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RLE 7 – BSN-3L

Trapeze
CARE OF PATIENT WITH TRACTION - a triangular device hung from the ceiling or from a bar over the bed which can be adjusted to the patient's
OBJECTIVES: reach; assist the client to change position in the bed or upon sitting.
After 6 hours of varied classroom discussion, the Level 3 students will be able to:

PURPOSES OF TRACTION
1. define the following terms:
1.1 counter traction
1.2 fixator ● to align fragment of broken bones
1.3 traction ● to maintain proper alignment of bone fragments during healing
1.4 trapeze
● to immobilize limb while soft tissue healing takes place

2. state the purposes of traction. ● relief of painful muscle spasms


3. enumerate the indications and contraindications of traction. ● correction and prevention of deformities
4. cite the types and application of the following:
● to reduce dislocations and subluxations
4.1 traction
4.2 fixator
5. explain the scientific principles involved in the care of patient’s with traction INDICATIONS
6. discuss the possible complications
7. discuss the general care for patients with traction ● Fracture
7.1 assessment of body part
- Traction is used to manage fractures in an effort to lessen muscle spasm, realign,
7.2 handling traction
immobilize, and maintain the corrected position, and promotes healing of broken bones.
7.3 skin care
7.4 turning
7.5 toileting and bathing ● Dislocations
7.6 preventing complications - Realign the dislocated portion of the joint in its original anatomical position by reduction. After
reduction, the extremity is usually immobilized by the use of traction to allow the torn ligaments and capsular
DEFINITION OF TERMS tissue time to heal.

Counter traction ● Severe strains and sprains


- is the force acting in the opposite direction. Usually the patient's body weight and bed position
- A severe sprain can result in an avulsion fracture, in which the ligament pulls a loose fragment
adjustments supply the needed counter traction. It must be maintained for effective traction.
bone.

Fixator
● Lower back pain
- device used to immobilize a fracture in which a system of percutaneous pins or wires are connected to a
- To relieve muscle spasm, or traction may be applied to lessen muscle spasm around a
rigid external frame or incorporated cast.
joint.

Traction
● Contractures
- is a technique in which a pulling force is used to stretch soft tissues and to separate joint surfaces or
- Intervention requires gradual and progressive stretching of the muscles or ligaments in the
bone fragments.
region of the joint. An application of a pulling force is necessary.
- Involves applying a force of sufficient magnitude and duration in the proper duration while simultaneously
resisting movement of the body
● Arthritis  Russell Traction
- The patient with arthritis who has flexion contractures of the hip and the knee may have - This form of traction may be used to treat fracture of the shaft of the femur. This creates a
traction applied to correct or prevent the development of deformities. forward and upward pull on the leg applying vertical traction at the knee on the tibia and
fibula.
CONTRAINDICATIONS
 Bryant’s Traction
● Osteomyelitis - Also called “Gallow’s traction”. This is occasionally used to

● Primary bone tumor or spinal cord tumor reduce fractured femurs or to reduce hip dislocations in very
young children under 2 years or 30 lbs (14 kgs.) in weight.
● Unstable fracture
● Severe osteoporosis
● Vascular insufficiency
● Patient with Diabetes if remained for a long period of time
● Patient with severely injured extremity with open wounds

TYPES AND APPLICATION OF TRACTION


 Pelvic belt
Skin traction - May be used to relieve low back pain which is not caused by spinal fracture or dislocation.
Skin traction uses five-to seven-pound weights attached to the skin to indirectly apply the necessary
pulling force on the bone. If traction is temporary, or if only a light or discontinuous force is needed, then skin traction
is the preferred treatment. Because the procedure is not invasive, it is usually performed in a hospital bed.
This is utilized when shorter periods or relatively light traction forces are needed.

