1. FUNDAMENTALS OF NURSING
LESSON 7
SPECIAL BEDS, TRACTION, CASTS, AND ASSISTIVE DEVICES

2. SUPPORT SURFACE MATTRESSES
USES
PRESSURE REDUCTION
PRESSURE RELIEF
ROTATION
SUPPORT OF THE MORBIDLY OBESE
REDUCE PRESSURE
PRIMARY FACTOR IS TO RELIEVE PRESSURE
HIGH NURSING CONCERN FOR THE NURSE
IF PATIENT IS IMMOBILE AND UNABLE TO REPOSITION SELF
PREVENT DECUBITUS ULCERS
#1 NURSING ISSUE

3. CAUSES OF PRESSURE ULCERS AND RISK FACTORS
PRESSURE ULCERS CAUSED BY PRESSURE OVER BONY PROMINENCES
CAUSED BY:
PRESSURE = GRAVITY
FRICTION = FORCE ON PARALLEL SKIN
SHEARING FORCE + GRAVITY + FUNCTION
INCREASED RISK:
MOISURE (URINE, SWEAT)
NUTRITIONAL FACTORS
BODY HEAT
ANEMIA (↓ OXYGEN TO CELLS)

4. SPECIAL TYPES OF MATTRESSES
EGGRATE OR FOAM OVERLAY
(Least effective)
FOAM REPLACEMENT MATTRESS
AIR MATTRESS OVERLAY
AIR MATTRESS
ALL OF THESE REDUCE PRESSURE ONLY

5. SPECIAL TYPES OF MATTRESSES
NURSING INTERVENTIONS:
REPOSITION PT Q 2 HOURS
INSPECT SKIN REGULARLY
DO NOT MASSAGE REDDENED AREAS (MAY ↑SKIN BREAKDOWN)
KEEP SKIN CLEAN AND DRY
ROM EXERCISES Q 8 HOURS

6. AIR SUPSPENSION BEDS USES ↓SHEARING ↓FRICTION ↓MACERATION ↓PRESSURE
↑SKIN INTEGRITY
NURSING IMPLICATIONS ARE THE SAME

7. AIR SUPSPENSION BEDS

8. AIR FLUIDIZED BED USES ↓SHEARING ↓FRICTION BENEFITS KEEPS PT DRY
LOW CAPILLARY PRESSURE
DISADVANTAGES
AWKWARD
NO HOB CHANGES
TRANSPORT DIFFICULT

9. AIR FLUIDIZED BED NURSING INTERVENTIONS POSITION AND ROM
ASSESS FOR CONTRACTURES AND PULMONARY COMPLICATIONS
FLUID AND ELECTROLYTES
ASSESS SKIN
ASSESS EMOTIONAL RESPONSE

10. AIR FLUIDIZED BED

11. ROTOKINETIC BEDS USES SKELETAL ALIGNMENT MOVEMENT
USED FOR SPINAL CORD INJ
ADVANTAGES
↓PRESSURE
STIMULATE BODY SYSTEMS

12. ROTOKINETIC BEDS DISADVANTAGES >20 HRS DAILY
SENSORY DISTRESS, DISEQUILIBRIUM
LIMITED VISUAL FIELD
STOP BED NO MORE THAN 30 MINUTES
NURSING INTERVENTIONS
MONITOR FOR OTHOSTATIC HYPOTENSION
MONITOR FOR DISORIENTATION

13. ROTOKINETIC BEDS

14. BARIATRIC BED USES MORBIDLY OBESE UP TO 850 POUNDS ADVANTAGES
WIDER, STURDIER
IN BED SCALE
SAFER

15. BARIATRIC BED
DISADVANTAGES
LACK OF DECREASED PRESSURE
DR ORDER NEEDED

16. BARIATRIC BED NURSING INTERVENTIONS ASSESS SKIN CHANGE POSITION
FREQUENTLY
USE TRAPEZE
ENCOURAGE MOBILITY

17. POSSIBLE NURSING DIAGNOSIS
IMPAIRED PHYSICAL MOBILITY
IMPAIRED SKIN INTEGRITY
RISK FOR INFECTION
ANXIETY
FEAR
HOPELESSNESS

18. TRACTION DEFINITION PRESCRIBED FOR PULLING FORCE AND A COUNTERTRACTION
TOO MUCH FORCE=NERVE AND TISSUE DAMAGE
TOO LITTLE=MUSCLE SPASM AND ↓HEALING
PRESCRIBED FOR
DEFORMITIES
CONTRACTURES
DISLOCATIONS
FRACTURES
MS DISEASE
PRE/POST-OP POSITION
IMMOBILIZATION

