MS2 ACTIVITY

SUBMITTED BY:

AUSTRIA, GIA LOURDES CAMILLE U.

COSAL, QUEEN ANGELOU S.
LIMOSNERO, MERRY ANGELY A.
SASIL, MITCH CHAMPAINE
SABALO, JOBELLE CHRISTIE S.

BSN 3 N0-2
GROUP DIVERGENT
 1. What is traction care, types of traction and what are the vital things to
remember in caring for patients with traction.

Traction care involves the application of a pulling force to a fractured or

dislocated body part to help stabilize and realign bones, reduce pain, and
promote healing. There are two main types of traction: skeletal traction and
skin traction. This is also an orthopedic treatment that involves placing
tension on a limb,bone or muscle group using various weight and pulley
systems.

Traction is applied to:

● Decrease muscle spasms
● Reduce, align, and immobolize fractures (femur fractures that cannot be immobilised
in a cast.)
● Correct or prevent deformity
● Increase space between joint surfaces.
Types of Traction

1. Straight or running traction (Buck’s Traction , pelvic traction) this involves straight
pulling force in one plane.
2. Balanced Suspension Traction (Pelvic Sling, Thomas leg splint) leg involves
exertion a pull while the limb is supported by a hammock or splint held by balanced
weights, which allows for some mobility without disruption of the line of pull.
3. Skeletal Traction: This involves placing a pin, wire, or screw in the fractured bone,
and attaching weights to it to pull the bone into the correct position. It's often used for
fractures of the femur or other long bones.
4. Skin Traction: This is less invasive and involves applying splints, bandages, or
adhesive tapes to the skin below the fracture, and then attaching weights. It's
typically used as a temporary measure until surgery can be performed.

Vital Things to Remember in Caring for Patients with Traction

As a student nurse, it's crucial to ensure the well-being and safety of patients with traction.
Here are the vital things to remember:

1. Neurovascular Checks: Regularly assess the patient's circulation, sensation, and

movement in the affected limb to identify any signs of complications early.
2. Skin Care: Maintain the cleanliness and dryness of the skin around the traction site to
prevent pressure sores and infections. Inspect the skin frequently.
3. Pain Management: Administer pain relief as prescribed and monitor the patient's
pain levels, ensuring they are as comfortable as possible.
4. Proper Positioning: Ensure the patient is correctly positioned to avoid complications
such as nerve damage or pressure sores. Regularly reposition the patient if needed.
5. Monitor Traction Equipment: Regularly check the traction setup to ensure it is
functioning correctly and make any necessary adjustments to maintain proper
alignment and tension.
6. Encourage Mobility: When possible, encourage the patient to perform a gentle range
of motion exercises to maintain joint flexibility and muscle strength.
7. Nutrition and Hydration: Support the patient in maintaining a balanced diet and
adequate fluid intake to promote healing and overall health.
8. Preventing Complications: Be vigilant for signs of infection, deep vein thrombosis,
and other potential complications, and take prompt action if any issues arise.
2. What are nursing responsibilities in caring for patients with fracture?

- As a student nurse caring for patients with fractures, it's essential to focus on several
key responsibilities to ensure proper healing and overall patient well-being. Here are
the vital responsibilities:
1. Assessment and Monitoring
○ Regularly assess the injured area for signs of swelling, bruising, and any
changes in color or temperature.
○ Monitor vital signs and pain levels, documenting any changes or concerns.
2. Pain Management
○ Administer pain medications as prescribed and employ non-pharmacological
methods like ice packs and elevation to manage pain.
3. Immobilization and Alignment
○ Ensure the fractured limb is properly immobilized using casts, splints, or
traction as ordered. Regularly check the fit and integrity of the immobilization
device to prevent complications.
4. Skin Care
○ Frequently inspect the skin around the cast or splint to detect any signs of
irritation, pressure sores, or infection. Provide appropriate skin care to prevent
these issues.
5. Patient Education
○ Educate the patient and their family about the importance of keeping the
immobilized limb elevated, avoiding pressure on the cast, and signs of
complications to watch for, such as increased pain or changes in sensation.
6. Activity and Mobility
○ Encourage safe, limited mobility as permitted, and assist with exercises to
prevent stiffness and promote circulation in unaffected limbs.
7. Nutritional Support
○ Promote a balanced diet rich in calcium and vitamin D to support bone healing
and overall health.
3. What are the different types of gait patterns?

