ATI/NCLEX Review Questions On Mechanical Mobilization

• Mechanical immobilization restricts movement to promote healing after musculoskeletal trauma.
• Orthoses, such as splints, immobilizers, and braces, support or align a body part to prevent or correct deformities.
• Traction applies a pulling force to an injured body part to maintain alignment and reduce pain.

Gerontologic Considerations

• Older adults often need mechanical devices for mobility issues like arthritis.
• Skin integrity needs special attention with older adults because they may not feel pressure from immobilizing devices, raising the risk of skin breakdown.
• Caregivers should relieve pressure every 2 hours for older patients unable to change positions.

Benefits of Mechanical Immobilization

• Reduces pain and muscle spasms
• Helps maintain proper alignment of skeletal injuries during healing
• Prevents further injury by restricting movement of the affected area
• Maintains a functional position until healing is complete, allowing some activity without risking further damage

Types of Mechanical Immobilizing Devices

• Splints immobilize and protect an injured body part; frequently used as a first aid measure for suspected fractures or sprains.
• Casts are rigid devices that encase a limb to immobilize it during healing, used for more severe injuries.
• Braces provide support and stability to joints and limbs, allowing some movement while protecting the injury.

Nursing Guidelines for Casts and Splints

• Regularly assess the skin for signs of pressure or irritation, especially in older adults.
• Elevate the immobilized part to reduce swelling and enhance venous return.
• If circulation is compromised (e.g., pale or cold fingers/toes), loosen the splint or cast to restore blood flow.

Emergency Splint Application

• Avoid moving the injured part to prevent further injury; keep it in its current position.
• Use rigid materials for splinting, such as boards or rolled newspapers, to provide adequate support.
• Pad bony prominences to reduce pressure and friction on the skin.

Types of Splints and Their Uses

• Commercial splints are designed for specific injuries, are more effective than improvised splints, and are available in various forms.
• Improvised splints can be made from available materials in emergency situations but may not provide the same level of support.

Inflatable Splints

• Also known as pneumatic splints, these become rigid when filled with air and are used primarily in emergency situations to control bleeding and swelling.

Traction Splints

• Metal devices that apply traction to immobilize and align fractured limbs, requiring special training for proper application.

Purpose of Immobilizers

• Immobilizers limit motion in areas of injury, particularly during the healing process.
• They are typically removed for short periods to allow for hygiene and dressing changes.
• Commonly used in cases of knee injuries, where movement can exacerbate pain and delay recovery.

Types of Immobilizers

• Molded splints are rigid orthotic devices used for chronic injuries with inflammation, such as carpal tunnel syndrome and plantar fasciitis.
• Orthopedic boots, also known as CAM walkers or fracture boots, stabilize the foot and ankle during recovery from injuries or surgery; they allow for controlled movement and weight distribution.
• Cervical collars are foam or rigid splints used to support the neck after injuries, such as whiplash; they help limit neck movement and reduce strain on the cervical spine.

Molded Splints

• Made from rigid materials.
• Provides support.
• Limits movement to prevent further injury.
• Particularly beneficial for conditions like Achilles tendonitis where inflammation is present.
• Maintains the affected body part in a functional position.
• Prevents contractures and muscle atrophy during periods of immobility.

Orthopedic Boots

• Used as a transitional device from a cast to allow for ambulation while protecting the foot/ankle.
• Typically featuring adjustable straps for a secure fit.
• Used to keep weight off specific areas, such as the toes during healing.
• Design allows for controlled ankle movement, which is crucial for recovery.

Cervical Collars

• Cervical collars treat neck injuries and limit movement to facilitate healing.
• The incidence of whiplash injuries has decreased due to improved protective equipment and vehicle safety features.
• Proper sizing is critical; measurements of neck circumference and shoulder-to-chin distance are taken to ensure a correct fit.

