By :Miss. Sanaa AL-Sulami

Definition of TractionIndication for TractionClassification of Traction Complications of TractionAssessment and Diagnostic Evaluation of TractionPrinciples to follow when caring for the patient in tractionTypes of Traction Nursing Management

At the end of this lecture the students will be able to:Define the traction discuss the indication for traction List the classification of traction list the complications of traction Describe the assessment of client with tractionDiscuss the Principles to follow when caring for the patient in tractionList the types of tractionDiscuss the nursing management for client with traction

Traction is the application of a pulling force to a part of the body.

Traction must be applied in the correct direction and magnitude to obtain its therapeutic effects.

Indications:

Traction is used to To minimize muscle spasm. To reduce align, and immobilize fractures To reduce deformity .

Classification of Traction :Skin Traction : is maintained by direct application of a pulling force on the clients skin . It is generally used as a temporary measure. To reduce muscle spasms To maintain immobilization before surgery.

Skeletal Traction : is attaches directly to bone , providing a strong steady, continuous pull, and can be used for prolonged periods .

Classification of Traction :The amount of weight used depends on the injury, pathologic condition, body size, and degree of muscle spasm.Manual Traction :is applied with hands to temporarily immobilize an injured part. A firm, smooth, steady pull is maintained . Manual Traction is used during casting, reduction of a fracture or dislocated joint.

complications:potential complications that may develop include the following:Neurovascular compromise.Inadequate fracture alignment..Skin breakdown .Soft tissue injury.

complications:potential complications that may develop include the following:Pin tract infection .Osteomyelitis can occur with skeletal traction.In additional, complications from immobility can be encountered , especially with long term traction and in older adult.

The nurse must be consider the psychological and physiological impact of the musculoskeletal problem, traction device, and immobility.

The nurse must assess and monitor the patients anxiety level and psychological responses to traction.

It is important to evaluate the body part to be placed in traction and its neurovascular status and compare it to the unaffected extremity. As long as the client is in traction, skin integrity must be assessed and documented, examining especially for redness, bruises, and lacerations.

Radiological Evaluation while the client is in traction determines the extent of injury, maintenance of bony alignment, and the progress of healing.

Additional principles to follow when caring for the patient in traction:

Traction must be continuous to be effective in reducing and immobilizing fractures.Skeletal traction is never interrupted. weights are not removed unless intermittent traction is prescribed.Any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated:

The factor that might reduce the effective pull or alter its resultant line of pull must be eliminated:The patient must be in good alignment in the center of the bed when traction is applied.Ropes must be unobstructed.Weights must hang free and not rest on the bed or floor .Knots in the rope or the footplate must not touch the pulley or the foot of the bed.

Types of Traction : Cervical skeletal tongs; Gardner-wells crutch field vinke

Halo vest

Skin chin halter straps

Types of Traction : Lower Extremity Bryants Traction

Bucks Traction

Balanced Traction

Nursing Management: Alteration in Peripheral Tissue Perfusion:Circulatory Care: tissue perfusion is enhanced by client exercises within the limitations of the traction.Exercises, regular deep breathing and coughing, adequate fluids, and elastic stocking work together to prevent deep venous thrombosis.Teaching the client about anti-coagulant is essential.

Nursing Interventions: High risk for peripheral neurovascular dysfunction:Peripheral sensation management : Accurate assessment of neurovascular status includes evaluating the clients pain, sensation, active and passive ROM, color, temperature, capillary refill time, and pulses.Neurologic impairment specific to the location of the traction should be assessed.The client must be instructed to report changes in sensation.Taught the client about the appropriate exercises.

Nursing Interventions:Providing pin site care:The wound at the pin insertion site requires attention . The goals to avoid infection and development of osteomyelitis.Initially : 1. the site is covered with sterile dressing. 2. the nurse must keep the area clean. 3. Slight serous oozing at the pin site is expected. 4. the nurse assess the pin site and drainage for signs of infection.

Nursing Interventions: Attaining maximum mobility with traction:During traction therapy: 1. The nurse encourage the patient to exercise muscles and joints that are not in traction to guard against their deterioration.During the patient exercises :1. The nurse ensures that traction forces are maintained and that the patient is properly positioned to prevent complications resulting from poor alignment.

Nursing Interventions: Maintaining the positioning :The nurse must maintain alignment of the patients body in traction as prescribed to promote an effective line of pull. The nurse positions the patients foot to avoid foot drop , inward rotation, and outward rotation.The patients foot may be supported in a neutral position by orthopedics devices.

Nursing Interventions: Monitoring and managing potential complications:Pressure UlcersThe nurse examines the patients skin frequently for evidence of pressure or friction.It is helpful to reposition the patient frequently and to use protective devices to relieve pressure. If the risk of skin breakdown is high, as in a patient with multiple trauma or a debilitated elderly patient, use of a specialized bed is considered to prevent skin breakdown. If a pressure ulcer develops, the nurse consults with the physician and the wound care nurse specialist.

Monitoring and managing potential complications:

PneumoniaThe nurse auscultate the patients lungs every 4 to 8 hours to determine respiratory status and teaches the patient deep-breathing and coughing exercises to aid in fully expanding the lungs and moving pulmonary secretions. If the patient history and baseline assessment indicate that the patient is at high risk for development of respiratory complications, specific therapies may be indicated. If a respiratory problem develops, prompt institution of prescribed therapy is needed.

Monitoring and managing potential complications:

Venous Stasis and Deep Vein ThrombosisVenous stasis occurs with immobility. The nurse teaches the patient to perform ankle and foot exercises within the limits of the traction therapy every 1 to 2 hours when awake to prevent DVT, which may result from venous stasis. The patient is encouraged to drink fluids to prevent dehydration. The nurse monitors the patient for signs of DVT, including calf tenderness, warmth, redness, swelling (increased calf circumference).

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