Fundamental Nursing
Chapter 25
Mechanical Immobilization
Inst.: Dr. Ashraf El - Jedi


Some clients are inactive and physically
immobile as a result of an overall debilitating
condition.
For others, mobility impairment results from
trauma or its treatment. Such is the case for
clients with orthoses, which are orthopedic
devices that support or align a body part and
prevent or correct deformities.
2

Examples of orthoses
immobilizers, and braces.
include
splints,

Other clients have limited mobility when use
of slings, casts, traction, and external fixators
is necessary. Caring for clients who are
mechanically immobilized with orthopedic
devices requires specialized nursing skills
described in this chapter
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Purposes of Mechanical Immobilization

Mechanical immobilization of a body part
accomplishes the following:
Relieves pain and muscle spasm
 Supports and aligns skeletal injuries
 Restricts movement while injuries heal
 Maintains a functional position until healing is
complete
 Allows activity while restricting movement of an
injured area
 Prevents further structural damage and deformity

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Mechanical Immobilizing Devices
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Splints

which is a device that immobilizes and
protects an injured body part. Splints are used
before or instead of casts or traction.
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Emergency Splints

Splints often are applied as a first-aid measure
for suspected sprains or fractures (Fig. 25-1).
See Nursing Guidelines 25-1.
Figure 25-1 • Emergency first aid
splinting immobilizes the injured leg
to the uninjured leg with a make-shift
splint, such as a board, broom
handle, or golf club. Neckties, belts,
or scarves keep the splint in place
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
Examples include inflatable splints, traction
splints, immobilizers, molded splints, and
cervical collars.

Inflatable and traction splints are intended for
short-term use: they usually are applied just
after the injury and are removed shortly after
more thorough assessment of the injury.
Immobilizers and molded splints are used for
longer periods.

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Inflatable Splints


are immobilizing devices that become rigid when
filled with air (Fig. 25-2). In addition to limiting
motion, they control bleeding and swelling.
When air is infused, the splint molds to the contour of
the injured part, preventing movement.
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Traction splints
are metal devices that immobilize and pull on
contracted muscles
 One example is a , which requires special
training for its application to prevent additional
injuries (Fig. 25-3).
Figure 25-3( •
A) Thomas splint( .
B) )Thomas splint applied
to the lower extremity.
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Immobilizers

are commercial splints made from cloth and
foam and held in place by adjustable straps
(Fig. 25-4).
Figure 25-4 • Leg immobilizer.
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Molded Splints

are orthotic devices made of rigid materials and used for
chronic injuries or diseases (Fig. 25-5).

They maintain the body part in a functional position to prevent
contractures and muscle atrophy during immobility.
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Cervical Collars

is a foam or rigid splint
placed around the neck. It is
used to treat athletic neck
injuries and other trauma that
results in a neck sprain or
strain (Fig. 25-6).
Figure 25-6
A) Foam cervical collar
B) Rigid cervical collar.
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Slings

A sling is a cloth device used to elevate,
cradle, and support parts of the body. Slings
are applied commonly to the arm (Fig. 25-8),
Figure 25-8
• A sling used for arm
suspension. (Copyright B.
Proud(.
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Braces

Braces are custom-made or custom-fitted
devices designed to support weakened
structures.
Figure 25-9 • A rehabilitative brace
that ensures appropriate control of
knee motion following an operative
procedure.
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Casts


A cast is a rigid mold placed around an injured
body part after it has been restored to correct
anatomic alignment.
The purpose of the cast is to immobilize the
injured structure. Casts usually are applied to
fractured (broken) bones. They are formed
using either wetted rolls of plaster of Paris or
premoistened rolls of fiberglass (Table 25-1).
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Types of Casts

There are basically three types of casts:
cylinder, body, and spica.
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1. Cylinder Cast

encircles an arm or leg and leaves the toes or
fingers exposed. The cast extends from the
joints above and below the affected bone. This
prevents movement, thereby maintaining
correct alignment during healing.
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2. Body Cast

A body cast is a larger form of a cylinder cast
and encircles the trunk of the body instead of
an extremity. It generally extends from the
nipple line to the hips.
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3. Bivalved Cast


one that is cut in two pieces lengthwise.
Creating a front and a back for a body cast
facilitates bathing and skin care.
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
A bivalved cast on an extremity (Fig. 25-10) is
created when
Swelling compresses tissue and interferes with
circulation.
 The client is being weaned from the cast.
 A sharp x-ray is needed.
 Painful joints need to be immobilized temporarily
in a client with arthritis.