Gait Cycle: Activity that occurs between heel strike of one extremity and subsequent heel
strike on the same side.

Stance Phase: Phase in which limb is in contact with the ground (60%)

Swing Phase: Phase in which the foot is in air for limb advancement. (40%)

Types of gait disorders can be of different types depending on musculoskeletal (orthopedic),

neuromuscular (neurological-nervous system), spine and brain damage. Some of the most
common types of gait are:

1. Normal Gait

● Smooth, coordinated, and efficient walking pattern. The heel strikes the ground first,
followed by rolling onto the ball of the foot, and then pushing off with the toes.
2. Abnormal Gait
● Any deviation from normal pattern of walking
● Caused:
> Motor System
> Skeletal supports
> Neural Control
> combination of the above.

Factors that lead to abnormal gait include muscle weakness, neurologic conditions, pain,

limb deformity, and joint disease.

1. Muscle weakness or paralysis: decreases ability to normally move a joint through

space. Walking strategies develop on the basis of the specific muscle or muscle

groups involved and the ability of the individual to acquire a substitution pattern to

replace that muscle’s action.

2. Neurologic conditions: may alter gait by producing muscle weakness, loss of

balance, reduced coordination between agonist and antagonist muscle groups

(ispasticity), and joint contracture.

● Hip scissoring is associated with overactive adductors, and knee flexion may be

caused by hamstring spasticity.

● Equinus deformity of the foot and ankle may result in steppage gait and backwards

setting of the knee.

3. Pain in a limb: creates an antalgic gait pattern in which the individual shortens

stance phase to lessen the time the painful limb is loaded. The contralateral swing

phase is more rapid.

4. Joint abnormalities: alter gait by changing the range of motion of that joint or

producing pain.

● A hip and knee with arthritis may have joint contractures and reduced range of

motion.

● An anterior cruciate–deficient knee has quadriceps avoidance gait, which represents

a decreased quadriceps moment during midstance.

3. Antalgic Gait/ Painful Gait

● A limp to avoid pain.

● The stance phase on the affected leg is shortened to minimize discomfort.
● Avoidance of weight bearing on the affected limb
● Shortening of stance phase in that limb.

4. Ataxic Gait

● Unsteady, uncoordinated walk often seen in patients with cerebellar disorders. The
steps are irregular in size and direction, and the patient may appear unsteady or
clumsy.
● Dysmetria and incoordination
● Staggering and lack of smooth movements (reeling or drunken gait)
● Fals to the side of lesion
● Compensated by wide based gait to increase base of stability.
5. Parkinsonian Gait
- (or festinating gait) is the type of gait exhibited by patients suffering from
Parkinson’s disease. This disorder is caused by a deficiency of dopamine in the basal
ganglia circuit leading to motor deficits. Gait is one of the most affected motor
characteristics of this disorder.
● Characterized by small, shuffling steps and a stooped posture.
● Lack of arm swing, short and quick steps with increasing speed and cannot stop

abruptly or change directions with stooped posture.

6. Hemiplegic Gait
- also known as Circumductory Gait and it includes impaired natural swing at the
hip and knee with leg circumduction.
● Seen in patients with stroke or hemiplegia.
● In extensor synergy
→ heel strike is missing and patient lands on forefoot

→ Since hip and knee are kept extended throughout the gait cycle, there is relative limb
lengthening and hence circumduction of hip hiking is used for clearance.

→ Toe drag may be present in swing phase

→ Decreased arm swing on the affected side.

● If flaccid paralysis or flexor synergy is present

→ Knee buckling and instability.
7. Trendelenburg Gait

● Caused by weakness in the hip abductor muscles. The patient’s pelvis drops on the
opposite side of the weak hip during the stance phase, resulting in a waddling motion.

> The gluteus medius during the stance phase,

pulls the stance side pelvis over the supporting
limb to prevent excessive pelvic drop in the
opposite swing limb.

> If the hip abductors are weakened, the

opposite limb pelvis may drop excessively
during the swing phase.

