Chapter 25 Mechanical Immobilization Copyright 2009 Wolters Kluwer

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

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

Question • Is the following statement true or false? A splint is a device

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: o Immobilizers o Molded splints, cervical collars Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mechanical Immobilizing Devices • Slings • Braces • Types of braces – Prophylactic –

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 o Cylinder (may be bivalved) o Body (may be bivalved) o Spica 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

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 –

Traction (cont’d) • Traction types include: – Manual – Skin – Skeletal Copyright ©

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 ©

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

External Fixators • Metal devices surgically inserted into or through one or more broken

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

$General Gerontologic Considerations • Common causes of hip fractures in older adults • Longer$

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

$General Gerontologic Considerations (cont’d) • Nonsurgical treatment of fractures of the upper extremities includes:$

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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins