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I. NURSING PROCESS
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Health History:
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Initial interview:
1. Obtain a general impression of the patient¶s health
status.
‡ Gather subjective data from the patient concerning
the onset of the problem and how it has been
managed.

PAIN
Most patients with diseases and traumatic
conditions or disorders of muscles, bones, and
joints experiences pain. Pain is variable, and its
assessment and management must be
individualized.
‡ s ne pain ± described as dull and deep ache in nature and
throbbing.
‡ Muscle pain ± described as soreness, or aching and is
referred to as ³muscle cramps´.
‡ Fracture pain ± sharp and piercing and is relieved by
immobilization.
‡ Sharp pain ± may also result from bone infection with
muscle spasm or pressure on a sensory nerve.
‡ Pain that increases with activity ± may indicate joint
sprain or muscle strain.
‡ Steadily increasing pain ± progression of an infectious
process or neurovascular complications.
‡ Radiating pain ± occurs in condition in which pressure is
exerted on a nerve root.
Òuesti ns that can be asked regarding pain:

Šoint Assessment:
‡ Any problem with your joints? Any pain?
‡ Location: which joint? On one side or both sides?
‡ Quality: what does the pain feel like?
‡ Severity: how strong is the pain?
‡ Onset: when did the pain started?
‡ Timing: what time of day does the pain occur? How long
does it last? How often does it occur?
 Is the pain aggravated by movements, rest position,
weather? Is the pain relieved by rest, medications,
application of heat or ice?
 Is the pain associated with chills, fever, recent sore throat,
trauma, repetitive activity?
‡ Any stiffness in your joints?
‡ Any swelling, heat, redness in the joints?
‡ Any limitation of movement in any joint? Which joint?

Muscle Assessment:
‡ Any problems in muscle, such as any pain or cramping?
Which muscles?
‡ If in calf muscles: is the pain with walking? Does it go away
with rest?
‡ Are your muscle aches associated fever, chills, or flu?
‡ Any weakness in muscles?
‡ Location: where is the weakness? How long have you
noticed weakness?
 Do the muscle look smaller?

Bones:
‡ Any bone pain? Is the pain affected by movement?
‡ Any deformity of any bone or joint? Is the deformity due to
injury or trauma? Does the deformity affect ROM?
‡ Any accidents or trauma ever affected the bones or joints:
fractures, joint stain, sprain, dislocation? Which ones?
‡ When did this occur? What treatment was given? Any
problem or limitations now as a result?
‡ Any back pain? In which part of the back? Is pain felt
anywhere else, like shooting down leg?
 Any numbers and tingling? Any limping?
unctional Assessment of ADL¶s
‡ Bathing: turning faucets? Getting in and out of the tub?
‡ Toileting: urinating, moving bowels, able to get self on / off
toilet, wipe self?
‡ Dressing: dong buttons, zipper, fasten opening behind
neck, pulling dress or sweater over head, pulling up pants,
tying shoes, getting shoes that fit?
‡ Grooming: shaving, brushing teeth, brushing or fixing hair,
applying make up?
‡ Eating: preparing meals, pouring liquids, cutting up foods,
bringing food to mouth, drinking?
‡ Mobility: walking, walking up or down stairs, getting in / out
of be, getting out of house?
‡ Communicating: talking, using phone, writing?
†. Concurrent health conditions and related problems, such as
familial or genetic abnormalities.

‡ Did the patient had any past problems or injuries to the

joints, muscles or bones. What treatment was given? If the
patient had any after effect from the injury or problem?

3. History of medications used and response to pain

medication.

Aevel pmental Hist ry:

‡ Was there any trauma to infant during labor and delivery?
Did the baby come head first? Was there a need for forcep?
‡ Were the baby¶s motor milestones achieved at about the
same time as siblings or age- mates?
‡ Does the child have broken any bones? Any dislocations?
How were these treated?
‡ Is there any noticeable bone deformity? Spinal curvature?
Unusual shape of toes or fee? Age of onset? Did they ever
sought treatment for any of these?

History for adolescents:

‡ Is the child involved in any sports at school or after school?
How frequently?
‡ Does the child use any special equipment?
‡ What is the nature of your daily warm up?
‡ What do you do if you get hurt?
S cial Hist ry:
Information concerning the patient¶s learning ability,
economic status, and current occupation, needed for
rehabilitation and discharge planning.
‡ Assess the patient¶s use of tobacco, alcohol, and other
drugs to evaluate how these agents may affect patient care.
‡ Does the patient drink alcohol or caffeinated beverages?
How much and how often?
‡ Describe the activities during a typical day. How much time
is spent in the sunlight?
 Describe any routine exercises that the patient do.
 Describe the patient¶s occupation.
 Describe your posture at work and at leisure.
 Does the patient have difficulty performing normal activities
of daily living? Do they use assistive devices to promote
mobility?
 How does musculoskeletal problems interfered with their
ability to interact or socialize with others? Have they
interfered with the usual sexual activity?

Psych l gical Hist ry:

‡ How did you view yourself before you had this
musculoskeletal problem, and how do you view yourself
now?
‡ Has your musculoskeletal problem added stress to your life?
Describe.
PHYSICAL ASSESSMENT:
The extent of assessment depend on the patients
physical complaints, health history, and physical clues that
warrant further exploration. Mostly the assessment
focuses on the patients ability to perform activities of daily
living; evaluating the patients posture, gait, bone integrity,
joint function, and muscle strength and size. In addition,
assessing the skin and neurovascular status is an
important part of a complete musculoskeletal assessment.

A.POSTURE
‡ Inspect the spinal curves and trunk symmetry from
posterior and lateral views.
‡ Stand behind the patient and note for differences in the
height of the shoulders and iliac crest. Gluteal folds are
normally symmetric.
‡ Shoulder and hip symmetry as well as the line of the
vertebral column are inspected with the patient erect and
the patient bending forward.
‡ Common deformities of the spine:
‡ Kyphosis ± an increased forward curvature of the
thoracic spine.
‡ Lordosis ± or swayback, an exaggerated curvature
of the lumbar spine.
‡ Scoliosis ± lateral curving deviation of the spine.

B. GAIT
‡ Gait is assessed by having the patient walk away from the
examiner for a short distance.
‡ Observe gait for smoothness and rhythm. Unsteadiness or
irregular movements are considered abnormal.
‡ Limping motion, most frequently caused by painful weight
bearing. Have the patient pin point the area of discomfort,
thus guiding further examination. One extremity is shorter
than the other.
‡ Limited joint motion may affect gait.
‡ A variety of neurological conditions are associated with
abnormal gait such as spastic hemiparesis gait ( stroke),
steppage gait (Lower motor neuron disease ), and
shuffling gait.

C. BONE INTEGRITY
‡ Bony skeleton is assessed for deformities and alignment.
‡ Symmetric parts of the body are observed.
‡ Abnormal bony growths due to bone tumors may be
observed.
‡ Shortened extremities, amputations, and body parts that
are not in anatomic alignment are noted.
‡ racture findings may include abnormal angulation of long
bones, motion at points other than joints, and crepitus at
the point of abnormal motion.
D. ŠOINT UNCTION
‡ Inspect for size, shape, color and symmetry. Note any
masses, deformities, or muscle atrophy. Compare bilateral
joint findings.
‡ Normally the joint moves smoothly
‡ Evaluated by noting range of motion, deformity, stability,
and nodular formation.
‡ Range of motion is evaluated both actively and passively.
‡ Test each joint¶s ROM. Demonstrate how to move each
joint through its normal ROM, then ask the client actively to
move the joint through the same motion. Compare bilateral
joint findings.
‡ Goniometer ± tool used to give precise measurement of
range of motion
‡ Palpation of the joint while it is passively moved provides
information about the integrity of the joint.
‡ Limited range
m ti n ± may be a result of skeletal
deformity, joint pathology or contracture of the surrounding
muscles, tendons and joint capsules.
‡ E

