FUNDAMENTALS OF NURSING

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

36. TRACTIONNURSING 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. TRACTIONNURSING 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: STABLE FRACTURE LONG-TERM USE ADVANTAGES: 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 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