Application Techniques

• Proper application of immobilizers is essential for effectiveness; cervical collars must be positioned correctly to support the chin and neck.
• Slings should be applied to elevate and cradle the injured area, commonly used for arms and legs after injury.
• The nurse must ensure that the client can breathe and swallow comfortably while wearing a cervical collar.

Monitoring and Assessment

• During recovery, nurses assess the client's neuro-muscular status by checking for movement and strength in the affected areas.
• Key movements include shoulder elevation, elbow flexion, and hand grip strength, which indicate intact neuromuscular function.
• Documentation of any differences in strength or movement is crucial for ongoing care and communication with physicians.

Case Studies

Carpal Tunnel Syndrome

• A patient with carpal tunnel syndrome may benefit from a molded splint to reduce inflammation and limit wrist movement during recovery.
• The splint helps alleviate pain and allows for healing of the median nerve.

Whiplash Injury

• A patient with a whiplash injury may be fitted with a cervical collar to limit neck movement and support the head.
• The collar is worn continuously for 10 days to 2 weeks, with periodic removal for gentle range-of-motion exercises.

Slings

• A sling is a cloth device used to elevate, cradle, and support parts of the body.
• Commonly applied to the arm, leg, or pelvis after injury examination.
• Slings are essential for immobilization and support, aiding in the healing process.
• Commercially made arm slings are preferred for their ease of use, while triangular cloth slings can be fashioned when necessary.
• Proper application of slings is crucial for effectiveness, as improper use can lead to inadequate support or discomfort.
• Slings are often used in emergency situations to stabilize injuries before further medical treatment.

Types of Slings

• Commercial slings are designed for specific body parts and provide consistent support.
• Triangular slings are versatile and can be adapted for various injuries, but may require more skill to apply correctly.
• Both types of slings should be assessed for fit and comfort to prevent complications such as circulation issues.
• The effectiveness of a sling can be influenced by the material used, with some being more breathable than others.
• Slings can be used in conjunction with other immobilization devices for enhanced support during recovery.

Braces

• Custom-made or fitted devices designed to support weakened structures, particularly joints.
• Categorized into three types: prophylactic, functional, and rehabilitative braces.
• Prophylactic braces are used to prevent joint injuries, while functional braces provide stability to unstable joints.
• Rehabilitative braces allow for protected motion of an injured joint post-surgery, facilitating recovery.
• Typically made from sturdy materials like metal or leather to withstand active use.
• Proper fitting is essential to avoid discomfort, deformity, and skin issues from friction.

Types of Braces

• Prophylactic braces are commonly used in sports to prevent injuries, such as knee braces for athletes.
• Functional braces are often used for conditions like ligament injuries, providing support during movement.
• Rehabilitative braces are used after surgeries, allowing limited movement while protecting the joint.
• The design of braces can vary significantly based on the intended use, with some incorporating shoes or additional support structures.
• Regular assessment of brace fit is necessary to ensure continued effectiveness and comfort.

Casts

• A cast is a rigid mold applied to an injured body part to immobilize it and maintain anatomical alignment during healing.
• Casts are primarily used for fractures and are made from plaster of Paris or fiberglass.
• They are not recommended for severe injuries with excessive swelling, as they can exacerbate complications.
• Proper application and care of casts are crucial to prevent skin maceration and abrasions from sharp edges.
• Casts can be trimmed or adjusted as healing progresses, allowing for continued support without restricting blood flow.
• The nurse plays a key role in monitoring the cast and the skin underneath for signs of irritation or complications.

Types of Casts

• Cylinder casts encircle an arm or leg.
• Leaving fingers or toes exposed.
• Most common type of cast.
• Body casts encircle the trunk and are used for more extensive injuries.
• Often extending from the nipple line to the hips.
• Bivalved casts are cut into two pieces to accommodate swelling or to allow for easier monitoring of the injury.
• Spica casts encircle one or both limbs and the trunk.
• Often used for hip or shoulder injuries.
• Can be particularly cumbersome for patients.
• Each type of cast has specific applications and considerations for care, especially regarding hygiene and mobility.