usi n ± excessive fluid within the capsule. Šoint motion
is compromised or joint is painful.
‡ Effusion is suspected if joint is swollen and the normal body
landmarks are obscured. The most common site for joint
effusion is the knee.
‡ Šoint deformity may be caused by:
a. contracture ( shortening of surrounding joint structures)
b. dislocation ( complete separation of joint surfaces)
c. subluxation ( partial separation of articular surfaces) or
disruption of structures surrounding the joint.
‡ Snap or crack may indicate that a ligament is slipping over
a bony prominence.
‡ Crepitus ± grating, crackling sound or sensation, result if
irregular joint surfaces move across one another.
‡ Surrounding joints are examined for nodule formation which
are present on the different types of arthritis.
E. MUSCLE STRENGTH AND SIZE
‡ Is assessed by noting the patient¶s ability to change
position, muscular strength and coordination, and the size
of individual muscles.
‡ Assessment of muscle strength is done by having patient
perform certain maneuvers with and without added
resistance.
‡ Test muscle strength by asking client to move each
extremity through its full ROM against resistance. Do this
by applying some resistance. If this is not possible, then
attempt passively to move the part through its full ROM. If
this is not possible, then inspect and feel for a palpable
contraction of the muscle while the client attempts to
move it.
‡ Do not force the part beyond its normal range. Stop passive
motion if the client expresses discomfort or pain. Be
especially cautious with the older client when testing ROM.
When comparing bilateral strength, keep in mind that the
client¶s dominant side will tend to be the stronger side.
‡ Cl nus ± rhythmic contractions of a muscle by sudden,
forceful, sustained dorsiflexion of the foot or extension of the
wrist.
‡ Fasciculati ns - involuntary twitching of muscle fiber
groups.
‡ girth of an extremity are also being measured to monitor
increase in size due to exercise, edema or bleeding into the
muscle.
. SKIN
‡ Inspect skin for edema, temperature, and color.
‡ Palpation of the skin can reveal whether any areas are
warmer, suggesting increased perfusion of infection. Or
cooler, suggesting decreased perfusion and whether
edema is present.

G. NEUROVASCULAR STATUS
‡ Neurologic system is responsible for coordinating the
functions of the skeleton and muscles.
‡ It is also important to perform neurovascular assessments
of patient with musculoskeletal disorders
 AIAGNOSTIC ASSESSMENT OR EVALUATION

IMAGING PROCEAURES
1. X-ray studies
‡ Important in evaluating patients with musculoskeletal
disorders.
‡ Multiple x-rays ± needed for full assessment of the
structure being examined.
‡ X-ray study of the cortex of the bone reveals any
widening, narrowing or signs of irregularity.
‡ s ne x-rays ± determines bone density, texture erosion
and changes in bone relationships.
‡ J int x-rays ± reveal fluid, irregularity, spur formation,
narrowing and changes in joint structure.
†. Computed Tomography
‡ It is used to identify the location and extent of fractures in
areas in areas that are difficult to evaluate.
‡ Shows in detail a specific plane of involved bone.
‡ Can reveal tumors of the soft tissue.
‡ Injuries to the ligaments or tendons.
‡ The patient must remain still during the procedure.

3. Magnetic resonance Imaging

‡ A non-invasive imaging technique that uses magnetic
fields, radio waves and computers to demonstrate
abnormalities.
‡ Contrast media may be injected intravenously to enhance
visualization.
‡ During the procedure the patient needs to lie still for 1 to
† hours.

4. Arthrogram
‡ A radiographic examination of the soft tissues of the joint
structures and is used to diagnose trauma to joint capsule
or ligaments.
‡ A local anesthetic is used for the procedure.
‡ A contrast medium or air is injected into the joint cavity,
and the joint is moved through ROM as a series of x-ray
films are taken.
Interventi ns:
‡ Assess the client for allergies to iodine or seafood before
the procedure
‡ Obtain an informed consent.
‡ Inform the client of the need to remain as still as possible,
except when asked to reposition.
‡ Minimize the use of the joint for 1†hours after the procedure.
‡ Instruct the client that the joint may be edematous and
tender for 1 to † days after the procedure and may be
treated with ice packs and analgesics as prescribed.
‡ Instruct the client that if edema and tenderness last longer
than † days to notify the physician.
‡ If air was used for injection, crepitus may be felt in the joint
for up to † days.

5. Arthroscopy
‡ Provides an endoscopic examination of various joints.
‡ Articular cartilage abnormalities may be assessed, loose
bodies can be removed, and the cartilage can be trimmed.
‡ A biopsy may be performed during the procedure.
Interventi n:
‡ Instruct the client to fast for 8 to 1† hours before the
procedure.
‡ Obtain an informed consent.
‡ Administer pain medication as prescribed post procedure.
‡ An elastic wrap should be worn for † to 4 days as
prescribed post procedure.
‡ Instruct the client that walking without weight bearing
usually is permitted after sensation returns but to limit
activity for 1 to 4 days as prescribed following the
procedure.
‡ Instruct the client to elevate the extremity as often as
possible for † days following the procedure and to place
ice on the site to minimize swelling.
‡ Reinforce instructions regarding the use of crutches, which
may be used for 5 to 7 days post procedure for walking.
‡ Advise the client to notify the physician if fever or increased
knee pain occurs or if edema continues for more than 3
days post procedure.