Common types of Skin Traction:


 Buck’s Extension Traction
– Is skin traction to the lower leg. It is used to provide immobility after fractures of the
 Cervical Halter
proximal femur before surgical fixation.
- a traction pull is extended on the cervical spine by means of a halter which encircles the
– Used for many conditions affecting the hip, femur, knee, or back and for temporary
head at the occiput and the chin. It is most often used in management of cervical muscle
immobilization and stabilization of fractured hips or fractures of the femoral shaft.
spasm and neck pain.
Skeletal Traction 2. INTERNAL FIXATION
Skeletal traction is performed when more pulling force is needed than can be withstood by skin traction; or
when the part of the body needing traction is positioned so that skin traction is impossible. Skeletal traction uses 1. Is a method of surgically repairing a fractured bone. An
weights of 25-40 pounds. internal fixation device may be used to keep fractured
Skeletal traction requires the placement of tongs, pins, or screws into the bone so that the weight is applied directly bones stabilized and in alignment. The device is inserted
to the bone. This is an invasive procedure that is done in an operating room under general, regional, or local surgically to ensure the bones remain in an optimal
anesthesia. position during and after the healing process.

Common types of Skeletal Traction:


 Overhead arm traction SCIENTIFIC PRINCIPLES INVOLVED
- Is used when relatively light traction is needed to immobilize and maintain the reduction of
the proximal humerus and shoulder. Anatomy and Physiology -having adequate knowledge in the structure and function of the human body
enables one to efficiently carry out appropriate action or care. .
 Lateral Arm
- Commonly used for immobilization of fractures and dislocations of the upper arm and Microbiology - -when caring for tractions, it is of utmost importance to do medical hand washing so as to
shoulder. The forearm is flexed and extended 90 degrees from the upper part of the body prevent infection of site (Pin sites).

 Balanced suspension traction Physics – provision of countertraction must be made to prevent the patient from sliding to the end or side

- Used for injury or fracture of the femoral shaft of the femur, acetabulum, hip, tibia, or any of the bed. Countertraction is the pull in opposition to the pulling force of traction and is commonly supplied by the

combination of these patient’s weight or may be augmented by elevating the end of the bed.

Psychology – explaining procedure to the patient would gain patient’s cooperation and reduces the
patient’s anxiety.

Body Mechanics - maintain proper posture, body alignment and balance through out the procedure to
maintain wellness and prevent fatigue.

COMPLICATIONS

TYPES OF FIXATORS ● Hypostatic pneumonia


● Constipation
1. EXTERNAL FIXATION
● Urine retention
● Impaired circulation
1. Is a technique of fracture immobilization in which a series of transfixing pins is inserted through
the bone and is attached to a rigid external metal frame
● Nerve damage

2. It is often the treatment of choice in closed fractures, in multiple traumas with a number of ● Hyperextension of the knee

