Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 25 Mechanical Immobilization

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Mechanical immobilization of a body part can relieve muscular pain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Most clients who require mechanical immobilization have suffered trauma to the musculoskeletal system. Mechanical immobilization relieves muscular pain and spasms.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Splints Splint types include: –Emergency –Commercial –Inflatable –Traction

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A splint is a device that mobilizes and protects an injured body part.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. A splint is a device that immobilizes and protects an injured body part. Splints are used before or instead of casts or traction.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Emergency Splints

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Inflatable Splints

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Traction Splints

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Splints Commercial splints –More effective than improvised splints –Include: oImmobilizers oMolded splints, cervical collars

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Mechanical Immobilizing Devices Slings Braces Types of braces –Prophylactic –Rehabilitative –Functional

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Braces that allow protected motion of an injured joint that has been treated operatively are called rehabilitative braces.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Braces that allow protected motion of an injured joint that has been treated operatively belong to the category of rehabilitative braces.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Rehabilitative Brace

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Casts Casts are used to immobilize injured body structures –Types of casts oCylinder (may be bivalved) oBody (may be bivalved) oSpica

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Cast Materials

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Cast Application (Refer to Skill 29-1 in the textbook.)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Casts (cont’d) Cast application and care Cast removal –Electric cast cutter may frighten clients due to noise –Skin care important after cast removal

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Cast Care

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Traction Traction is used to: –Reduce muscle spasms –Realign bones –Relieve pain –Prevent deformities

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Traction (cont’d) Traction types include: –Manual –Skin –Skeletal

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Traction (cont’d) Traction care –External fixator –Pin site care to prevent infection Effective traction depends on consistent application of traction principles

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Skin Traction

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Traction Care (Refer to Nursing Guidelines 25-3 in the textbook.)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles for Maintaining Effective Traction

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins External Fixators Metal devices surgically inserted into or through one or more broken bones to stabilize during healing

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question An external fixator is inserted through which body part? a. Nostrils b. Broken bones c. Mouth d. A gaping wound in the leg

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. Broken bones An external fixator is a metal device inserted into and through one or more broken bones to stabilize fragments during healing.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk for Peripheral Neurovascular Dysfunction

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General 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

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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