Question

Olivia, a 20 month old , is admitted to the hospital with a fractured femur. She is placed in Bryant’s traction.

1. Olivia’s mother asks why this particular traction is used. How should the nurse reply?
2. What specific areas of Olivia’s body should be assessed? Provide rationales.
3. What are some diversional activities the nurse could plan for the child? Utilizing chapter 15, prepare a plan of care incorporating knowledge of growth and development and Olivia’s traction limitations.

Answer 1

1. Olivia’s mother asks why this particular traction is used. How should the nurse reply?

answer 1:The nurse reply to Olivia's mother to explain the rationale of the usage of the particular traction in the child is as under

1. Distraction force:

Olivia's mother must be explained about the forces that appear at the fracture site and the optimisation of these forces to promote the fracture healing.For a fracture to heal there must be force applied to provide distraction at the fracture site and promote healing. The skin adhesives and bandages in byrant’s traction provide a force in the upward direction at the fracture site which is balanced by the gravitational force in the downward direction and this distraction force at the fracture site helps to keep the bone edges of the broken bone apart , providing the healing of the fracture site without any deformity within the framework of the natural course of alignment of the broken bone edges.

2. Fracture reduction .prevention of deformity , prevention of dislocation, promotion of bone healing

  Olivia's mother must be explained that the traction helps to reduce the bone edges at the fracture site without causing any deformity or dislocation of the broken edges and promotes the normal healing of the bone by providing rest and distraction to the cut edges of the bone. Healing of the bone in its normal course of alignment prevents any deformity.

3. pain reduction

Immobilization of the fracture site and providing rest decreases the pain that is felt by the child and this must be explained to the mother.

4. prevention of muscle spasms:

  Olivia's mother must be explained that muscle spasms develop at a fracture site and tend to cause a deformity by pulling the fracture site in different directions to that of the expected healing of the fracture site .Applying the traction to the child's skin helps to keep the muscles aligned in its normal direction ,decreases the pain and decreases the muscle spasms. Thus it decreases the pain and risk of deformity that is associated with the muscle spasms.

5. soft tissue contracture correction:

The soft tissues at the fracture site tend to contract due to the immobilization,the disuse and the muscle spasms This can be corrected by applying the force to gently stretch the soft tissues and the keep their normal stretch and alignment. It must be explained to Olivia's mother that the traction that is used for the fracture will help to prevent the soft tissue contracture and the resulting deformity.

In reply to Olivia’s mother query, all the above explanation must be given, giving her proper knowledge about the reasons for the traction application and how it helps in the healing of the fracture.

2.What specific areas of Olivia’s body should be assessed? Provide rationales

answer 2:The specific areas of the body that must be assessed with their rationales is listed below

1. The skin integrity under the bandages:

rationale: There is a risk of excoriation of the skin due to the compression necrosis or allergy to the bandage or adhesive if that is used , in providing the traction. As a result the skin must be assessed 4 hourly to find out if there is any local skin necrosis, excoriation, ulcer or redness with edema or inflammatory signs due to allergy.

2. Skin wrinkling, skin intendations:

Rationale: The skin can develop intendations due to the wrinkling in the bandage and this must be carefully observed while observing for the skin integrity. Wrinkling in the bandage damages the fragile skin of the child and must be corrected or new bandage must be provided.Use of barrier skin emollients as per the practice of the place and physicians instructions must be done.

3. Temperature of the toes ,colour and perfusion and the body temperature:

rationale: To rule out any vascular compromise and compartment syndrome by compression bandage. The temperature of the toes must be taken at regular intervals and compared to that of the body temperature. Any coldness in the toes is an indicator of vascular compromise The palor of toes.bluish discoloration of the toes with the decrease in the capillary perfusion indicates compression and must be immediately resolved by releasing the the bandage pressure and watching for signs of reperfusion.The examination of the body temperature rules out fever or any infection.

5. sensations of the toes and the movements of the toe digits.

rationale :To rule out any nerve compression and compartment syndrome by the compression bandage.The bandage can cause nerve compression and decrease in the sensations of the the toes or affect the  digits movements by nerves pressure damage.(most common nerve involved-common peroneal nerve) So. this must be checked at regular intervals.

6. The skin of the lower back for any pressure sores.

rationale: Due to prolonged immobilization and pressure there is a tendency for pressure sores to develop in the skin of the lower back.(decubitus ulcers).So this area must be observed frequently. kept dry. the bedsheet below the lower back must be wrinkle free and changed if soggy.

7.The heels and the ankles and the tendoachilles tendon for any pressure sores.

Rationale:Due to compression pressure. there is a risk of the pressure sores and pressure necrosis of the heels, ankle over the Achilles tendon These areas must be padded and observed in frequently in order to prevent pressure necrosis and pressure sores.

8. Perineal care :

Rationale:To avoid compression of the genitals and the perineal area by using soft foams or a padded diaper and performing regular checks at 4 hourly interval. .

9.abdominal examination for distension to rule out fecal impaction:

rationale:There is a risk of constipation due to the prolonged immobilization bed rest and recumbent posture of the child hence the abdomen must be examined for any destination obvious signs of fecal retention.

10.Respiratory system examination:

rationale:There is a risk of infection due to aspiration and prolonged recumbency and lying down position. This must be ruled out by regular examination of the respiratory system and watching for any foreign breath sounds.

In addition to the body areas; the rope, the weights and the alignment must be also checked at regular intervals to ensure that the patient is receiving the correct traction with the correct alignment.The weights must not be placed on the floor the bed. the rope must be hanging freely and alignment should be correct for proper healing to occur

3.What are some diversional activities the nurse could plan for the child?

answer 3:The diversion activities can be planned by the nurse as per the routine practices in the hospital , the child's response and as per the usual diversionary measures that is used by the mother to divert the child routinely and in case of distress.

Some of the diversional activities the nurse could plan for the child are

1 playing of nursery rhymes or music for jingles or story next to the child to keep the child diverted and happy.

2 providing the child with toys like pop-up toys . toys with music and lightning to keep the child engaged.

3 providing hand held toys that makes sound on pressure or play music or recite on pressing.

3.providing the child with age appropriate non toxic, non sharp blocks for attaching and detaching

4. playing peekaboo with the child.

6. playing cartoon movie on mobile phone or tv

6. Involving in the routinediversionary activities as per family rearing practice.The diversionary activity that is used by the mother to divert the child in case of crisis must be found out by engaging in a discussion with the mother and adopting the same.

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