Cast Application Process

• Cast application typically requires a team approach, involving preparation and assistance from nursing staff.
• The process includes assembling materials and ensuring the client is comfortable and informed about the procedure.
• Light-cured fiberglass casts require exposure to UV light for hardening, which is a unique aspect of their application.
• Proper technique during application is essential to avoid complications such as pressure sores or improper alignment.
• The nurse must educate the client on the importance of keeping the cast dry and intact to prevent skin issues.

Cast Removal Techniques

• Casts are usually removed when healing is sufficient or if complications arise, using an electric cast cutter.
• The cast cutter is designed to safely remove the cast without harming the skin underneath, though it can be intimidating for clients due to noise.
• Post-removal care is important to assess the skin and joint function, as well as to provide rehabilitation guidance.
• Clients may experience discomfort or stiffness after cast removal, necessitating gradual reintroduction to movement.
• Education on skin care and monitoring for signs of complications post-removal is crucial for recovery.

Electric Cast Cutter

• Resembles a circular saw.
• Used to remove casts safely.
• Operates with a noisy mechanism that may cause anxiety in clients due to the fear of injury.
• Designed to cut through the cast material without harming the skin underneath.
• Proper technique is essential; training is provided to cast technicians, physician assistants, and medical assistants.
• After cast removal, clients may experience muscle atrophy, limited joint mobility, and skin changes such as pallor and waxiness.
• Skin care post-cast removal involves gentle washing and moisturizing to aid in recovery.

Skin Condition

• The skin under the cast often appears pale and may have scales or patches of dead skin.
• Important to wash the skin with warm, soapy water while avoiding the removal of semi-attached skin.
• Moisturizing lotion can help prevent rough skin edges from catching on clothing.
• Dead skin will eventually shed naturally, and care should be taken to avoid irritation.
• Regular skin assessments are crucial to monitor for any signs of infection or complications.
• Educating clients on skin care post-cast is vital for their comfort and recovery.

Traction Techniques

• Therapeutic method that applies a pulling force to the skeletal system to treat musculoskeletal injuries.
• Reduce muscle spasms.
• Realgin bones.
• Relieve pain.
• Prevent deformities.
• Requires the counterpull from the client's body weight, ensuring balanced force application.
• Can be applied using various methods, including manual, skin, and skeletal traction.
• Proper setup and maintenance of traction equipment are essential for patient safety and treatment efficacy.
• Continuous monitoring of the client's condition is necessary to adjust traction as needed.

Types of Traction

Manual Traction: Involves using hands to apply force, typically for short durations to realign bones or reduce dislocations. Skin Traction: Utilizes devices applied to the skin, such as pelvic belts or cervical halters, to exert a pulling effect; common forms include Buck and Russell traction. Skeletal Traction: Involves direct attachment of weights to the skeletal system through pins or wires, allowing for continuous traction over extended periods.

Nursing Diagnoses

• Common nursing diagnoses for clients with casts or traction include acute pain, altered skin integrity risk, and altered tissue perfusion.
• Clients may also experience activity of daily living (ADL) deficits due to immobilization.
• Identifying these diagnoses helps in planning appropriate nursing interventions and monitoring outcomes.
• Education on pain management and skin care is essential for client comfort and recovery.
• Regular assessments of neurovascular status are crucial to detect complications early.
• Collaboration with the healthcare team is necessary to address any emerging issues promptly.

Compartment Syndrome

• A serious condition that can occur post-cast application, characterized by increased pressure within a muscle compartment.
• Symptoms include severe pain, swelling, and decreased blood flow to the affected area.
• Early recognition and intervention are critical to prevent permanent damage.
• Nursing assessments should include monitoring peripheral circulation and comparing affected and unaffected extremities.
• Elevating the affected limb and applying ice can help manage symptoms.
• Immediate reporting of worsening symptoms to the healthcare provider is essential for timely intervention.

