Mechanical Mobilization Fundamental Nursing Skills and Concepts Chapter 25 Cheryl Proffitt RN, MSN October, 2015

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 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 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 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 Devices Splints- immobilizes and protects an injured body parts. Used before or instead of a cast Splint types include: Emergency Commercial Inflatable Traction

Emergency Splints

Inflatable Splints

Traction Splints

Other Splints Commercial splints More effective than improvised splints Include: Immobilizers , Inflatable splints Molded splints, traction splints Cervical collars

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 Molded 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 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 sling

Casts 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 Cylinder (may be bi-valved) Body (may be bi-valved) Spica

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

Cast Materials

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

Basic Cast Care

Traction 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 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 Mauual traction Skin traction, Pelvic belt& cervical Halter

Traction (cont’d) Traction care External fixator- Pin site care to prevent infection Effective traction depends on consistent application of traction principles

Skin Traction

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

Principles for Maintaining Effective Traction

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

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

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

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) 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) 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) Nonsurgical treatment of fractures of the upper extremities includes: Immobilization Occupational and physical therapy to regain function and range of motion

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