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What is traction?
*application of a pulling force to a part of the body to provide reduction, alignment, and rest
*used to decrease muscle spasms (relieving pain) and prevent/correct deformity and tissue damage
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What is the difference between running traction and balanced suspension?
*Running traction-the pulling force is in one direction and the pt's body acts as countertraction. If bed or pt is moved, the counteraction force is altered.
*Balanced suspension-provides the coutertraction so that the pulling force or the traction is not altered when the bed or pt is moved. Allows for increased movement and facilitates care
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What are the two most common types of traction?
- skin- involves a boot called buck's traction;
- primary function is to decrease muscle spasms; weight is 5-10lbs to prevent injury to skin
skeletal-pins/screws in bone, allow longer use of traction time and weight of 15-30lbs; bone relaignment
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What is Russell traction
-knee is suspended in sling 20 degrees above bed
-upward and forward pulley system
-allows for slight turning movement to change linens, bedpan
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What is Bryants traction?
-used for developmental dislocated hips in children
-keeps femor in hip socket
-bandages, weights, both legs in the air
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What is pelvic traction?
-treats back and hip pain
-snug belt around hips attached to a spreader bar that has weights perscribed by physician
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What is the nurses role in the management of traction? (6)
-inspect q 8-12hrs, ropes, pulleys and knots for loosening, fraying, and positioning
-check weight w perscription order
-keep weights off of floor
-if pt reports severe pain weights may be too heavy or pt may need realigned
-monitor circulation q hr for 24 hrs then q 4 hrs thereafter
-inspect skin q 8 hrs
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What are some relief measures for pt's in traction/
-opiod (pain) NSAIDS (inflammation)
-ice/elevation for swelling/pressure
-heat/massage for muscle spasms
-complementary therapies
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Common charateristics of amputation
-elective: complications of peripheral disease (diabetes, arteriosclerosis), lower extremity, more common
-traumatic: result from accident, more common in upper extremeties
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What are some complications of amputations?
- Hemmorhage
- Infection
- Phantom limb pain
- Neuroma
- Flexion contractures
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what is the difference between an open (guillotine) amputation and a closed amputation
-open amputation is when the dead tissue is removed and the surgeon leaves the skin and nerves pulled back from the amputation site for 10-14 days to ensure there is not infection
-closed amputation is when the skin flaps are sewn together over the amputation site after the 10-14 day period or if the surgeon is sure of a decreased risk for infection
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What is Phontom Limb Pain and name some charactertistics?
-sensation is felt is the amputation part immediately after sx and usually diminishes over time; more ocmmon in chronic limb pain
-pt c/o burning, crushing, cramping, uncomfortable position, numbness and tingling, pain
-pain can be triggered from touching the residual limb, changes in temperature, stress, fatigue, anxiety, touching any body part(stimulation)
-tx pain as though it is real
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What is neuroma?
-a sensitive tumor consisting of damaged nerve cells-forms most often in amputations of the upper extremeties but can occur anywhere
-dx with ultrasound, tx surgically but often grows back and is more painful; non-sx steroid injections, nerve blocks, hypnosis
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how can you avoid flexion contractions in an amputation pt?
-often in hip/knee amputation
-proper positioning, and active ROM exercises help prevent
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What types of circulations assesments need to be checked for an amputation pt?
-neurovascular assessment (if pt has peripheral vascular disease check both legs)
-Assess skin color, temp, sensation, pulses, capillary refill(least effective)
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what is the emergency care to provide for a traumatic amputation?
-call 911
-assess for airway/breathing
-examine site, apply direct pressure w layers of dry guaze, clean gloves
-elevate extremity above pt heart to decrease bleeding
-do not remove dressing to prevent dislodging the clot
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what do you do with a amputated finger (limb)?
- -wrap in dry sterile gauze/clean cloth
- -put is watertight, sealed plastic bag
- -place bag in ice water never directly on ice (1 part ice to 3 parts water)
- -part goes with pt to hospital
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what is the nurses primary focus for an amputation pt?
-monitor for signs indicating tissue perfusion but no hemorrhage
-residual limb should be pink, warm, assess closest proximal pulse
-pain management for PLP, opiods not as effective calcitonin will reduce plp pain; beta-blockers for burning, antipileptic for sharp pain and antispasmodics for spasms
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what therapies can be percribed for amputaiton pts
- ultrasound therapy
- massage
- heat
- biofeedback
- relaxation therapy
- hypnosis
- psychotherapy
- TENS (transcutaneous electrical nerve stimulation)
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what can the pt be taught for amputation/prosthesis
-practice prior to sx for easier ambulation after sx
-how to perform ROM exercises, turn q 2 hrs
-firm mattress q 3-4 hrs for 20-30 mins in prone position
-pull residual limb close to other leg and squeeze buttocks for muscle strengthening
-push residaul limb towards bed with soft pillow, then firm pillow, then hard surface to decrease PLP
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what are some ways to reduce the size of residual limb for prosthesis
-Rigid, removeable dressings: decrease edema, rotect shape, easy access for wound inspection
-Elastic bandages: reapply q 4-6 hrs, use figure eight, decrease tightness when wrapping residual end
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