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.
g. 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
h. 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.
Section VII. CONTUSIONS, SPRAINS, STRAINS, AND DISLOCATIONS
a. A contusion is an injury to the soft tissues caused by a blunt force such as a
kick, fall, punch, or other similar impact. There is no associated break in the skin and it
appears as an area of ecchymosis (a bruise). The rupture of small blood vessels cause
hemorrhage into the injured area and this produces the familiar black-and-blue
discoloration. As absorption of the blood takes place, the black-and-blue spot gradually
changes color to brown-green, then to yellow, and finally disappears. A hematoma
forms when the bleeding into the tissue is more than slight.
b. Nursing management consists of elevating the affected part and applying cold
compresses for the first 8-12 hours after the injury. This produces vasoconstriction,
which will reduce the hemorrhage and edema. Cold applications should be intermittent
and continued for about 15-20 minutes at a time. After the first 8-12 hours, the recovery
phase begins and moist heat should be applied. Again, applications should be
intermittent and continued for about 20 minutes at a time. The application of heat will
promote tissue repair and absorption of the blood.
a. A sprain is an injury to a joint in which the ligaments, capsule, and
surrounding tissues are partially torn or severely stretched. This type of injury is caused
by wrenching or twisting the ligaments around the joint beyond their normal range of