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Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1
Types of TractionTypes of Traction
Bryant’s traction: used for children younger Bryant’s traction: used for children younger than 3 years and weighing less than than 3 years and weighing less than 35 pounds who have a fractured femur or 35 pounds who have a fractured femur or congenital hip dyplasiacongenital hip dyplasia
Buck’s traction: used for knee immobilization Buck’s traction: used for knee immobilization or for short-term immobilization of a fractureor for short-term immobilization of a fracture
Dunlop’s traction: used for supracondylar Dunlop’s traction: used for supracondylar fractures of the humerusfractures of the humerus
Russell’s traction: used for fractures of the Russell’s traction: used for fractures of the femur and lower legfemur and lower leg
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2
Types of TractionTypes of Traction
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3
Types of TractionTypes of Traction
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4
Disadvantages of TractionDisadvantages of Traction
Need for hospitalizationNeed for hospitalization Prolonged immobilityProlonged immobility Always assume that traction is continuous Always assume that traction is continuous
unless the physician states otherwiseunless the physician states otherwise
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5
Physiologic Effects of ImmobilizationPhysiologic Effects of Immobilization
Directly or indirectly relate to decreased Directly or indirectly relate to decreased muscle activity and have an impact on all muscle activity and have an impact on all systemssystems
IntegumentaryIntegumentary Red or irritated skinRed or irritated skin Presence of ulceration or drainagePresence of ulceration or drainage
GastrointestinalGastrointestinal Decreased mobility leads to constipationDecreased mobility leads to constipation
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6
Physiologic Effects of ImmobilizationPhysiologic Effects of Immobilization
RespiratoryRespiratory Lying supine for prolonged periods leads to Lying supine for prolonged periods leads to
altered respirationsaltered respirations GenitourinaryGenitourinary
Decreased urinary output from stasis or retentionDecreased urinary output from stasis or retention MusculoskeletalMusculoskeletal
Significant loss of muscle strength, endurance, Significant loss of muscle strength, endurance, and muscle massand muscle mass
Bone demineralizationBone demineralization Loss of joint mobilityLoss of joint mobility
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7
Psychologic Effects of ImmobilizationPsychologic Effects of Immobilization
Immobilization narrows the amount and Immobilization narrows the amount and variety of environmental stimuli a child variety of environmental stimuli a child receives through the sensesreceives through the senses
Physical interference with the activities of Physical interference with the activities of infants and young children gives them a infants and young children gives them a feeling of helplessness and has been found to feeling of helplessness and has been found to affect speech and language developmentaffect speech and language development
Sensory deprivation in the school-age child Sensory deprivation in the school-age child and adolescent leads to feelings of isolation, and adolescent leads to feelings of isolation, boredom, and being forgotten, especially by boredom, and being forgotten, especially by peerspeers
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8
The struggle for independence in each of The struggle for independence in each of Erikson’s phases is thwarted by imposed Erikson’s phases is thwarted by imposed immobilityimmobility Toddlers: need exploration and the ability to Toddlers: need exploration and the ability to
imitate behaviors to develop a sense of autonomyimitate behaviors to develop a sense of autonomy Preschoolers: expression of initiative is evidenced Preschoolers: expression of initiative is evidenced
by their need for vigorous physical activityby their need for vigorous physical activity
Psychologic Effects of ImmobilizationPsychologic Effects of Immobilization
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9
Psychologic Effects of ImmobilizationPsychologic Effects of Immobilization
School-age: industry is influenced by School-age: industry is influenced by physical achievement and competitionphysical achievement and competition
Adolescence: rely on mobility to achieve Adolescence: rely on mobility to achieve independence, one of the steps in creating independence, one of the steps in creating their identitytheir identity
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10
Behavioral Changes Behavioral Changes in Immobilized Childrenin Immobilized Children