6. Bone Mineral Density Measurement

a. Dual energy x ± ray absorptiometry
‡ Measures bone mass of the spine, other bones, and the
total body.
‡ Radiation exposure is minimal.
‡ Is used diagnose metabolic bone disease and to monitor
changes in bone density with treatment.
‡ Inform client that procedure is painless.

b. Quantitative ultrasound
‡ Evaluates strength, density and elasticity of various bones
using ultrasound rather than radiation.
‡ Inform client that the procedure is painless.

OTHER STUAIES
1.Bone Scan
‡ Radioisotope is injected intravenously and will collect in
areas that indicate abnormal bone metabolism and some
fractures, if they exist.
‡ The isotope is excreted in the urine and feces within 48
hours and is not harmful to others.
Interventi n:
‡ Hold fluids for 4 hours before the procedure. Can
eliminate isotope.
‡ Obtain an informed consent.
‡ Remove all jewelry and metal objects.
‡ ollowing the injection of the radioisotope, the client must
drink 3† oz of water (if not contraindicated) to promote
renal filtering of the excess isotope.
‡ rom 1 to 3 hours after the injection, have the client void,
and then the scanning procedure are performed. ull
bladder interferes with the scanning of the pelvic bones.
‡ Inform the client of the need to lie supine during the
procedure and that the procedure is not painful.
‡ No special precautions required after the procedure
because a minimal amount of radioactivity exists in the
radioisotope.
‡ Monitor the injection site for redness and swelling.
‡ Encourage oral fluid intake following the procedure.
‡ Scan is performed †- 3 hours after the injection.
‡ Encourage patient to drink plenty of water before the
procedure to help distribute and eliminate the isotope.
‡ Before the scan, ask the patient to empty to empty the
bladder because full bladder interferes with scanning of the
pelvic bones.
†. Arthrocentesis
‡ Involves aspirating synovial fluid, blood, or pus via a
needle inserted into a joint cavity.
‡ Medication may be instilled into the joint if necessary to
alleviate inflammation.
Interventions:
‡ Obtain an informed consent.
‡ Apply a compress bandage post procedure as prescribed.
‡ Instruct the client to rest the joint for 8 to †4 hours post
procedure.
‡ Instruct the client to notify the physician if a fever or
swelling of the joint occurs.

3.Electromyography
‡ Provides information about the electrical potential of the
muscles.
‡ Test is done to evaluate to evaluate muscle weakness,
pain and disability
‡ Purpose of the procedure is to determine any abnormality
of function and to differentiate muscle and nerve problems.
‡ Needles are inserted into the muscle, and recording of
muscular electrical activity are traced on the recording
paper through an oscilloscope.
Interventi n:
‡ Obtain an informed consent.
‡ Instruct the client that the needle insertion is
uncomfortable.
‡ Instruct the client not to take any stimulants or sedatives
for †4 hours before the procedure.
‡ Inform the client that slight bruising may occur at the
needle insertion sites.
4. Biopsy
‡ Performed to determine the structure and composition of
bone marrow, bone muscle, or synovium to help diagnose
specific disease.
‡ Done during surgery or though aspiration or needle biopsy.
Interventi n:
‡ Obtain an informed consent.
‡ Monitor for bleeding, swelling, hematoma, or severe pain
‡ Elevate the site for †4 hours following the procedure to
reduce edema.
‡ Apply ice packs as prescribed following the procedure to
prevent the development of a hematoma.
‡ Monitor for signs of infection following the procedure.
‡ Inform the client that mild to moderate discomfort is normal
following the procedure.