fractures, and in comminuted bone fractures. ● Disuse osteoporosis; contractures


● Osteomyelitis
● Pin site infection
II. Handling new traction

GENERAL CARE FOR PATIENTS WITH TRACTION -inspect traction apparatus frequently to ensure the ropes are running straight and through the middle of the
I. Assessment of the Body Part pulleys; that weight are hanging free; that bed clothes, the bed or the frame and bars on the bed are not
impinging on any part of the traction apparatus
1) Circulation -check ropes frequently to be sure they are not frayed
-check skin color, joint motion, complaints of numbness, coldness or swelling over the extremity. -avoid adding weight to the traction
Avoid pressure in the popliteal space. -avoid bumping into or jarring the bed or traction equipment
-be sure weights are securely fastened to their ropes
2.) Condition of the skin -avoid manipulation of pins
-check skin areas over Achilles’ tendon, dorsum of the foot, heel, and sacral region.
III. Skin Care
3.) Body alignment and position of the extremity
-is the purpose of the traction being accomplished? - Encourage the patient to turn slightly from side to side and to lift up on the trapeze to relieve pressure
on the skin of the sacrum and scapulae; have the patient lift up for routine skin care
4.) Prevention of deformity - Inspect skin frequently to be sure it is not being rubbed, contused or macerated by traction
-have measures been provided to prevent drop foot, hip flexion and contracture? Is the backrest equipment; re-adjust splints or the extremity in the splint to free the skin from pressure
lowered several times daily to provide for complete extension of the hip joints? - Keep skin areas around pin sites clean and dry; direct care to pin sites(that is cleansing with cotton
applicators and hydrogen peroxide or alcohol)is controversial so check with physician to determine if
5.) Countertraction pin care is to be done routinely and what method the physician prefers.
-is countertraction sufficient or does the footplate frequently rest against the foot of the bed?
IV. Turning
6.) Slipping
-is there slipping of the traction tapes, and does outer bandage need rewrapping? - Check the doctor’s orders to determine whether a patient can turn or if traction can be removed
periodically.
7.) Pressure - Never lift or change traction weights without a doctor’s orders.
-is there pressure on the lateral aspect of the leg over the head of the fibula? Pressure in this area - Do not remove traction or increase or decrease the amount of the weight without specific orders.
may result in a palsy of the peroneal nerve. - If the doctor states that the traction may be removed periodically, lift and reapply weights gently so
the patient is not subjected to the sudden release from traction or to the sudden reapplication of
8.) Patient’s comfort tension.
-traction should never be a source of undue discomfort for the patient. Listen carefully and heed - Always tell the patient when you are going to remove or reapply the tension.
complaints of discomfort. - Never “drop” a weight when reapplying traction, but gradually lower the weight so the patient does not
undergo sudden extreme stress.
- A patient in traction should not roll laterally or have the position of the bed changed without the
physician’s permission.
9.) Complication - A patient who may have the headrest up and down should be positioned completely flat at least half
-because of prolonged bed rest and minimal activity, hypostatic pneumonia is a constant threat, the time to prevent hip flexion contractures.
particularly to the elderly patient. Encourage coughing and deep breathing. - If the doctor gives permission for the patient to turn slightly, make certain you know which side the
patient may turn toward.
- When the patient moves about (lifts up for back care or slides up in bed), someone should steady the Constipation and Anorexia
traction equipment while another person assist the patient or provide s other care e.g. places a bed
pan or gives skin care -reduce GIT motility results in constipation and anorexia. A diet high in fiber and fluids may help to stimulate
- When traction is applied to the leg, a footplate may be applied to prevent foot drop. gastric motility
- Prevent rotation of the leg and splint. The heel should not rest on the bed or pressure necrosis will -if constipation develops, therapeutic measures might include stool softeners, laxatives, suppositories and
develop. enemas
- If patient’s leg is in traction the foot should never rest against the foot of the bed. -to improve the patient’s appetite, the nurse identifies and includes the patient’s food preferences, as
- If pillows are permitted, the doctor should place them the first time sp the limb is positioned as desired appropriate, within the prescribed therapeutic diet.
with effective traction.
- If pillows are used, they should be firm so they will provide adequate support and will maintain Urinary Stasis and Infection
alignment of the limb with the traction apparatus. -incomplete emptying of the bladder related to positioning in bed can result in urinary stasis and infection. In
- Does not support just a portion of the extremity, but rather provide support along its entire length. addition, the patient may find use of the bedpan uncomfortable and may limit fluids to minimize frequency of
- Elevation of the heel should not hyperextend the knee. urination. The nurse monitors the fluid intake and character of the urine.
-the nurse teaches the patient to consume adequate amounts of fluid
V. Toileting and Bathing -if the patient exhibits the signs and symptoms of UTI, the nurse notifies the physician

- When possible, a fracture bedpan is used for a patient with fracture. When permitted, placing a pillow Venous Stasis and Deep Vein Thrombosis
under the back and shoulders keeps patient more level with the bedpan. - The nurse the patient to perform ankle and foot exercises within the limits of the traction therapy
- Protect the ring of the Thomas splint with waterproof material when female patients are using the every 1 to 2 hours when awake to prevent DVT, which may cause result from venous stasis.
bedpan. - The patient is encouraged to drink fluids to prevent dehydration and associated hemoconcentration,
- which contribute to stasis.
VI. Prevention of Complications -
- The nurse monitors the patient for signs of DVT, including calf tenderness, warmth, redness, swelling
Pressure Ulcers and a positive Homan’s sign and the nurse promptly reports findings to the physician for definitive
evaluation and therapy.
-the nurse examines the patient’s skin frequently for evidence of pressure or friction, paying special attention
to bony prominences.
-it is helpful to reposition the patient frequently and to use protective devices to relieve pressure
-if the risk of skin breakdown is high, use of specialized bed is considered to prevent skin breakdown
-if a pressure ulcer develops, the nurse consults with the physician