19. TRACTION PULLING FORCE—ROPES, PULLEYS, WEIGHTS
COUNTERTRACTION—ELEVATING FOOT OR HOB
TYPES
BALANCED
SUSPENSION
STRAIGHT
TYPE USED DEPENDS ON
INJURY/CONDITION
PURPOSE
AGE
WT/HEIGHT
SKIN CONDITION
LENGTH OF TIME NECESSARY

20. BALANCED TRACTION
COUNTERTRACTION

21. CERVICAL SKIN TRACTION
OTHER TRACTION
DUNLOP SKIN TRACTION
CERVICAL SKIN TRACTION

22. TRACTION TYPE USED DEPENDS ON INJURY/CONDITION PURPOSE
AGE (#1 THOUGHT WHEN CONSIDERING SAFETY)
WEIGHT/HEIGHT
SKIN CONDITION
LENGTH OF TIME NECESSARY

23. SKIN TRACTION FORCE APPLIED TO SKIN AND SOFT TISSUE CONTINUOUS
HIP OR EXTREMITY
RELIEVES MUSCLE SPASM
INTERMITTENT
FOR BACK
TO RELIEVE SCIATIC PAIN
BUCKS TRACTION: MOST COMMMON
*IMMOBILIZATION OF A HIP FRACTURE

24. SKIN TRACTION ON 4 SHORTER PERIODS INCREASE SKIN PROBLEMS
CONTRAINDICATED:
ULCERS
BURNS
DERMATITIS
DIABETES
ELDERLY

25. SKIN TRACTION PURPOSE: DECREASE MUSCLE SPASMS & MVMT PROPER ALIGNMENT
CERVICAL DISK DISEASE
PELVIC FX
SPINAL DEFORMITIES
PREOP IMMOBILIZATION OF HIP FXs

26. SKELETAL TRACTION FORCE APPLIED DIRECTLY TO BONE USES
FEMUR & CERVICAL SPINE FX
IMMOBILIZATION
EXTERNAL FIXATION
PURPOSE
IMMOBILIZE FOR LONG PERIODS
ENABLE HEALING

27. SKELETAL TRACTION

28. SKELETAL TRACTION

29. SKELETAL TRACTION

30. SKELETAL TRACTION

31. TRACTION NURSING INTERVENTIONS PIN CARE REPOSITIONING
DR GUIDES INTERVENTIONS

32. TRACTION EXTERNAL FIXATION FRAMES WITH SPREADER BAR
HOLDS PINS DRILLED DIRECTLY INTO BONES.
PATIENT IS USUALLY D/C WITH THEM IN PLACE.
USED FOR
SKULL OR FACIAL FRACTURES
RIBS
ALL BONES OF EXTREMITIES
PELVIS

33. TRACTION EXTERNAL FIXATION: NURSING INTERVENTIONS PREPARE PATIENT
ASSESS SKIN
ASSESS NEUROVASCULAR STATUS AND BODY PART TO BE IN TRACTION
SUPPORT ADLS
MAINTAIN SKIN INTEGRITY

34. TRACTION NURSING INTERVENTIONS
4 P’S
POUNDS: CORRECT WEIGHT IN PLACE
PULL DIRECTION: ALIGNED WITH LONG AXIS OF BONE
PULLEYS: ROPE OVER PULLEY GLIDING SMOOTHLY
PRESSURE: EVERY CLAMP AND CONNECTION TIGHT

35. TRACTION NURSING INTERVENTIONS
NEUROVASCULAR CHECKS
SKIN COLOR AND TEMPERATURE
CAPILLARY REFILL
SENSATION/PULSE
MOVEMENT OF PARTS DISTAL TO TRACTION
*NUMBNESS MAY INDICATED COMPROMISED NERVE FUNCTION

36. TRACTION NURSING INTERVENTIONS
TOILETING
IMMOBILIZED: USE FLAT, FRACTURE BEDPAN
USUALLY NEED STOOL SOFTENERS
TURNING AND POSITIONING
MAINTAIN LINE OF PULL
PREVENT FRICTION
MAINTAIN COUNTERTRACTION
MAINTAIN CONTINUOUS TRACTION
MAINTAIN CORRECT BODY ALIGNMENT

37. TRACTION NURSING INTERVENTIONS
EQUIPMENT
SPREADER BAR
WEIGHT HOLDER
PELVIC BELT AND SLING

38. CASTS ALSO CALLED IMMOBILIZATION DEVICE APPLIED EXTERNALLY
IMMOBILIZATION: PREVENTS MOVEMENT OF INJURED TISSUE
CORRECT OR PREVENT MALFORMATION
DECREASE RISK OF SOFT TISSUE DAMAGE