5. Myelogram
‡ Requires injection of dye or air into the subarachnoid
space followed by radiography to detect abnormalities of
the spinal cord and vertebras.
‡ Obtain an informed consent.
‡ Provide hydration for at least 1† hours before the test.
‡ Assess client for allergies to iodine or seafood.
‡ Premedicate for sedation as prescribed.
P st pr cedure Interventi n
‡ Obtain vital signs and perform neurological assess ment
frequently as prescribed
‡ If a water based dye is used, elevate the head 15 to 30
degrees for 8 hours as prescribed.
‡ If an oil base dye is used, keep the client flat 6 to 8 hours as
prescribed.
‡ If air is used, keep head lower than the trunk.
‡ Encourage fluids and monitor intake and output.
PLANNING FOR HEALTH PROMOTION &
MAINTENANCE / IMPLEMENTATION

A. CAST
A cast is a rigid external immobilizing device that is
molded to the contours of the body.
‡ Purposes:
‡ a. to immobilize a body part in a specific position and to
apply uniform pressure on encased sot tissue.
‡ b. to immobilize a reduced fracture.
‡ c. to correct deformity.
‡ d. to apply uniform pressure to underlying soft tissue or to
support and stabilize weakened joints.
CASTING MATERIALS:

Nonplaster ± generally referred to as fibreglass casts. A water

activated polyurethane materials that have the versatility of
plaster.
‡ Lighter in weight, stronger, water resistant and durable.
‡ Consists of an open ± weave, non-absorbent fabric
impregnated with cool water-activated hardeners that bond
and reach full rigid strength in minutes.
‡ Porous, and therefore diminish skin problems. They do not
soften when wet.
‡ When wet they are dried with a hair drier on a cool setting.
Thorough drying is important to prevent skin breakdown.
‡ They are used for non displaced fractures with minimal
swelling and for long term wear.
Plaster ± rolls of plaster bandage are wet in water and applied
smoothly to the body.
‡ a crystallization reaction occurs, and heat is given off.
‡ Inform patient that the heat is given off can be
uncomfortable and there is an increasing sensation of
warmth so the patient would not become alarmed.
‡ The crystallization process produces a rigid dressing.

Assessment:

Before the cast is applied:

1.Asses the patients general health
†.Presenting signs and symptoms.
3.Emotional status
4. Understanding of the need for the cast
5. Condition of the body part to be immobilized.

Major goals for the patient:

1. Knowledge of the treatment regimen.
‡ The patient need information concerning the pathologic
problems and the purpose and expectations of the
prescribed treatment regimen.
‡ This knowledge promotes the patients active participation
in and adherence to the treatment program.
‡ It is important to prepare the patient for the application of
the cast by describing the anticipated sights, sound and
sensations.
‡ The patients need to know what to expect during
application and that the body part will be immobilized
after casting.
†. Relief of pain
‡ Carefully evaluate pain associated with musculoskeletal
problems and help determine its cause.
‡ Most pain can be relieved by elevating the involved part.
‡ Applying cold as prescribed.
‡ Administer usual dosage of analgesics.
‡ Pain associated with disease process is frequently
controlled by immobilization.
‡ Pain due to edema that is associated with trauma,
surgery, or bleeding into the tissues can be controlled by
elevation and intermittent application of cold.
‡ Pain may be indicative of complications.
‡ Severe pain over a bony prominence warns of an
impending pressure ulcer. Pain decreases when
ulceration occurs
‡ Discomfort due to pressure on the skin may be relieved
by elevation that controls edema or by positioning that
alters pressure.

3. Improved physical mobility.

‡ Every joint that is not immobilized should be exercised
and moved through its range of motion to maintain
function.
4.Healing of lacerations and abrasions.

5.Maintenance of Adequate Neurovascular function and

Absence of Complications.
‡ monitors circulation, motion, sensation of the affected
extremity.
‡ Assessing the fingers or toes, of the casted extremity
and comparing them with those of the opposite extremity.
‡ Normal findings: minimal swelling, minimal discomfort,
pink color, warm to touch, rapid capillary refill response
normal sensations, and ability to exercise fingers or toes.
‡ Early recognition of diminished circulation and nerve
function is essential to prevent loss of function.
‡ Assessment data: unrelieved pain, pain on passive
stretch, paresthesia, motor loss, sensory loss, coolness,
paleness, slow capillary refill.

6. Teaching Self Care

Instruct the patient the following:
‡ Move about as normally as possible, but avoid excessive
use of the injured extremity and avoid walking on wet,
slippery floors or sidewalks.
‡ Perform prescribed exercises regularly as scheduled.
‡ Elevate the casted extremities to heart level frequently to
prevent swelling.
‡ Do not attempt to scratch the skin under the cast. This may
cause a break in the skin and result in the formation of a
skin ulcer. Cool air from a hair dryer may alleviate an itch.
‡ Cushion rough edges of the cast with tape.
‡ Keep the cast dry but do not cover it with plaster or rubber,
because this causes condensation, which dampens the
cast and skin. Moisture softens a plaster cast.
‡ Report any of the following to the physician: persistent
pain, swelling that does not respond to elevation, changes
in sensation, decreased ability to move exposed fingers or
toes, and changes in skin color and temperature.
‡ Note odors around the cast, stained areas, warm spots,
and pressure areas. Report them to the physician.
TRACTION
Is the application of a pulling force to a part of the
body. It must be applied in the correct direction and
magnitude to obtain its therapeutic effects. Traction is
used primarily as a short term intervention until other
modalities (Such as external or internal fixation.) are
possible. Traction means that a pulling force is applied to a
part of the body or an extremity where countertraction pulls
in the opposite direction.

