Mechanical Mobilization Mechanical Mobilization

Fundamental Nursing Skills and Concepts

Chapter 25

Cheryl Proffitt RN, MSN

October, 2015

Mechanical Mobilization Mechanical Mobilization• Learning Objectives

List at least three purposes of mechanical immobilization

Name four types of splints

Discuss why slings and braces are used

Explain the purpose of a cast

Name three types of casts

Describe at least five nursing actions that are appropriate when caring for clients with casts

Mechanical Immobilization Mechanical Immobilization• Learning Objectives Cont’d

Discuss how casts are removed

Explain what traction implies

List three types of traction

Name seven principles that apply to maintaining effective traction

Describe the purpose of an external fixator

Identify the rationale for performing pin site care

Mechanical Immobilization Mechanical Immobilization• Introduction

Mechanical immobilizations are used for clients with impaired mobility as a result from trauma or debilitating condition.

Orthoses – orthopedic devices that support or align body parts and prevent or correct deformities. Examples of orthoses are splints, immobilizers, and braces.

Purposes of Mechanical Immobilization

Purposes of Mechanical Immobilization

• Mechanical immobilization is usually used to treat musculoskeletal trauma in order to:

Reduce pain and muscle spasms; support and align skeletal injuries

Restrict movement and maintain functional position while injuries heal; allow activity while restricting movement of injured area

Prevents structural damage and Deformity

Mechanical Immobilizing DevicesMechanical Immobilizing Devices

• Splints- immobilizes and protects an injured body parts. Used before or instead of a cast

• Splint types include:

– Emergency

– Commercial

Inflatable

Traction

Emergency SplintsEmergency Splints

Inflatable SplintsInflatable Splints

Traction SplintsTraction Splints

Other SplintsOther Splints• Commercial splints

– More effective than improvised splints

– Include:

o Immobilizers , Inflatable splints

o Molded splints, traction splints

o Cervical collars

Mechanical Immobilizers Mechanical Immobilizers

Inflatable Splints or pneumatic splint, becomes rigid when filled with air.

• They control bleeding and swelling

Traction Splint are metal devices that immobilize and pull on contracted muscles. An example Thomas splint (fig 25-3)

Immobilizers made from cloth and foam and held in place by adjustable hook and loop tape. Such as velcro strap ( fig 25-4).

Mechanical Immobilizers Cont’d Mechanical Immobilizers Cont’dMolded splints used for chronic injuries or diseases.

They provide support and limit movement to prevent further injury and pain, and also maintain the body part in a functional position, preventing contractures.

Cervical Collars is a foam or rigid splint around

the neck, treatment for neck sprains or strains.

Worn continuously, , removed for gentle ROM

exercises.

Mechanical Immobilizing Devices Cont’d

Mechanical Immobilizing Devices Cont’d

• Slings- a cloth device that elevates, cradles and support parts of the body, applied to arms, legs

• Braces- custom made devices designed to support weakened muscles.

• Types of braces

– Prophylactic- reduces severity of joint injury. Rehabilitative protects operative joint during movement. Functional provides stability

Rehabilitative Brace & A slingRehabilitative Brace & A sling

CastsCasts

• Casts are rigid molds used to immobilize injured body structures after alignment. Applied to fractured bones. POP is used (Plaster of Paris)

– Types of casts

o Cylinder (may be bi-valved)

o Body (may be bi-valved)

o Spica

Casts Cont’d Casts Cont’d

• Cylinder Casts- covers the arms and legs, but leaves the toes or fingers exposed.

• Body Cast- encircles the trunk of the body, from the nipple line to the hips

• Bi-Valve Cast- cast is cut into two pieces lengthwise. Done when there is swelling, interfering with circulation, there is pain or the client is being weaned from the cast

• Spica Cast- encircles one or both the arms and legs and the chest or trunk. Upper body is called shoulder spica, lower body is called hip spica.

examples of Cast examples of Cast

Cast MaterialsCast Materials

Cast ApplicationCast Application

This procedure requires more than one person

Nurse prepares the client, assembles the client, assembles cast supplies, making appropriate assessments to prevent complications

(Refer to Skill 25-2 in the textbook.( Page 551-552)

Basic Casts Care (cont’d)Basic Casts Care (cont’d)• Cast Removal

• Cast are removed when they need to be changed and reapplied, or when the injury has healed sufficiently that the cast is no longer necessary. Casts are removed

– Electric cast cutter may frighten clients due to noise

– Skin care important after cast removal

Cast Removal Cast Removal

Basic Cast CareBasic Cast Care

TractionTraction

• Traction: pulling effect exerted on a part of the skeletal system. It is a treatment measure for musculoskeletal trauma and disorders

• It is Used

– Reduce muscle spasms; Realign bones

– Relieve pain; Prevent deformities

– Traction is from the clients own body wt.

Traction (cont’d)Traction (cont’d)• Traction types include:

– Manual-pulling on the body using muscular strength, to realign broken bone.(f-25-14

– Skin- pulling effect on the skeletal system by applying devices to the skin

– Skeletal-means pull exerted directly on the skeletal system by attaching wires,pins, or tongs into a bone

Examples of tractions Examples of tractions

Skin traction, Pelvic belt& cervical Halter

Mauual traction

Traction (cont’d)Traction (cont’d)

• Traction care

– External fixator-

– Pin site care to prevent infection

• Effective traction depends on consistent application of traction principles

Skin TractionSkin Traction

Traction CareTraction Care

(Refer to Skill 25-4 in the textbook.)

Principles for Maintaining Effective Traction

Principles for Maintaining Effective Traction

External FixatorsExternal Fixators

• Metal devices surgically inserted into or through one or more broken bones to stabilize during healing

Nursing Implications Nursing Implications

• Nursing diagnoses include:

– Acute pain; impaired physical mobility or bed mobility

– Risk for disuse syndrome, peripheral neurovascular dysfunction, impaired skin integrity, ineffective tissue perfusion

– Self-care deficit: bathing/hygiene

Risk for Peripheral Neurovascular Dysfunction

Risk for Peripheral Neurovascular Dysfunction

General Gerontologic ConsiderationsGeneral Gerontologic Considerations

• Common causes of hip fractures in older adults

• Longer healing time due to brittle bones

• Stiffer joints due to decreased synovial joint fluid

General Gerontologic Considerations (cont’d)

General Gerontologic Considerations (cont’d)

• Due to diminished tactile sensation, older adults may be unaware of skin pressure from cast, brace, etc.

• Remove indwelling catheters as soon as possible after surgery to prevent incontinence and urinary tract infections

• Cautious use of narcotics for pain management to avoid adverse effects

General Gerontologic Considerations (cont’d)

General Gerontologic Considerations (cont’d)

• Implement measures to increase bone density in older adults to prevent fractures:

– Drink liquid supplements high in nutrients; include protein, calcium, and zinc in diet to promote healing in a musculoskeletal injury

– Encourage sun exposure for vitamin D absorption

General Gerontologic Considerations (cont’d)

General Gerontologic Considerations (cont’d)

• Post-orthopedic surgery interventions for older adults

– Bladder training schedules to maintain or regain continence

– Appropriate rolling technique when using fracture-style bedpan

General Gerontologic Considerations (cont’d)

General Gerontologic Considerations (cont’d)

• Nonsurgical treatment of fractures of the upper extremities includes:

– Immobilization

– Occupational and physical therapy to regain function and range of motion

References References

Timby, B. (2009). Fundamental nursing skills and concepts (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Google pictures. (2015, August 10). Retrieved from http://www.google.com