Pneumonia

-the nurse auscultates the patient’s lungs every 4-8 hours to determine respiratory status and teaches the
patient deep breathing and coughing exercises to aid in fully expanding the lungs and moving pulmonary
CARE OF PATIENT WITH CAST
secretions
-if the patient history and baseline assessment indicate that the patient is at high risk for development of Objectives:
respiratory complications specific therapies (incentive spirometer) may be indicated After 6 hours of varied teaching- learning activities, the Level 3 students will be able to:
1. define the ff. terms:
a. Avulsion - pulling away of a fragment of bone by a ligament or tendon or its attachment
1.1 cast
1.2 closed reduction b. Comminuted - bone has splintered into several fragments
1.3 open reduction
c. Compound - damage involves the skin or mucous membranes; also called open fracture
1.4 fixation
d. Compression - bone has been compressed (seen in vertebral fractures)
1.5 trabecular
1.6 splint e. Depressed - fragments are driven inward (seen frequently in fractures of skull and facial bones)
1.7 fracture
f. Epiphyseal - fracture through the epiphysis
2. review the types of fracture.
g. Greenstick - one side is broken and the other side is bent; also called incomplete fracture
3. state the purpose of casting.
4. discuss casting as to: h. Impacted - bone fragment is driven into another fragment
4.1 indications, contraindications and complications
i. Oblique - occurs at an angle across the bone (less stable than transverse)
4.2 types
j. Pathologic - occurs through an area of diseased bone (e.g. bone cyst, Piaget’s disease, bone metastasis, tumor);
4.3 the scientific principles involved
can occur without trauma or fall
5. identify the materials used.
k. Simple - remains contained; does not break the skin
6. discuss the general care for the patient with cast
6.1 assessment of the body part l. Spiral - twisting around the shaft of the bone
6.2 handling new cast
m. Transverse – a fracture that is straight across the bone shaft
6.3 cast care
6.4 skin care
6.5 warning signs following cast application
6.6 turning
6.7 toileting and bathing
6.8 prevention of complications

DEFINITION OF TERMS

Cast - rigid mold that immobilizes an injured structure while it heals.

Closed reduction – a procedure for setting a broken bone without making an incision (cut) in the skin.

Open reduction – refers to the method wherein the fracture fragments are exposed surgically by dissecting the
tissues.

Fixation – the process of holding, suturing or fastening in a fixed position.

Trabecular – lattice-like bone structure; cancellous bone.

Splint - device designed specifically to support and to immobilize a body part in desired position.

Fracture – any damage in the continuity of the bone.


Purpose of Casting

 To immobilizing device used for faster healing of a fracture.


TYPES OF FRACTURE
 To correct a deformity.
 To apply uniform pressure to underlying soft tissue. • Patient must learn to tense or contract muscles without moving the part. This helps reduce muscle atrophy
 To support and stabilize weakened joints.
and maintain muscle strength.

• Nurse must teach pt with leg cast- push down the knee and pt with arm cast- make a fist

Indications of Cast application


TYPES OF CAST
- Patients with fractured long bones, such as femur, tibia, fibula, radius, ulna or humerus.
a. Short Arm Cast - extends from the elbow to the palmar crease, secured around the base of the thumb. If the
- Femoral fractures especially in children. thumb is included, it is known as the thumb spica or gauntlet cast.

- Spine injuries of the thoracic or lumbar spine. b. Long Arm Cast - extends from the upper level of the axillary fold to the proximal palmar crease, the elbow is
usually immobilize at a right angle.

