Nursing Care Related to the Musculoskeletal System


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As stated earlier in the text, the basis of the nursing care plan will be determined by two factors: the basic position of the patient in traction and permissible movement. Normal activities of daily living are significantly altered by immobilization and confinement. Nursing management begins with assessing the patient. What are his needs? What are his limitations? Determine which activities the patient can do by himself and with which activities he requires assistance. Basic considerations are nutritional needs, hygiene, and elimination needs and the need for some sort of diversional activities. In addition to this, nursing management involves maintenance (keep traction from being compromised) and prevention (observe for complications).


a. When assisting with a.m. and p.m. care, encourage the patient to do as much for himself as is possible within the constraints of his immobilization. Assist with or perform those tasks that the patient cannot perform.


b. Assess the patient and the traction set-up to determine the best method for changing the bed linen. There are several acceptable methods for making an occupied bed and, depending upon the type of traction in use, you will want to use the method that is easiest. For some patients, a head-to-toe technique may work better than side-to-side. Always be sure that the linen is smooth and dry. Utilize draw sheets when appropriate. Reposition supporting pillows and change the pillow cases as often as needed to prevent the patient from being supported by soiled, damp, wrinkled, or flattened pillows.


c. When assisting with the bedpan or urinal, provide adequate time and privacy for the patient. Many patients do not adjust easily to the awkwardness of using a bedpan or urinal. The presence of roommates, visitors, or hospital personnel just outside the privacy curtain is enough to make anyone uncomfortable. Always place toilet tissue, moist towelettes, and call bell within easy reach. Check daily to see whether the patient has had a bowel movement. Treating constipation will prevent the more serious problem of fecal impaction. Physicians will routinely prescribe a stool softener for immobilized patients in order to prevent constipation.


d. Encourage the patient to eat all of the prescribed diet. If permitted by the physician, suggest that family and friends bring fruit or a "healthy" favorite food from home. A recovering patient's diet should be high in calcium, protein, iron, and vitamins. Plenty of fluids and foods high in roughage will help prevent bowel and bladder complications.



e. Assist the patient to take several deep breaths each hour. Coughing and deep breathing will help prevent respiratory complications. Encourage the patient to actively exercise the unaffected extremities.


f. Eliminate any factors that reduce the traction pull or alter its direction. Ropes and pulleys should be in straight alignment and the ropes should be unobstructed. Traction is NOT accomplished if the knot in the rope is touching the pulley or the foot of the bed. The weights must be suspended and not in contact with the bed or resting on the floor. The patient's body should always be in alignment with the force of traction. Check the patient's position each time you enter the room and help the patient slide up in bed if necessary. Encourage the patient to use the overhead trapeze instead of elbows to move in bed.


g. Check the extremities for color (pallor, cyanosis), numbness, edema, signs of infection, and pain. Look for areas of skin breakdown or pressure sores on all skin surfaces.


h. Orthopedic patients confined in traction will need some sort of diversional activity to relieve boredom and prevent depression. If your treatment facility has no occupational therapy department, encourage family and friends to visit frequently and bring books or games for the patient. Television and radio may also help to pass the time. The nursing personnel should make opportunities to stop and chat with the patient, both to distract the patient from boredom and to assess the patient's mental status. It is often easy to see a state of depression beginning and it will be easier to dispel in its early stages.


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