> To avoid this, the entire trunk shifts to the stance side
to bring the stance pelvis on to the supporting
limb.
> This is known as gluteus medius lurch or trendelenburg gait.
8. Myopathic Gait
● If both hip abductors are weak,
the trunk sways from side to side
during the stance phase to
bring the pelvis level on the supporting limb.
● Waddling gait
● Muscular dystrophies
● Accompanied by excess lumbar lordosis
to compensate for hip extensor weakness.

9. Steppage Gait

● The patient lifts their leg higher than normal due to foot drop, often caused by
peripheral neuropathy. The foot slaps down onto the ground with each step.
● This could be due to a bilateral foot drop or it may signify problems with balance or
proprioception.
10. Spastic Gait

● Stiff, jerky movements often seen in patients with upper motor neuron lesions. The
legs may cross over each other (scissoring) due to increased muscle tone.

11. Scissoring Gait

● Spasticity of the hip adductors with relative weakness of hip abductors and
secondary changes in the hip gives rise to, a stiff-legged gait with the legs
crossing each other is often associated with the muscle imbalance found in
cerebral palsy.Often, there is also a crouched posture with flexed hips and
knees, feet that are in equinus and both limbs internally rotated.
→ rigidity and excessive adduction of the leg in swing

→ plantar flexion of the ankle

→ increased flexion at the knee

→ adduction and internal rotation at the hip.

12. Vaulting

● Seen in limb length discrepancy, hamstring weakness or extension

contractures of the knee.
● The knee is hyperextended and locked at the end of stance phase and
entire swing phase.
● So to clear the leg the patient goes up on the toes of the other leg to clear
the affected limb.
13. Drop-foot gait

During the swing phase, there is no ‘pick up’ of the foot so it effectively ‘drops’ into

equinus; if the foot was not lifted higher than usual to accommodate this, the toes

would drag along the floor.

This is caused by disorder or damage to the peripheral nerves supplying the foot

dorsiflexors (peroneal nerve)

REFERENCES:

● Mann RA, Hagy J. Biomechanics of walking, running, and sprinting. Am J

Sports Med. 1980 Sep-Oct;8(5):345-50. doi: 10.1177/036354658000800510.

PMID: 7416353.

● Gait Analysis: Normal and Pathological Function. J Sports Sci Med. 2010 Jun

1;9(2):353. PMCID: PMC3761742.

● Perry J: Stride analysis. In: Perry J, ed. Gait Analysis: Normal and Pathological

Function. Thorofare, NJ: Slack Inc, 1992:431–441.

● Donatelli R, Wilkes R: Lower kinetic chain and human gait. J Back

Musculoskelet Rehabil 2:1–11, 1992.

● Levine D, Whittle M: Gait Analysis: The Lower Extremities. La Crosse, WI:

Orthopaedic Section, APTA, Inc., 1992.

● Mann RA, Hagy J: Biomechanics of walking, running, and sprinting. Am J

Sports Med 8:345–350, 1980.

● Mann RA, Hagy JL, White V, et al: The initiation of gait. J Bone Joint Surg

Am 61A:232–239, 1979.

● Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

● Millers Review of Orthopaedics -7th Edition Book.

● Mann RA, Hagy J. Biomechanics of walking, running, and sprinting. Am J

Sports Med. 1980 Sep-Oct;8(5):345-50. doi: 10.1177/036354658000800510.

PMID: 7416353.

● Gait Analysis: Normal and Pathological Function. J Sports Sci Med. 2010 Jun

1;9(2):353. PMCID: PMC3761742.

● Perry J: Stride analysis. In: Perry J, ed. Gait Analysis: Normal and Pathological

Function. Thorofare, NJ: Slack Inc, 1992:431–441.

● Donatelli R, Wilkes R: Lower kinetic chain and human gait. J Back

Musculoskelet Rehabil 2:1–11, 1992.

● Levine D, Whittle M: Gait Analysis: The Lower Extremities. La Crosse, WI:

Orthopaedic Section, APTA, Inc., 1992.

● Mann RA, Hagy J: Biomechanics of walking, running, and sprinting. Am J

Sports Med 8:345–350, 1980.

● Mann RA, Hagy JL, White V, et al: The initiation of gait. J Bone Joint Surg

Am 61A:232–239, 1979.

● Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

● Millers Review of Orthopaedics -7th Edition Book.