Contraindications of Cast Application c. Short Leg Cast - extends from below the knee to the base of the toes. The foot flexed at a right angle in a neutral
position.
- Patients who are allergic to cast material.
d. Long Leg Cast - extends from the junction of the upper and middle third of the thigh to the base of the toes. The
- Patients who are suffering from skin disorders. knee may be slightly flexed.

- Patients with varicosities in the area for the cast. e. Walking Cast - short or long leg cast reinforced for strength.

f. Body Cast - larger form of a cylinder cast that encircles the trunk from the nipple line to the iliac crest.

Complications of Cast application g. Shoulder Spica Cast - body jacket that encloses the trunk and the shoulder and the elbow.

h. Hip Spica - encloses the trunk and a lower extremity. A double hip spica includes both legs.
Compartment Syndrome

• Increased tissue pressure in the limited space that compromise the circulation and function of the tissue Type of Cast Location Uses
within the area

• To relive the pressure cast must be bivalve (cut in half longitudinally) while maintain alignment and the Short arm cast: Applied below the elbow to the Forearm or wrist fractures. Also used to hold
hand. the forearm or wrist muscles and tendons in
extremities must be elevated no higher that the heart level. place after surgery.

• If pressure is not relieve and circulation is not restored, Fasciotomy is done.


Long arm cast: Applied from the upper arm to Upper arm, elbow, or forearm fractures. Also
the hand. used to hold the arm or elbow muscles and
Pressure Ulcers tendons in place after surgery.

Arm cylinder cast: Applied from the upper arm to To hold the elbow muscles and tendons in
• Pressure of the cast on soft tissue may cause anoxia and pressure ulcer.
the wrist. place after a dislocation or surgery.
• The main pressure sites on the upper extremities are located at the medial epicondyle of the humerus and
the ulnar styloid

• Patient reports pain and tightness to the area affected. Warm area on the cast suggests underlying tissue
erythema.

Disuse Syndrome
Type of Cast Location Uses
Shoulder spica cast: Applied around the trunk of the Shoulder dislocations or after surgery on the
body to the shoulder, arm, and shoulder area.
hand.
Type of Cast Location Uses

Minerva cast: Applied around the neck and After surgery on the neck or upper back area.
trunk of the body. Short leg hip spica cast: Applied from the chest to the To hold the hip muscles and
thighs or knees. tendons in place after surgery to
allow healing.
Short leg cast: Applied to the area below the Lower leg fractures, severe ankle
knee to the foot. sprains/strains, or fractures. Also used to hold
the leg or foot muscles and tendons in place
after surgery to allow healing.

Leg cylinder cast: Applied from the upper thigh to Knee, or lower leg fractures, knee
the ankle. dislocations, or after surgery on the leg or
knee area.

Type of Cast Location Uses

Abduction boot cast: Applied from the upper thighs to the To hold the hip muscles and tendons
feet. A bar is placed between both in place after surgery to allow
legs to keep the hips and legs healing.
immobilized.

Type of Cast Location Uses

Unilateral hip spica cast: Applied from the chest to the foot on Thigh fractures. Also used to hold
one leg. the hip or thigh muscles and tendons
in place after surgery to allow SCIENTIFIC PRINCIPLES
healing.

One and one-half hip spica cast: Applied from the chest to the foot on Thigh fracture. Also used to hold the 1. MICROBIOLOGY -when caring for casts, it is of utmost importance to keep the cast dry as to prevent
one leg to the knee of the other leg. hip or thigh muscles and tendons in accumulation of bacterias in the moist area.
A bar is placed between both legs place after surgery to allow healing.
to keep the hips and legs
immobilized. 2. CHEMISTRY - the use of plaster and other materials for casting.

