Nursing Management of Patients in Traction
Lea is up all night studying in advance for Monday’s lecture. Tonight, she is reading all about traction. While staring at pictures of patients in traction, she just couldn’t help but be curious of what role the nurse should play in cases such as this. How exactly does one manage a patient in traction?
Role of the Nurse in Caring for Patients in Traction
- RNs shall not apply or set up skeletal or cervical traction.
- RNs shall not remove, add, or lift up on weight when the patient is in traction for the treatment of fractures.
- RNs may remove or add weights to balance suspension (slings), which is used with skeletal traction.
- RNs shall not release a patient from traction for the purpose of transfer to and from bed, stretcher, or procedure tables. The nurse shall notify the physician, so the physician may come and remove traction for transfer and to replace traction.
- RNs shall provide pin care per physician order.
Maintenance of the Traction Apparatus
- The traction apparatus shall be maintained at all times so that the alignment of pull is correct.
- If traction is not in alignment or there appears to be a discrepancy in the number of pounds, the nurse shall notify the physician. The nurse shall document in a quick note.
- The nurse shall document the number of pounds of traction every twelve (12) hours.
- The nurse shall check the traction apparatus to verify that the following are allowed. The ropes are unobstructed, not in contact with the bed or equipment, and move smoothly over the pulleys and the weights are hanging freely.
Assessment of the Patient in Traction
- The nurse shall perform neurovascular, sensory, motor assessments, and document as ordered.
- What are his needs? What are his limitations? The nurses shall 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.
- The nurse shall notify the physician immediately of any acute changes in sensation, movement, or neurovascular status.
Care for Patients In Traction
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Care of Patients in Cervical Traction
For patients in cervical traction, the nurse shall do the following.
- Verify that the head of the bed (HOB) is adjusted per physician’s order.
- Verify that suction is available at the patient’s bedside.
- When conducting Cardiopulmonary resuscitation (CPR), use jaw lift maneuver to open the airway without hyperextending the neck. Realign patient horizontally if HOB is elevated and put board behind patient’s neck.
- If the patient requires logrolling, the RN or licensed practitioner shall direct patient movement from head of bed.
- Patients shall be turned every two (2) hours per physician order. The skin shall be assessed with each turn for evidence of pressure, paying close attention to the occipital area, any bony prominences and traction sites.