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Figure 25-10( •
A )A bivalved cast( .
B )The two halves are rejoined
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4. Spica Cast


encircles one or both arms or legs and the
chest or trunk. It generally is strengthened with
a reinforcement bar. When applied to the upper
body, the cast is referred to as a one applied to
the lower extremities is called a (Fig. 25-11).
When applied to a lower extremity, the cast is
trimmed in the anal and genital areas to allow
elimination of urine and stool.
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Figure 25-11 • Hip spica cast. (Timby, B. K., Smith, N. [2007 .]Introductory
medical-surgical nursing9[ th ed., p. 1191]. Philadelphia: Lippincott Williams &
Wilkins).
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Cast Application

The nurse prepares the client, assembles the
cast supplies and help the physician during
application (skill 25-2)
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Basic Cast Care

The nurse is responsible for caring for the cast
and making appropriate assessments to prevent
complications. See Nursing Guidelines 25-2.
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Figure 25-12 • Assessing capillary refill. (Copyright B. Proud(.
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Figure 25-13 • Checking mobility .
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Figure 25-14 • Assessing sensation in exposed fingers
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Figure 25-15 • Soft edges of cast minimize risk for skin irritation .
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Figure 25-16 • Applying ice pack to minimize pain
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Cast Removal


casts are removed when they need to be
changed and reapplied or when the injury has
healed sufficiently that the cast is no longer
necessary. A cast is removed prematurely if
complications develop.
Most casts are removed with an electric cast
cutter, an instrument that looks like a circular
saw (Fig. 25-17).
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Figure 25-17 • Cast removal .
A) The cast is bivalved with an electric cast cutter( .
B) The cast is split( .
C) The padding is manually cut.
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
Proper use of an electric cast cutter, however, leaves
the skin intact.

When the cast is removed, the unexercised muscle is
usually smaller and weaker. The joints may have a
limited range of motion. The skin usually appears
pale and waxy and may contain scales or patches of
dead skin. The skin is washed as usual with soapy
warm water, Applying lotion to the skin adds
moisture and tends to prevent the rough skin edges
from catching on clothing.
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Traction

Traction is a pulling effect exerted on a part of the
skeletal system. It is a treatment measure for
musculoskeletal trauma and disorders. Traction is
used to accomplish the following:
Reduce muscle spasms
 Realign bones
 Relieve pain
 Prevent deformities

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
The pull of the traction generally is offset by
the counterpull from the client's own body
weight. Except for traction exerted with the
hands, application of traction involves the use
of weights connected to the client through a
system of ropes, pulleys, slings, and other
equipment.
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Types of Traction
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1. Manual Traction

Manual traction means pulling on the body
using a person's hands and muscular strength
(Fig. 25-18). It most often is used briefly to
realign a broken bone. It also is used to replace
a dislocated bone into its original position
within a joint.
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Figure 25-18 • Manual traction
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2. Skin Traction

Skin traction means a pulling effect on the
skeletal system by applying devices, such as a
pelvic belt and a cervical halter, to the skin
(Fig. 25-19). Other names for commonly
applied forms of skin traction are Buck's
traction and Russell's traction (Fig. 25-20).
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Figure 25-19
A)
B)
Pelvic belt .
Cervical halter.
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Figure 25-20( • A )Buck's traction( .B )Russell's traction.
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3. Skeletal Traction

Skeletal traction means pull exerted directly
on the skeletal system by attaching wires, pins,
or tongs into or through a bone (Fig. 25-21).
Skeletal traction is applied continuously for an
extended period.
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Figure 25-21 • The application of skeletal traction( .A )A pin transects the
bone( .B )Traction is applied.
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Traction Care

Regardless of the type of traction used, its
effectiveness depends on the application of
certain principles during the client's care (Box
25-1). See Nursing Guidelines 25-3.
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Box 25-1 • Principles for Maintaining Effective Traction
• Traction must produce a pulling effect on the body.
• Countertraction (counterpull) must be maintained.
• The pull of traction and the counterpull must be in exactly
opposite directions.
• Splints and slings must be suspended without interference.
• Ropes must move freely through each pulley.
• The prescribed amount of weight must be applied.
• The weights must hang free
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External Fixators

external fixator is a metal device inserted into
and through one or more broken bones to
stabilize fragments during healing (Fig. 2522).

During recovery, the nurse provides care for
the pin site (location where pins, wires, or
tongs enter or exit the skin). to prevent
infection
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Figure 25-22 • An external
fixator. Metal rods exert traction
between two sets of skeletal
pins.
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Nursing Implications
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Acute Pain
Impaired Physical Mobility
Risk for Disuse Syndrome
Risk for Peripheral Neurovascular Dysfunction
Impaired Bed Mobility
Risk for Impaired Skin Integrity
Risk for Ineffective Tissue Perfusion
Self-Care Deficit: Bathing/Hygiene
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