Bilateral long leg hip spica cast: Applied from the chest to the feet. A Pelvis, hip, or thigh fractures. Also 3. ANATOMY and PHYSIOLOGY - having adequate knowledge in the structure and function of the human
bar is placed between both legs to used to hold the hip or thigh muscles body enables one to efficiently carry out appropriate action or care.
keep the hips and legs immobilized. and tendons in place after surgery to
allow healing.
4. BODY MECHANICS - maintain proper posture, body alignment and balance through out the procedure to
maintain wellness and prevent fatigue.
MATERIALS USED IN CAST APPLICATION • After you have adjusted to your cast for a few days, it is important to keep it in good condition. This will help your
recovery.
Nonplaster -Fiberglass • Keep your cast dry. Moisture weakens plaster and damp padding next to the skin can cause irritation. Use two
- Water activated polyurethane materials have the versatility of plaster. layers of plastic or purchase waterproof shields to keep your cast/splint dry while you shower/bathe.
- Lighter in weight, stronger, water resistant and durable • Do not walk on a “walking cast” until it is completely dry and hard. It takes about one hour for fiberglass, and 2-3
- Non absorbent fabric impregnated with cool water activated hardeners. days for plaster to become hard enough to walk on.
- They are porous and therefore diminish the skin problems. • Keep dirt, sand, and powder away from the inside of your cast.
- They are used in non displaced fracture for minimal swelling and long-term use. • Do not pull out the padding from your cast.
• Do not stick objects such as coat hangers inside the cast to scratch itchy skin.
Plaster – traditional cast • Do not apply powders or deodorants to itchy skin. If itching persists, contact your physician.
• Do not break off rough edges of, or trim, the cast before asking your physician.

• Rolls of plaster bandage are moistened in cool water and applied smoothly on the body. • Inspect the skin around the cast/splint. If your skin becomes red or raw around the cast contact your physician.
• Inspect the cast/splint regularly. If it becomes cracked or develops soft spots, contact your physician.
• Crystallizing reaction occurs and heat is given off. Speed of ration varies from 15-20 mins.

• Requires 24-72 hrs of drying up completely SPECIFIC CARE MANAGENT CONSIDERATIONS


Arm Cast
• Freshly applied should be exposed directly to air for t to be dried and should not be covered with clothing
If swelling occurs, elevate immobilized arm. When pt. is lying down, elevate it higher than the preceding
or linens proximal joints. Sling may be used to ambulate.
To prevent pressure on cervical spinal nerves, remove he sling and elevate the hand frequently.
Contractures of fingers and wrist occurs as the result of obstructed arterial blood flow to the forearm and
GENERAL CARE FOR THE PATIENT WITH CAST
hands. This is a serious complication that can be prevented with nursing surveillance and proper care.

Assessment of the body part


Leg Cast
The nurse support the pt. legs on the pillow to heart level to control swelling and applies icepacks as
Before the cast is applied, the nurse completes an assessment of the patient’s general health, presenting prescribed over the fractured site for 1-2 days. Pt assume recumbent position with casted leg elevated to promote
signs and symptoms, emotional status, understanding of the need for the cast, and condition of the body part to be venous return and control swelling
immobilized. Physical assessment of the part to be immobilized must include assessment of the neurovascular Assess for capillary refill on the exposed toe. Nerve function should be assed by observing pt ability to
move toes by asking about the sensations of the foot.
status (neurologic and circulatory functioning) of the body part, degree and location of swelling, bruising, and skin Nurse should teach patient to transfer and ambulate with assistive devices
abrasions.
Skin care
Handling new cast
 Wash skin area around cast taking care not to saturate cast in the process.
• The cast must dry completely to support your arm/leg. The cast will get lighter as it dries. A plaster arm or leg cast  Rub the areas around the cast frequently with alcohol. Lotion has a tendency to build up on the inside of
dries in about 24 to 48 hours the cast and becomes sticky, so it should never be used around the cast or under it.
• Until the cast dries, place rubber or plastic between your cast and other items (e.g. pillow) so the items do to get  If edges are causing irritation to the skin, pad with some soft materials such as cotton or foam. Be sure
wet. the padding is well anchored to the cast.

