removed unless intermittent traction is prescribed. (e.g., Apply traction for 2hrs and then rest for 1hr)
  • Any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated:
• Types of Traction


  • Straight or running tractions
  • Balanced suspension traction
  • Skin tractions
  • Buck's Extension Traction
  • Skeletal Traction
• Nursing Interventions (Traction)


  1. Ensuring effective traction

  2. Maintaining effective traction

  3. Maintaining Positioning

  4. Preventing skin breakdown

  5. Neurovascular assessment

  6. Providing pin site care

  7. Promote exercise
• Skin breakdown


  Inspect the skin, the ankle, and the achilles tendon 3x a day<|>Palpate the area if the traction ta
• Traction


  • Frequently used 7-12kg (15-25lbs) to achieve the therapeutic effect
• Nursing Interventions


  1. Ensuring effective traction

  2. Maintaining effective traction

  3. Maintaining Positioning

  4. Preventing skin breakdown

  5. Neurovascular assessment

  6. Providing pin site care

  7. Promote exercise
• Maintaining effective traction


  1. Ensure that the ropes are in the wheel grooves of the pulleys, that the ropes are not frayed, that the weights hang freely, and that the knots on the rope are tier securely

  2. Evaluate the patient's positioning
• Maintaining Positioning


  Maintain alignment of the patient's body in traction as prescribed to promote an effective line of pull
• Neurovascular assessment


  Assess neurovascular status at least every hour initially then every 4 hours
• Providing pin site care

  1. Goal is to avoid infection and development of osteomyelitis

  2. Performed initially 1-2 times a day

  3. Inspect the pin site every 8 hours for reaction
• MONITORING AND MANAGING POTENTIAL COMPLICATIONS

  1. Skin breakdown

  2. Nerve damage

  3. Circulatory Impairment

  4. Atelectasis and Pneumonia

  5. Constipation and Anorexia

  6. Urinary Stasis and Infection

  7. Venous Thromboembolism
• Monitoring and managing skin breakdown


  1. Inspect the skin, the ankle, and the achilles tendon 3x a day

  2. Palpate the area if the traction tapes daily to detect underlying tenderness

  3. Provide back care at least every 2 hours to prevent pressure ulcers

  4. Uses special mattress overlays
• Monitoring and managing nerve damage

  1. Regularly assess sensation and ask the patient to move toes and foot

  2. Immediately investigate complaint of burning sensation under the traction bandage or foot
• Monitoring and managing circulatory impairment

  1. Assess circulation of the foot within 15-30 mins initially then every 1-2 hours

  2. Assess peripheral pulses, color, capillary refill, and temperature of the fingers or toes

  3. Observe for indicators of DVT
• Monitoring and managing atelectasis and pneumonia

  1. Auscultates the patient's lungs every 4-8 hours to assess respiratory status

  2. Teach deep-breathing and coughing exercises
• Monitoring and managing constipation and anorexia

  1. Diet high in fiber and fluids may help stimulate gastric motility

  2. Stool softeners, laxatives, suppositories and enemas
• Monitoring and managing urinary stasis and infection

  1. Monitors the fluid intake and the character of the urine

  2. Encourage to consume adequate amounts if fluid and void every 3-4 hours
• Monitoring and managing venous thromboembolism

  1. Perform ankle and foot exercises within the limits of the traction therapy every 1-2 hours when awake to prevent DVT

  2. Encourage to drink fluids to prevent dehydration and associated hemoconcentration

  3. Monitor patient for signs of DVT, including unilateral calf tenderness, warmth, redness, and swelling

  4. Encourage patient to exercise muscles and joints that are not in traction to prevent deterioration, deconditioning, and venous stasis
• Indications for orthopedic surgery

  • Age
  • Underlying orthopedic condition
  • General physical physical health
  • Impact of joint disability on daily activities
• Surgery should be performed before surrounding muscles become contracted and atrophied and serious structural abnormalities occur
• Joint replacement


  • Most joint replacements consists of metal and high-density polyethylene components
  • Excellent pain reliefs is obtained in most patients
  • Return of motion and function depends on the preoperative soft tissue condition, soft tissue reactions, and general muscle strength
  • Early failure of joint replacement: excessive activity and preoperative joint and bone pathology
• Nursing Intervention for joint replacement

  1. Preop: evaluate cardiovascular, respiratory, renal and hepatic functions

  2. Preop: assess neurovascular status of extremity undergoing joint replacement

  3. Preventing infection: prophylactic antibiotics given 60 mins prior to incision

  4. Promoting ambulation: assist the patient in achieving the goal of independent ambulation