Pain Assessment and Management

• Post-cast bivalving, the client reports pain at 5, suggesting some relief but still significant discomfort.
• Pain management strategies should include medication, elevation of the affected limb, and application of ice to reduce swelling.
• Continuous assessment of pain levels is crucial to determine the effectiveness of interventions and to identify potential complications.
• educating clients on pain management techniques.
• Importance of reporting changes in pain levels.

Immobilization Techniques

• Immobilization is essential to prevent further injury and promote healing
• Allows activity while restricting movement of the injured area.
• Types of immobilization devices include splints, casts, and traction, each serving specific purposes based on the injury type.
• Splints can be inflatable, molded, or rigid, and are used to protect and immobilize an injured body part before casting or traction is applied.
• Casts are rigid molds that maintain anatomical alignment and are made from materials like plaster of Paris or fiberglass, each with distinct properties.

Altered Tissue Perfusion

• Assess skin color and temperature in both extremities to identify any discrepancies that may indicate compromised circulation.
• Neurological assessment includes asking the client to move toes or fingers and testing sensation with sharp, dull, warm, or cold stimuli.
• Pain quantification is essential; understanding its location, characteristics, and response to pain-relieving measures can indicate underlying issues.
• Signs of altered tissue perfusion may include cyanosis, swelling, and changes in temperature or sensation in the affected limb.

Neurological Assessment Techniques

• Techniques for assessing neurological status include capillary refill time, peripheral pulse palpation, and sensory testing.
• Importance of monitoring for signs of compartment syndrome, which can arise from swelling within non-expanding fascia, leading to severe complications.
• Regular assessment of the affected limb's circulation and sensation is critical to prevent permanent damage.

Cast and Traction Care

• Different types of casts include cylinder casts, body casts, and spica casts, each designed for specific injuries.
• Cast care involves monitoring peripheral circulation, assessing neurologic status, and ensuring the cast remains dry and intact.
• Complications of casts can include pressure sores, impaired circulation, and compartment syndrome, necessitating vigilant monitoring.
• Traction is a pulling force applied to the skeletal system to treat musculoskeletal injuries and disorders.
• Types of traction include manual, skin, and skeletal traction, each with specific applications and care requirements.
• The nurse must ensure that traction weights are appropriately positioned and that the client's limb is aligned correctly to prevent complications.

Mechanical Immobilization

• Hand hygiene is crucial in preventing the transfer of microorganisms during medical procedures.
• Alcohol-based hand rubs are effective alternatives to soap and water, especially in clinical settings.
• Regular hand washing is emphasized in nursing protocols to maintain patient safety and health.

Types of Slings

Canvas Sling: Used for supporting the forearm and elbow, ensuring the elbow is flush with the sling's corner. Triangular Sling: Provides support by creating a hammock effect for the arm, reducing pressure on the skin.

Application Techniques

• Proper positioning of the forearm is essential; the elbow should not exceed 90 degrees of flexion to avoid injury.
• The strap of the sling should be padded to prevent friction and pressure on the skin, promoting circulation.

Steps for Applying a Canvas Sling

• Wash hands or use an alcohol-based rub before starting the procedure.
• Position the forearm across the client's chest with the thumb pointing upward.
• Slip the flexed arm into the canvas sling, ensuring the elbow fits snugly.

Evaluation Criteria for Sling Application

• Ensure the forearm is adequately supported and the wrist is elevated to reduce swelling.
• Monitor circulation, mobility, and sensation in the fingers regularly, at least once per shift.
• Document any changes in the client's condition, especially regarding pain and sensation.

Pre-application Assessment

• Assess the skin condition and circulation of the area where the cast will be applied.
• Gather necessary materials such as stockinette, padding, and cast material before starting the procedure.

Steps for Cast Application

• Clean the client's skin with soap and water to remove any dirt or oil.
• Cover the skin with stockinette to protect it from direct contact with the cast material.
• Apply the cast material while supporting the extremity to ensure proper alignment.