• To avoid changing the shape of the cast (which could cause skin irritation or sores), be careful not to dent the cast
while it's still wet. Warning signs following cast application

• Persistent pain.
Cast care
• Your cast feels too tight. Fiberglass or Synthetic Cast
• Your cast becomes loose, broken, or cracked. • Check with your doctor to find out if you may bathe, shower, or swim.
• You have painful rubbing under your cast.
• If he does allow you to swim, he'll probably tell you to flush the cast with cool tap water after swimming in a
• You experience coldness or notice a whitish or bluish discoloration of your fingers or toes
chlorinated pool or a lake.
• You have pain, numbness or a tingling in your fingers or toes
• Make sure that no foreign material remains trapped inside the cast.
• You notice any drainage or unusual odor from you cast/splint
• To dry a fiberglass or synthetic cast, first wrap the cast in a towel. Then prop it on a pad of towels to absorb any

Turning remaining water. The cast will air-dry in 3 to 4 hours; to speed drying, use a hand-held blow-dryer.

 Patients in body or spice casts must be turned from supine to prone to permit thecast to dry, to prevent Prevention of complications

pressure areas by redistribution of body weight, and to preventrespiratory and urinary complications.
Evaluation of a casted patient for indications of cast-related complications should be conducted in a
 The patient is turned initially as ordered by the physician and must usually be turned a minimum of every
planned, orderly manner so that significant findings are not missed.
two hours (unless otherwise indicated by the physician) for as long as he remains in the cast. Until the cast
is thoroughly dry, at least three people should turn the patient so that there is no strain on the patient or on
Assess for:
the damp cast.
 In any turning procedure, the patient must be turned "as a unit" with the affected side ("bad side")
Movement of toes and fingers: Have your patient move or wiggle his fingers or toes often.
uppermost. The patient should be turned, or log-rolled, toward the unaffected side of his body ("good
side").
Sensation (feeling): Touch the area above and below the cast several times a day. Call your patient’s doctor right
 Utilizing the pillows on which the patient is resting, and/or a draw sheet, move the patient to the side of the away if your child complains of numbness, tingling or pain.
bed with a steady, even, pulling motion.
Blood flow (circulation): Press briefly on your patient’s middle fingernail or large toenail several times a day. When
 Remember that the patient must be moved as a unit. When the patient is in the proper position, his "bad it turns white, let go. If pink color does not return in three seconds, call the doctor right away.
side" will be at the edge of the bed and his "good side" will be near the center of the bed.
Temperature: If the patient’s hand or foot is cold, cover it with a blanket or sock or raise it above the level of the
heart. Check it again in 20 minutes, if it is still cold, check feeling and blood flow. If you think there may be a
problem, call the doctor right away.

Severe swelling: Look for swelling above and below the cast several times each day. A little swelling is normal, but
a lot of swelling is not. Compare the extremity with the cast to the other one. If there is swelling, raise it higher
than the level of the heart for one hour. Watch it closely and call the doctor if the swelling does not go down.

One way of remembering some of the significant symptoms of cast-related complications is the mnemonics of the “5
P’s”: Pain, Pallor, Pulselessness, Paresthesia, and Paralysis.
Toileting and bathing

Irrigating CYSTOCLYSIS
Plaster Cast
Objectives:
• If you have a plaster cast, you'll need to cover it with a plastic bag before you shower, swim, or go out in wet
After 6 hours of varied teaching-learning activities, the Level 3 students will be able to:
weather. You can use a garbage bag or a cast shower bag, which you can buy at a drug store or medical supply
store. 1. discuss cystoclysis as to:
• DON'T get a plaster cast wet. Moisture will weaken or even destroy it. a. definition.
• If the cast gets a little wet, let it dry naturally, such as by sitting in the sun. b. purposes.
c. indications, contraindications and complications.
d. the scientific principles involved. • Infection
e. types. - Cystoclysis is an invasive procedure that it may cause infection if not performed aseptically.
f. guidelines. Open system poses greater risk for infection since it involves opening of the close drainage system.
g. the nursing responsibilities before, during and after irrigation.
• Trauma to the wall of the bladder
2. demonstrate beginning skills in cystoclysis. – too much pressure may traumatize the bladder wall.
3. record urine volume after each irrigation.

