1-39. NURSING MANAGEMENT OF THE PATIENT IN TRACTION
As stated earlier in the text, the basis of the nursing care plan will be determined
by two factors: the basic position of the patient in traction and permissible movement.
Normal activities of daily living are significantly altered by immobilization and
confinement. Nursing management begins with assessing the patient. What are his
needs? What are his limitations? 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. In addition to this, nursing management involves maintenance
(keep traction from being compromised) and prevention (observe for complications).
a. 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.
b. 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
c. 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.
d. 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
e. 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.
f. 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.