Changes related to high levels of anxietyChanges related to high levels of anxiety RestlessnessRestlessness DepressionDepression RegressionRegression EgocentrismEgocentrism Difficulty with problem solvingDifficulty with problem solving Inability to concentrate on activitiesInability to concentrate on activities
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11
Behavioral Changes Behavioral Changes in Immobilized Childrenin Immobilized Children
Changes related to monotonyChanges related to monotony Hallucinations Hallucinations DisorientationDisorientation Dependence Dependence DepressionDepression Acting-out behavior Acting-out behavior Increased fantasizingIncreased fantasizing Sluggish intellectual responsesSluggish intellectual responses Sluggish psychomotor responsesSluggish psychomotor responses Decreased communication skillsDecreased communication skills
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12
Nursing ConsiderationsNursing Considerationsfor the Child in a Cast or in Tractionfor the Child in a Cast or in Traction
Monitor for complications of fracture reductionMonitor for complications of fracture reduction Infection Infection Nerve compression syndromeNerve compression syndrome Kidney stonesKidney stones Pulmonary emboli Pulmonary emboli Circulatory impairmentCirculatory impairment Fat embolism (pulmonary embolism)Fat embolism (pulmonary embolism)
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13
Nursing ConsiderationsNursing Considerationsfor the Child in a Cast or in Tractionfor the Child in a Cast or in Traction
Keep cast or other appliance clean and dry Keep cast or other appliance clean and dry (especially from urine or feces)(especially from urine or feces)
Monitor bowel soundsMonitor bowel sounds Assess for abdominal distentionAssess for abdominal distention Provide optimal nutrition for bone healing, Provide optimal nutrition for bone healing,
growth, and developmentgrowth, and development
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14
Nursing ConsiderationsNursing Considerationsfor the Child in a Cast or in Tractionfor the Child in a Cast or in Traction
Neurovascular assessment every 1 to 2 Neurovascular assessment every 1 to 2 hours after application of devicehours after application of device
Assessment of strength of pulse distal Assessment of strength of pulse distal to the siteto the site
Assessment of capillary refillAssessment of capillary refill Assessment of five P’sAssessment of five P’s Reposition every 2 hours; encourage mobility Reposition every 2 hours; encourage mobility
within the confines of traction or castwithin the confines of traction or cast Prevent skin breakdownPrevent skin breakdown
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15
Nursing ConsiderationsNursing Considerationsfor the Child in a Cast or in Tractionfor the Child in a Cast or in Traction
Maintain hydrationMaintain hydration Encourage or provide range of motion Encourage or provide range of motion
exercises as appropriate for cast or tractionexercises as appropriate for cast or traction Provide opportunities for therapeutic playProvide opportunities for therapeutic play Encourage and provide opportunities for Encourage and provide opportunities for
school-age child and adolescent to keep up school-age child and adolescent to keep up with school work and friendswith school work and friends
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16
Soft Tissue InjuriesSoft Tissue Injuries
Contusions: damage to the soft tissue, Contusions: damage to the soft tissue, subcutaneous structures, and musclesubcutaneous structures, and muscle
Dislocations: bone ends displaced from their Dislocations: bone ends displaced from their normal positionnormal position
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17
Soft Tissue InjuriesSoft Tissue Injuries
Sprains occur when trauma to a joint is so Sprains occur when trauma to a joint is so severe that a ligament is either stretched or severe that a ligament is either stretched or partially or completely torn by the force created partially or completely torn by the force created as a joint is twisted or wrenchedas a joint is twisted or wrenched
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18
Soft Tissue InjuriesSoft Tissue Injuries
Clinical manifestationsClinical manifestations PainPain SwellingSwelling Localized tendernessLocalized tenderness Limited range of motionLimited range of motion Poor weight bearingPoor weight bearing Popping or snapping sound (sprains)Popping or snapping sound (sprains) Diagnostic evaluationDiagnostic evaluation Clinical picture and historyClinical picture and history Radiographs to rule out fractureRadiographs to rule out fracture
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19
Soft Tissue Injuries:Soft Tissue Injuries:Nursing ConsiderationsNursing Considerations
RRestest IIcece CCompressionompression EElevationlevation
IIcece CCompressionompression EElevationlevation SSupportupport