39. CASTS MATERIALS USED PLASTER OF PARIS USES: UNSTABLE FRACTURE
TISSUE EDEMA
FREQUENT CAST CHANGE ANTICIPATED.
DISADVANTAGES:
SLOW TO DRY
48 HRS BEFORE WEIGHT BEARING
DIFFICULT TO X-RAY
CRUMBLES AND FLAKES
CANNOT GET WET
POSSIBLE ALLERGY

40. CASTS MATERIALS USED PLASTER OF PARIS ADVANTAGES: SMOOTH SURFACE
GREATER MOLDABILITY
INEXPENSIVE
STRONG

41. CASTS SYNTHETIC USES: ADVANTAGES: STABLE FRACTURE LONG-TERM USE
7-15 MIN DRYING TIME
WEIGHT BEARING IN 30 MIN
CAN BE X-RAYED
DURABLE
CAN BE IMMERSED IN WATER
STRONGER THAN PLASTER

42. CASTS SYNTHETIC DISADVANTAGES: ROUGH SURFACE POSSIBLE ALLERGY
LIMITED MOLDABILITY
MAY NEED SPECIAL CAST SAW
NONABSORBANT LINING
EXPENSIVE

43. CASTS NURSING INTERVENTIONS
SUPPORT JOINTS ABOVE AND BELOW THE CASTED AREA WHEN LIFTING WET CAST—USE PALMS OF HANDS
USE FAN TO AID DRYING
KEEP CAST ABOVE LEVEL OF HEART X 48HRS.
COVER WITH PLASTIC BEFORE BATHING
IF SYNTHETIC GETS WET—RINSE WELL, DRY THOROUGHLY
DO NOT ALLOW OBJECTS UNDER CAST
MAY NEED TO SMOOTH RAW EDGES (PETALING)

44. CASTS
MANY TYPES

45. CASTS APPLICATION ASSESSMENT MATERIALS EVALUATION REPORT TO MD
Health status
Skin
Neurovascular status
applying
MATERIALS
EVALUATION
REPORT TO MD

46. CASTS REMOVAL PREPARE PT COLD WATER ENZYME WASH SORENESS OR PAIN
PATIENT TEACHING

47. ASSISTING WITH AMBULATION
INDICATION
MOST COMMON AIDS
CANES
CRUTCHES
WALKERS
TEMPORARY OR PERMANENT

48. TYPES OF ASSISTIVE DEVICES
Canes:
Widens base of support
Increased security
3 Types:
Standard
T-handled
Quad cane

49. TYPES OF ASSISTIVE DEVICES
QUAD CANE

50. TYPES OF ASSISTIVE DEVICES
Crutches:
Wood or metal
Ground to axilla
3 types:
Axillary
Loftstrand
Platform
AXILLARY

51. TYPES OF ASSISTIVE DEVICES
LOFTSTRAND OR CANADIAN

52. TYPES OF ASSISTIVE DEVICES
PLATFORM CRUTCH

53. TYPES OF ASSISTIVE DEVICES
Crutches:
Measurements in 3 areas
Pt height
Crutch pad & axilla
Angle of pt flexion
AXILLARY

54. 4 Point Gait MOST STABLE 3 POINTS OF SUPPORT
REQUIRES WEIGHT BEARING ON ALL FOURS

55. 3 Point Gait
REQUIRES USE OF
ONE FOOT & 2 ARMS

56. GAITS
2-POINT
SWING-TO
SWING-THROUGH
STAIRS

57. TYPES OF ASSISTIVE DEVICES
WALKERS
4 LEGS
WIDE BASE OF SUPPORT
GREAT STABILITY FOR FULL/PARTIAL WEIGHT BEARING
USED FOR PTS WITH WEAKNESS OR BALANCE ISSUES

58. NURSING INTERVENTIONS FOR ASSISTIVE DEVICES
ALL SHOULD HAVE RUBBER TIPS
SURFACE CLEAN, DRY, WELL LIGHTED AND LEVEL
APPROPRIATE HEIGHT FOR PT

59. SIGNIFICANT ASSESSMENT DATA
PREVIOUS AND CURRENT HEALTH STATUS
ABILITY TO SAFELY AMBULATE
VISUAL, PERCEPTUAL, SENSORY DEFICITS
APPROPRIATE FOOTWEAR

60. THE END