1200 UNIT XI / Responses to Altered Musculoskeletal Function

■ In skeletal traction, never remove the weights.■ In skin traction, remove weights only when intermittent skin

traction has been ordered to alleviate muscle spasm.■ For traction to be successful, a countertraction is necessary. In

most instances, the countertraction is the client’s weight.Therefore, do not wedge the client’s foot or place it flush withthe foot-board of the bed.

■ Maintain the line of pull:a. Center the client on the bed.b. Ensure that weights hang freely and do not touch the

floor.■ Ensure that nothing is lying on or obstructing the ropes. Do

not allow the knots at the end of the rope to come into con-tact with the pulley.

■ If a problem is detected, assist in repositioning.The area of thefracture must be stabilized when the client is repositioned.

■ In skin traction:a. Frequently assess skin for evidence of pressure, shearing,

or pending breakdown.b. Protect pressure sites with padding and protective dress-

ings as indicated.■ In skeletal traction:

a. Frequent skin assessments should include pin care perpolicy.

b. Report signs of infection at the pin sites, such as redness,drainage, and increased tenderness.

c. The client may require more frequent analgesic adminis-tration.

■ Perform neurovascular assessments frequently.■ Assess for common complications of immobility, including

formation of pressure ulcers, formation of renal calculi, deepvein thrombosis, pneumonia, paralytic ileus, and loss of ap-petite.

■ Teach the client and family about the type and purpose of thetraction.

BOX 38–5 ■ Nursing Implications forClients Receiving Traction

• Balanced suspension traction involves more than one forceof pull. Several forces work in unison to raise and supportthe client’s injured extremity off the bed and pull it in astraight fashion away from the body. The advantage of thistype of traction is that it increases mobility without threaten-ing joint continuity. The disadvantage is that the increaseduse of multiple weights makes the client more likely to slidein the bed.

• Skeletal traction is the application of a pulling forcethrough placement of pins into the bone. The client receiveslocal anesthetic, and the pin is inserted in a twisting motioninto the bone. This type of traction must be applied understerile conditions because of the increased risk of infection.One or more pulling forces may be applied with skeletal trac-tion. The advantage of this type of traction is that moreweight can be used to maintain the proper anatomic align-ment if necessary. The disadvantages include increased anx-iety, increased risk of infection, and increased discomfort.Nursing implications for clients receiving traction are pre-sented in Box 38–5.

CastsA cast is a rigid device applied to immobilize the injured bonesand promote healing. The cast is applied to immobilize the jointabove and the joint below the fractured bone so that the bonewill not move during healing. A fracture is first reduced manu-ally and a cast is then applied. Casts are applied on clients whohave relatively stable fractures

The cast, which may be composed of plaster or fiberglass,is applied over a thin cushion of padding and molded to thenormal contour of the body. The cast must be allowed to drybefore any pressure is applied to it; simply palpating a wetcast with the fingertips will leave dents that may cause pres-sure sores. A plaster cast may require up to 48 hours to dry,whereas a fiberglass cast dries in less than 1 hour. The type ofcast applied is determined by the location of the fracture(Figure 38–7 ■). Nursing implications for clients with castsare discussed in Box 38–6. During follow-up appointments,the physician may X-ray the bone to assess alignment andhealing, and possibly remove the cast for skin assessment.

Electrical Bone StimulationElectrical bone stimulation is the application of an electri-cal current at the fracture site. It is used to treat fractures thatare not healing appropriately. The electrical stress increasesthe migration of osteoblasts and osteoclasts to the fracturesite. Mineral deposition increases, promoting bone healing.Electrical bone stimulation can be accomplished invasivelyor noninvasively (Figure 38–8 ■). In invasive stimulation,the surgeon inserts a cathode and a lead wire at the fracturesite. The lead wire is attached to an internal or external gen-

Nursing Responsibilities■ Perform frequent neurovascular assessments.■ Palpate the cast for “hot spots”that may indicate the presence

of underlying infection.■ Report any drainage promptly.

Client and Family Teaching■ Do not place any objects in the cast.■ If the cast is made of plaster, keep it dry.■ If the cast is made of fiberglass, dry it with a blow dryer on the

cool setting if it becomes wet.■ Assess the injured extremity for coolness, changes in color, in-

creased pain, increased swelling, and/or loss of sensation.■ Use a blow dryer on the cool setting to relieve itching by

blowing cool air into the cast.■ If a sling is used, it should distribute the weight of the cast

evenly around the neck. Do not roll the sling; this can impaircirculation to the neck.

■ If crutches are used, arrange for physical therapist to teachcorrect crutch walking.

■ When the cast is removed, an oscillating cast remover will beused. A guard prevents the cast remover from penetratingpast the depth of the cast, so it will not cut the client. It is noisy,and the client will feel vibration.

■ Nursing Implications forClients with Casts