Analgesics for pain management in combination with distraction as well as age-appropriate play activities
Review principles of RICE/ICES with parents
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20
Congenital Musculoskeletal Congenital Musculoskeletal Health ProblemsHealth Problems
ClubfootClubfoot Developmental dysplasia of the hipDevelopmental dysplasia of the hip Osteogenesis imperfectaOsteogenesis imperfecta
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 21
ClubfootClubfoot
Congenital malformation of the lower Congenital malformation of the lower extremity that affects the lower leg, ankle, extremity that affects the lower leg, ankle, and footand foot
Clinical manifestationsClinical manifestations One or a combination of One or a combination of
four deformitiesfour deformities Plantar flexionPlantar flexion DorsiflexionDorsiflexion Varus deviation (foot turns in)Varus deviation (foot turns in) Valgus deviation (foot turns out)Valgus deviation (foot turns out)
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 22
ClubfootClubfoot
Involves bone deformity and malposition with Involves bone deformity and malposition with soft tissue contractionsoft tissue contraction
May be unilateral or bilateralMay be unilateral or bilateral Affected foot is usually smaller and shorter, Affected foot is usually smaller and shorter,
with an empty heel pad and transverse with an empty heel pad and transverse plantar creaseplantar crease
Easily recognized at birthEasily recognized at birthTherapeutic managementTherapeutic management Serial manipulation and castingSerial manipulation and casting If sufficient correction not achieved within 3 If sufficient correction not achieved within 3
to 6 months, surgery is performedto 6 months, surgery is performed Long-term follow-upLong-term follow-up
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 23
Clubfoot Clubfoot
Postoperative nursing considerationsPostoperative nursing considerations Neurovascular checks at least every 2 hoursNeurovascular checks at least every 2 hours Observe for any swelling around cast edges Observe for any swelling around cast edges Elevate ankle and foot on pillows; apply iceElevate ankle and foot on pillows; apply ice Monitor drainage in castMonitor drainage in cast Pain management Pain management
(analgesics as ordered, distraction)(analgesics as ordered, distraction) Education for home management Education for home management
(discharge teaching)(discharge teaching)
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 24
Developmental Developmental Dysplasia of the HipDysplasia of the Hip
Also called congenital Also called congenital dislocation of the hipdislocation of the hip
Refers to a variety of Refers to a variety of conditions in which the conditions in which the femoral head and femoral head and acetabulum are acetabulum are improperly alignedimproperly aligned
May be unilateral May be unilateral or bilateralor bilateral
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 25
Developmental Developmental Dysplasia of the HipDysplasia of the Hip
Predisposing factorsPredisposing factors TwinsTwins Breech deliveryBreech delivery Maternal hormones relaxin and estrogenMaternal hormones relaxin and estrogen Large infantLarge infant
Clinical manifestations in the neonateClinical manifestations in the neonate Displaced femoral head from the acetabulum Displaced femoral head from the acetabulum
on manipulation (positive Ortolani’s on manipulation (positive Ortolani’s maneuver)maneuver)
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 26
Developmental Developmental Dysplasia of the HipDysplasia of the Hip
Clinical manifestations Clinical manifestations in the infantin the infant Asymmetry of the gluteal Asymmetry of the gluteal
skin folds skin folds Limited range of motion Limited range of motion in the affected hipin the affected hip Asymmetric abductionAsymmetric abduction Femur on affected side Femur on affected side appears shortappears short
Clinical manifestations Clinical manifestations
in the childin the child Clinical manifestations Clinical manifestations
in the infant in the infant plusplus Minimal to pronounced Minimal to pronounced
variations in gait, with variations in gait, with lurching toward lurching toward
affected sideaffected side
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 27
Developmental Developmental Dysplasia of the HipDysplasia of the Hip
Diagnostic evaluation Screening at birth with Ortolani’s and
Barlow's maneuvers Ultrasound is useful between 4 and 6
weeks of age Radiography in older infants and children
Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 28
Developmental Developmental Dysplasia of the HipDysplasia of the Hip
Therapeutic management in the neonatal periodTherapeutic management in the neonatal period Splinting the hips with a Splinting the hips with a
Pavlik harness to maintain Pavlik harness to maintain flexion, abduction, and flexion, abduction, and external rotationexternal rotation