Purp ses:
1. To prevent / correct deformities
†. Relieve pain
3. Relieve muscle spasm
4.Reduce / immobilize / align fractures
Principles
E

ective Tracti n
‡ Counter traction must be used to achieve effective traction.
Usually the patient¶s body weight and bed position
adjustments supply the needed countertraction.
‡ Traction must be continuous to be effective in reducing and
immobilizing fractures.
‡ Weights are not removed unless intermittent traction is
prescribed.
‡ Any factor that might reduce the effective pull or alter its
resultant line of pull must be eliminated.
ßthe patient must be in good body alignment in the
center of the bed when traction is applied.
ßRopes must be unobstructed.
ßWeights must hang free and not rest on the bed or
floor.
ßKnots in the rope or the footplate must not touch the
pulley or the foot of the bed.
Types
Tracti n
1. Skin Traction
A direct application of pulling force on a skin adherent
that is attached to the skin to maintain a steady pull. It is
often a temporary measure used to before surgery or to
reduce muscle spasm. It should be removed and reapplied
at least once a day. It also can be used for an extended
period of time and is removed and reapplied intermittently
as prescribed by the physician. The amount of weight
applied must not exceed the tolerance of the skin. No more
than † to 3.5 kg of traction can be used on an extremity.

†. Skeletal Traction
Skeletal traction is applied directly to the bone. This
method of traction is used occasionally to treat fractures of
the femur, tibia and cervical spine.
The traction is applied directly to the bone by use of a metal
pin or wire that is inserted through the bone distal to the
fracture, avoiding nerves, blood vessels, muscles, tendons,
and joints.

Nursing Interventions:
1. Promoting Understanding of the Treatment Regimen.
†. Reducing Anxiety
3. Maintaining Position
‡ Patient¶s body in traction must maintain proper alignment
to promote an effective line of pull.
‡ Position the patients foot accordingly to prevent foot drop.
4. Preventing Skin Breakdown
‡ Protect the clients elbows and heel and inspect it for
pressure areas.
‡ Suspend a trapeze overhead within easy reach of the
patient. This apparatus helps the patient to move about in
bed and to move on and off the bedpan.
‡ Specific pressure points are assessed for redness and skin
breakdown.
‡ If patient is not permitted to turn on one side or the other,
the nurse must make a special effort to provide back care
and to keep the bed dry and free of crumbs and wrinkles.

5. Monitoring Neurovascular Status

‡ Neurovascular status of the immobilized extremity is
assessed at least every hour initially and then every 4 hours
‡ Instruct the patient to report any changes in sensation or
movement immediately so they can be promptly evaluated.
‡ Encourage the patient to do active flexion ± extension ankle
exercises and isometric contraction of the calf muscles 10
times an hour while awake to decrease venous stasis.
6. Providing Pin Site Care
‡ Assess pin site and drainage for signs of infection such as
redness, tenderness and purulent drainage.
‡ Wound in pin insertion needs attention to avoid infection.
‡ Initially the site is covered with a sterile dressing.
‡ The nurse must keep the area clean.
‡ Slight serous oozing at pin site is expected, but crusting
should be prevented.

7. Promoting Exercise
‡ Encourage the patient to exercise within the therapeutic limit
of the traction, to assist maintain muscle strength, muscle
tone and promoting circulation.
‡ Active exercises include pulling up on the trapeze, flexing
and extending the feet, range of motion, and weight
resistance exercises for non-involved joints
8. Achieving a Maximum level of Comfort
‡ Special mattress or mattress overlays designed to minimize
the development of pressure ulcers may be placed on the
bed before traction is applied.
‡ The nurse can relieve pressure on dependent body parts by
turning and positioning the patient for comfort within the
limit of the traction and by making sure the bed linens
remain wrinkle free and dry.

