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

2. 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

3. 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

4. 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.

5. 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

6. 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

7. Emergency Splints

8. Inflatable Splints

9. Traction Splints

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

11. 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).

12. 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.

13. 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

14. Rehabilitative Brace & A sling

15. 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

16. 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.

17. examples of Cast

18. Cast Materials

19. (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 )

20. 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

21. Cast Removal

22. Basic Cast Care

23. 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.

24. 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

25. Examples of tractions Mauual traction
Skin traction, Pelvic belt& cervical Halter

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

27. Skin Traction

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

29. Principles for Maintaining Effective Traction

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

31. 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

32. Risk for Peripheral Neurovascular Dysfunction

33. 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

34. 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

35. 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

36. 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

37. 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

38. References
Timby, B. (2009). Fundamental nursing skills and concepts (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Google pictures. (2015, August 10). Retrieved from