• Bladder Spasms
– if the irrigation solution used is too cold.
Definition of Terms:
• Bladder Distention
Cystoclysis is a type of irrigation wherein saline solution is introduced into the bladder. It is also called as - if the tubing has been kinked, not patent, induce secondary hemorrhage, clamp is closed by
continuous bladder irrigation. stretching the coagulated blood vessel in the prostatic capsule

Purpose of Irrigating Cystoclysis


• to restore or maintain the patency of the bladder – detects/prevents obstruction in Scientific Principles Involved in Irrigating Cystoclysis
the catheter
• to prevent formation of calcific deposits in and around the indwelling catheter • Microbiology
• to relieve bladder spasm – draining the urine from the overdistended bladder can Observing the aseptic technique is a must to avoid complication.
relieve spasm
• to drain the bladder when acute urinary retention is present • Psychology

• to irrigate bladder with a medication to treat an infection or local bladder irritation Explaining the procedure to the client helps him/her relax, reduce anxiety and cooperate during
the procedure.

Indications
• Urinary Tract Infection • Anatomy and Physiology

• Post-genitourinary surgery We have to know the parts involved in the procedure and its function to give the right health
teachings. And so as not to cause further injury to the organ and other structures involved.
• Post-surgically after prostatectomy / who have had surgery of the urinary tract -
prevents formation of clots that may cause blockage to the bladder
• Physics
• Prostatic hematuria – prevents formation of clots that may cause blockage to the
Avoid too much pressure to prevent causing trauma to the wall of the bladder.
bladder
Contraindications
• Hypersensitivity to the solution to be used
Types of Irrigating Cystoclysis
• Patients with defects in the bladder mucosa or bladder wall – it can cause further
1. Closed Bladder Irrigation System
injury to the bladder wall
- does not require that the system be opened
- for frequent intermittent irrigations or continuous irrigation without disrupting the sterile
alignment of the catheter and drainage system through use of a three-way catheter
Complications of Irrigating Cystoclysis
2. Open Irrigation System After:
- The bladder is drained using a 60-mL syringe. 1. after care
- opening of the closed drainage system to instill bladder irrigations 2. do proper documentation
- is used when bladder irrigations are required less frequently and there are no blood - amount of solution used as irrigant, amount returned as drainage, characteristics of output,
clots or large mucous fragments calculation
- poses greater risk for causing infection

Guidelines Involved in Irrigating Cystoclysis


RECORDING URINE IRRIGATION

a. Determine whether the irrigation will be open or close. FORMULAS:


b. Observe universal precaution.
Amount instilled solution
c. Set up sterile irrigating supplies, maintaining sterile technique per agency protocol.
Present volume of 2pm – Present volume of 3pm = Amount instilled solution
d. Use only clearly labeled or prepared solutions for irrigation.
e. Flush tubing prior to irrigation to clear air from the tubing that might cause bladder distention. Total Urine Output
f. Check for bladder distention – detects whether catheter is malfunctioning or blocking urinary drainage.
= check urine output
g. Cleanse site of entry or end of Y-connector with an antiseptic/disinfectant.
Actual Urine Output
h. Monitor and maintain correct flow rate as necessary.
i. Check urine output every hour. Total Urine Output – Amount Instilled Solution = Actual Urine Output
j. Do necessary documentation.
Example:
Nursing Responsibilities
Before:
1. check physician’s order for type of irrigation and irrigation solution to use, date, time room and
name of the client
2. explain the procedure to the client
Date Bottle # Total Time Rate Time Present Amount Total Actual
3. gather the necessary materials Volume hooked of Volume Instilled Urine Urine
4. do medical handwashing Flow Solution Output Output
2/20/0 1 1000 ml 2pm titrated 2pm 1,000 - - -
5. open the IV tubing then do priming 9
6. assess lower abdomen for bladder distention 3pm 900 100 240 140
4pm 750 150 240 90
7. position the patient 5pm 550 200 300 100
- dorsal recumbent or supine 6pm 450 100 170 70
7pm 350 100 60 -40

During:
1. drape the patient exposing the leg where the catheter is being taped
2. do gloving
3. cleanse the catheter injection port with antiseptic swab
4. regulate the flow rate in its ordered rate
5. measure urine output every hour