1. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 Types of Traction Types of Traction  Bryant’s traction: used for children younger than 3 years and weighing less than 35 pounds who have a fractured femur or congenital hip dyplasia  Buck’s traction: used for knee immobilization or for short-term immobilization of a fracture  Dunlop’s traction: used for supracondylar fractures of the humerus  Russell’s traction: used for fractures of the femur and lower leg

2. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Types of Traction

3. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Types of Traction

4. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Disadvantages of Traction  Need for hospitalization  Prolonged immobility  Always assume that traction is continuous unless the physician states otherwise

5. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 Physiologic Effects of Immobilization  Directly or indirectly relate to decreased muscle activity and have an impact on all systems  Integumentary  Red or irritated skin  Presence of ulceration or drainage  Gastrointestinal  Decreased mobility leads to constipation

6. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Physiologic Effects of Immobilization  Respiratory  Lying supine for prolonged periods leads to altered respirations  Genitourinary  Decreased urinary output from stasis or retention  Musculoskeletal  Significant loss of muscle strength, endurance, and muscle mass  Bone demineralization  Loss of joint mobility

7. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Psychologic Effects of Immobilization  Immobilization narrows the amount and variety of environmental stimuli a child receives through the senses  Physical interference with the activities of infants and young children gives them a feeling of helplessness and has been found to affect speech and language development  Sensory deprivation in the school-age child and adolescent leads to feelings of isolation, boredom, and being forgotten, especially by peers

8. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8  The struggle for independence in each of Erikson’s phases is thwarted by imposed immobility  Toddlers: need exploration and the ability to imitate behaviors to develop a sense of autonomy  Preschoolers: expression of initiative is evidenced by their need for vigorous physical activity Psychologic Effects of Immobilization

9. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 Psychologic Effects of Immobilization  School-age: industry is influenced by physical achievement and competition  Adolescence: rely on mobility to achieve independence, one of the steps in creating their identity

10. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Behavioral Changes in Immobilized Children  Changes related to high levels of anxiety  Restlessness  Depression  Regression  Egocentrism  Difficulty with problem solving  Inability to concentrate on activities

11. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Behavioral Changes in Immobilized Children  Changes related to monotony  Hallucinations  Disorientation  Dependence  Depression  Acting-out behavior  Increased fantasizing  Sluggish intellectual responses  Sluggish psychomotor responses  Decreased communication skills

12. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Nursing Considerations for the Child in a Cast or in Traction  Monitor for complications of fracture reduction  Infection  Nerve compression syndrome  Kidney stones  Pulmonary emboli  Circulatory impairment  Fat embolism (pulmonary embolism)

13. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Nursing Considerations for the Child in a Cast or in Traction  Keep cast or other appliance clean and dry (especially from urine or feces)  Monitor bowel sounds  Assess for abdominal distention  Provide optimal nutrition for bone healing, growth, and development

14. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Nursing Considerations for the Child in a Cast or in Traction  Neurovascular assessment every 1 to 2 hours after application of device  Assessment of strength of pulse distal to the site  Assessment of capillary refill  Assessment of five P’s  Reposition every 2 hours; encourage mobility within the confines of traction or cast  Prevent skin breakdown

15. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Nursing Considerations for the Child in a Cast or in Traction  Maintain hydration  Encourage or provide range of motion exercises as appropriate for cast or traction  Provide opportunities for therapeutic play  Encourage and provide opportunities for school-age child and adolescent to keep up with school work and friends

16. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 Soft Tissue Injuries  Contusions: damage to the soft tissue, subcutaneous structures, and muscle  Dislocations: bone ends displaced from their normal position

17. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Soft Tissue Injuries Sprains occur when trauma to a joint is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched

18. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Soft Tissue Injuries Clinical manifestations  Pain  Swelling  Localized tenderness  Limited range of motion  Poor weight bearing  Popping or snapping sound (sprains)  Diagnostic evaluation  Clinical picture and history  Radiographs to rule out fracture

19. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 Soft Tissue Injuries: Nursing Considerations  Rest  Ice  Compression  Elevation  Ice  Compression  Elevation  Support  Analgesics for pain management in combination with distraction as well as age-appropriate play activities  Review principles of RICE/ICES with parents

20. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 Congenital Musculoskeletal Health Problems  Clubfoot  Developmental dysplasia of the hip  Osteogenesis imperfecta

21. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 21 Clubfoot  Congenital malformation of the lower extremity that affects the lower leg, ankle, and foot Clinical manifestations  One or a combination of four deformities  Plantar flexion  Dorsiflexion  Varus deviation (foot turns in)  Valgus deviation (foot turns out)

22. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 22 Clubfoot  Involves bone deformity and malposition with soft tissue contraction  May be unilateral or bilateral  Affected foot is usually smaller and shorter, with an empty heel pad and transverse plantar crease  Easily recognized at birth Therapeutic management  Serial manipulation and casting  If sufficient correction not achieved within 3 to 6 months, surgery is performed  Long-term follow-up

23. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 23 Clubfoot Postoperative nursing considerations  Neurovascular checks at least every 2 hours  Observe for any swelling around cast edges  Elevate ankle and foot on pillows; apply ice  Monitor drainage in cast  Pain management (analgesics as ordered, distraction)  Education for home management (discharge teaching)

24. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 24 Developmental Dysplasia of the Hip  Also called congenital dislocation of the hip  Refers to a variety of conditions in which the femoral head and acetabulum are improperly aligned  May be unilateral or bilateral

25. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 25 Developmental Dysplasia of the Hip Predisposing factors  Twins  Breech delivery  Maternal hormones relaxin and estrogen  Large infant Clinical manifestations in the neonate  Displaced femoral head from the acetabulum on manipulation (positive Ortolani’s maneuver)

26. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 26 Developmental Dysplasia of the Hip Clinical manifestations in the infant  Asymmetry of the gluteal skin folds  Limited range of motion in the affected hip  Asymmetric abduction  Femur on affected side appears short Clinical manifestations in the child  Clinical manifestations in the infant plus  Minimal to pronounced variations in gait, with lurching toward affected side

27. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 27 Developmental Dysplasia 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

28. Elsevier items and derived items © 2007, 2002 by Saunders, an imprint of Elsevier Inc. Slide 28 Developmental Dysplasia of the Hip Therapeutic management in the neonatal period  Splinting the hips with a Pavlik harness to maintain flexion, abduction, and external rotation