9. Achieving Maximum Self Care

‡ The nurse helps the patient to eat, bathe, dress, and toilet.
Convenient arrangement of items such as telephone,
tissues, water and assistive devices may facilitate self care.
‡ Nurse and patient can creatively develop a routine that
maximizes the patient¶s independence.
10. Attaining Maximum Mobility with Traction
‡ Encourage the patient to exercise the muscles and joints
that are not in traction to guard against their deterioration.

11. Monitoring and Managing Potential Complications

a. Pressure Ulcers
- examine frequently the patient¶s skin for evidence of
pressure paying more attention to bony prominences.
- reposition patient frequently and use protective
devices to relieve pressure such as elbow protector.
- if a pressure ulcer develops the nurse consults with
the physician.

b. Pneumonia
- auscultate the patients lung every 4 to 8 hours to
determine respiratory status.
 - teach the client deep ± breathing and coughing
exercises to aid in fully expanding the lungs and
moving pulmonary secretions.
- if a respiratory problem develops, prompt institution of
prescribed therapy is needed.

c. Constipation and Anorexia

- a diet high in fiber and fluids may help to stimulate
gastric motility.
- therapeutic measures such as stool softeners,
laxatives, suppositories and enemas.
- identify and include patients food preference within
the prescribed therapeutic diet.
d. Urinary Stasis and Infection
- monitor the patients fluid intake.
- teach the patient to consume adequate amounts of
fluid and to void every 3 to 4 hours.
- Notify the physician if the patient exhibits signs and
symptoms of urinary tract infection.
Types of Cast

Short Leg Cast

- rom foot to below knee
- racture of the foot, ankle,
or distal tibia or fibula.
- severe sprain or strain
- postoperative
immobilization following
open reduction and
internal fixation
Long Leg Cast

- oot to upper thigh

- racture of the distal
femur, knee or lower
leg.
- Soft tissue injury to the
knee or knee dislocation
- Postoperative
immobilization
Abduction boots

- eet to below knee

or upper thigh
- Postoperative
immobilization
following hip abductor
release
- Maintain abduction
Unilateral Hip Spica cast

- Entire leg and trunk

to waist or nipple line

- racture of the femur

- Postoperative
immobilization
- Correction of deformity
such as congenital
soft tissue injury
following dislocation
of the hip
Bilateral long ± leg Hip Spica Cast

- Entire leg bilaterally to

waist or nipple line

- ractures of femur,
acetabulum, or pelvis
- Postoperative
immobilization
Short Leg Hip Spica Cast

- Knees or thighs bilaterally

to waist or nipple line

- Developmental dysplastic
hip
Short Arm Cast

- Hand to below elbow

- racture of the hand

or wrist.
- Postoperative
immobilization
Long Arm Cast

- Hand to Upper Arm

- racture of the forearm,

elbows or humerus.

- Postoperative
immobilization
Shoulder Spica Cast

- Trunk and Shoulder,

arm and hand

- Shoulder dislocation
- Soft tissue injury to the
shoulder
- Postoperative
immobilization
Types of Traction

1.Cervical Traction
- Used for fractures or dislocation of cervical or high thoracic
vertebrae
Halo Vest
- ractures or dislocation of cervical or high thoracic vertebrae
Bryant¶s Traction
- Used for femur fractures and congenital hip dislocation
- Used in children younger than 3 years old, weighing less
than 30 lbs.
- Applied bilaterally with hips flexed 45 degrees and legs in
extension.
Buck¶s Traction
- Used for hip and knee contracture and immobilization of hip
fractures.
- This form of skin traction to the lower limb provides for
straight pull through a single pulley attached to a crossbar at
the foot of the bed.
- The limb in traction lies parallel to the bed. The foot of the
bed is routinely elevated to provide counter traction and to
keep the patient from being pulled down to the foot of the
bed.
- In Buck's extension traction, the patient is usually not
allowed to turn and must remain flat on his back
Aunl p skeletal tracti n
- An orthopedic mechanism that helps immobilize the upper
arm in the treatment of contracture or supracondylar fracture
of the elbow. The mechanism uses a system of traction
weights, pulleys, and ropes and may be accompanied by
skin traction. Dunlop skeletal traction is usually applied
unilaterally but may also be applied bilaterally.
Balanced Traction

- Used for femur fractures. Hip and knee contracture and for
postoperative positioning and immobilization.