Monitoring and Evaluation

• Check the condition of the skin and circulation after the cast is applied.
• Ensure the client understands discharge instructions regarding cast care and when to seek further medical attention.

Sample Documentation

• Document the type of cast applied, the materials used, and the physician's name.
• Include assessment findings and any significant changes in the client's condition post-application.

Purpose of care

• Casts immobilize broken bones or injured limbs to promote healing.
• Providing support and protection to the affective area
• Casts can be made from various materials, including plaster and fiberglass, each with unique properties and drying times.

Types of Casts

• Plaster casts typically take 24-72 hours to dry completely and are heavier and less water-resistant than fiberglass.
• Fiberglass casts dry within 30 minutes and are lighter and more durable, making them more comfortable for patients.
• Spica casts are used for immobilizing the hip and thigh, often requiring special care during patient movement.

Initial Assessment

• Assess the type of cast and the body location it covers, noting when it was applied.
• Evaluate the neurovascular status of the limb, including color, temperature, and capillary refill time.
• Document any swelling or pain levels, and establish a baseline for future assessments.

Basic Care Procedures

• Always wash hands or use an alcohol-based hand rub before handling the cast to prevent infection.
• Position the bed at a comfortable height to avoid back strain during care.
• Use pillows to support the cast and prevent it from losing shape during the drying process.

Monitoring and Observations

• Check the cast every 30 minutes initially, then twice per shift once dried, for signs of complications.
• Observe the cast for any changes in color, temperature, or odor, which may indicate issues such as infection or impaired circulation.
• Assess the condition of the skin around the cast edges to prevent irritation or breakdown.

Managing Complications

• Elevate swollen extremities to promote venous return and reduce swelling.
• Apply ice packs to the cast to control swelling and bleeding, ensuring they are placed at the level of injury.
• Monitor for signs of compartment syndrome, such as unrelieved pain or increasing swelling.

Evaluation Criteria for care

• Ensure the cast is dry, without dents or cracks, and that the skin is warm and appropriately colored.
• Pain should be managed effectively, with the client able to move fingers or toes and exhibit normal sensory perception.
• Document any abnormal findings and the measures taken to address them.

Sample Documentation

• Date and time of assessment, including specific observations about the cast and limb condition.
• Record pain levels and any interventions used, along with the client's response to those interventions.
• Include communication details regarding abnormal findings to other healthcare providers.

Importance of Care

• Accurate documentation is crucial for continuity of care and legal protection.
• Provides a clear record of the patient's condition and the care provided
• Helps in identifying trends in the patient's recovery or complications that may arise.

Evaluating Traction Effectiveness

• Regularly assess the alignment of the client with the pull of the traction to ensure effectiveness.
• Check that weights hang freely and that traction ropes are intact and functioning properly.
• Monitor for signs of complications, such as impaired skin integrity or neurovascular issues.
• Evaluate the client's pain levels and overall comfort to adjust care as needed.
• Document all findings, including any changes in the client's condition, to maintain a comprehensive care record.
• Use sample documentation to guide accurate and thorough reporting.

Sample Documentation Practices

• Include date, time, and specific details of traction applied (e.g., type, weight).
• Document the client's position and any observations regarding skin integrity and circulation.
• Record subjective remarks from the client regarding pain or discomfort.
• Note any interventions taken in response to abnormal findings.
• Ensure that documentation is clear, concise, and follows institutional protocols.

Overview of Traction Care

• Used to immobilize and align bones or joints.
• Often after fractures or surgeries.
• Application of a pulling force to a body part.
• Relief pain
• Maintain alignment
• Promote healing.

Assessment in Traction Care

• Checking medical orders for type and amount of traction prescribed.
• Inspecting equipment to ensure proper function.
• Assessing the client’s skin integrity.
• Monitor vital signs.
• Evaluate emotional state and pain level
• Document all of these