3. 4. Monitor circulation in, sensation of, and motion of affected part (see Fracture care, p. 576).

   5. Maintain mobility in unaffected limb and unaffected joints; prevent footdrop of affected lim

4. Running traction:

   1. Keep well centered in be

   2. Elevate head of bed only to point of countertraction.

   3. No turning from side to side—will cause rubbing of bony fragments.

   4. Check distal circulation frequently.

   5. Frequent back care to prevent skin breakdown.

   6. Fracture bed pan for toiletin

   7. Avoid excessive padding of splints in groin area to prevent tissue traum

5. Balanced suspension traction:

   1. Maintain alignment and countertraction:

      1. (a) Ropes on pulleys.

      2. (b) Weights hang fre

      3. (c) Elevate head of bed as prescribe

      4. (d) Check knots routinely.

   2. May move patient, but turn only slightly (no more than 30 degrees to unaffected side).

   3. Heel of affected leg must remain free of the be

   4. 20-degree angle between thigh and be

   5. Check for pressure from sling to popliteal are

   6. Provide foot support to prevent footdrop.

   7. Maintain abduction of extremity.

   8. Check for signs of infection at pin insertion sites; cleanse tid as ordere

   9. If tape or moleskin is used, shave extremity and apply benzoin to improve adherence of strip and reduce itchin

6. Cervical traction:

   1. May be placed on specialized bed, , Stryker fram

   2. Position: maintain body alignment.

   3. Keep tongs free from bed, and keep weights hanging freely to allow traction to function properly.

7. ► Halo traction:

   1. Several times a day, check screws to the head and screws that hold the upper portion of the frame, to determine correct position.

   2. Pin sites cleansed tid with bacteriostatic solution to prevent infection.

   3. Monitor for signs of infection.

   4. Position as any other patient in body cast, except no pressure to rest on halo—pillows may be placed under abdomen and chest when patient is pron

   5. Institute ROM exercises to prevent contractures.

   6. Turn frequently to prevent development of pressure areas.

   7. Allow patient to verbalize about having screws placed in skull.

   8. Postapplication nursing care same as pin insertion for other traction.

8. ► External fixation devices:

   1. Pin care same as for skeletal traction.

   2. Teach clothing adjustment.

   3. Teach to adjust for size of apparatus.

9. Internal fixation devices:

   1. Monitor for signs of infection/allergic reaction to materials used for maintenance of reduction (drainage, pain, increased temperature).

   2. Position as ordered to prevent dislocation.

10. ► Casts:

    1. Support drying cast on firm pillow; avoid finger imprints on cast.

    2. Elevate limb to reduce edem

    3. Prevent complications of fractures as liste

    4. Closely monitor circulation (blanching, swelling, decreased temperature); sensation (absence of feeling; pain or burning); and motion (inability to move digits of affected limb).

    5. Be prepared to notify MD or cut cast if circulatory impairment occurs.

    6. Protect skin integrity: avoid pressure of edges of cast; petal pm.

    7. Monitor for signs of infection if skin integrity impaire

Goal: provide care related to ambulation with crutches.

1. See Table 7-38.

2. Measure crutches correctly (Table 7-39).