Traction and Hot Fomentations for Osteo-Arthritis.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.In this month's article, from the May 1925 issue, nurse Ellen G. Dawson from Evanston Hospital in Illinois presents three case studies as evidence for a new use for immobilizing traction: the treatment of osteoarthritis. The protocol includes the use of traction for days or weeks, hot fomentations (poultices) applied to the skin over the painful joint, and a body cast (for back pain) or leg cast (for knee pain) worn for an extended period afterward. If the joint pain was severe, a lotion made from tinctures of opium and arnica, witch hazel, and lead water was also applied. The author notes, "We could cite case after case, with varying lengths of time, where the results have been equally gratifying."Today, nurses are involved in more formal arthritis research. In this issue, So-Hyun Park and Shiela M. Strauss examine the impact of arthritis on recommended physical activity in their original research article, "Arthritis-Related Functional Limitations and Inadequate Physical Activity Among Female Adult Cancer Survivors."

Factors that influence the quality of pain management in patients with skin traction.

BACKGROUND: Pain management is a systematic multidimensional process with differing approaches. Investigating the factors that affect the quality of pain management may provide nurses with ideas, suggestions, and trends that target improvements in the pain management experience among orthopaedic patients. AIMS: To assess the elements of the quality of pain management and identify factors that significantly predict higher quality pain management in patients with skin traction. METHODS: A descriptive correlational design was used to recruit a convenience sample of 116 patients. The revised American Pain Society Patient Outcome Questionnaire was used to explore the quality of pain management. RESULTS: Patients suffered from severe pain for more than 64% of the time during the first 24 h after the skin traction was applied. The uncontrolled pain negatively affected patients' abilities to carry out activities in bed, fall asleep, and stay asleep. The quality of pain management indicators using a scale of one to 10 were: "pain severity" = 5.93, "pain interference" = 5.01, "side effects of medications" = 1.5", and "satisfaction about care" = 6.2". CONCLUSIONS: The quality of pain management for fracture patients on skin traction was not optimum in this study. The uncontrolled pain negatively affected patients' physical status and general wellbeing.

Traction removal of percutaneous endoscopic gastrostomy devices in children.

BACKGROUND: There are few published data on non-endoscopic removal of percutaneous endoscopic gastrostomy devices in children. AIMS: To describe prospective data acquired for traction removal of percutaneous endoscopic gastrostomy devices at a single pediatric center over a 5-year period. METHODS: Data were obtained from endoscopy records, computerized hospital patient information systems and case note analysis. The device that could be removed by traction was the Corflo (Merck) 12-Fr percutaneous endoscopic gastrostomy tube with a collapsible internal retention dome. All procedures were performed under general anesthesia. RESULTS: Between 2002-2006, 220 children underwent percutaneous endoscopic gastrostomy removals (166 by traction, 51 endoscopically and 3 Foley catheter to button conversions). The median duration between percutaneous endoscopic gastrostomy insertion and low profile button device substitution was 0.83 years (0.12-3.86). Complications from traction removal included internal retention dome separation in two cases (allowed to pass per rectum, uneventfully), failure to a insert a low profile button device needing percutaneous endoscopic gastrostomy reinsertion, enterocutaneous fistula requiring surgical closure in one patient and laparoscopy for suspected low profile button device misplacement in one instance. The material cost of endoscope disinfection (£10) and disposable usage (£80) avoided by traction removal was calculated at £90 per procedure. CONCLUSION: No mortality occurred as a result of the traction removal of percutaneous endoscopic gastrostomy tubes. Laparoscopy for suspected low profile button device misplacement was needed in one case (0.60%). Traction removal of percutaneous endoscopic gastrostomy tubes was generally safe and a cost-saving procedure in our experience.

Recognising and treating Colles' type fractures in emergency care settings.

In this article, the author explains how to identify a Colles' type fracture, explains how to insert a haematoma block, and gives a step by step guide to reducing this type of fracture.

Protocolo de Cuidados Enfermeros a los Pacientes con tracción cutánea o esquelética de miembros inferiores / Protocol for nursing care for patients with skin or skeletal traction of lower limbs

Protocolizar los cuidados de enfermería nos hacen mucho más cómodo y seguro nuestro trabajo diario. Además con ellos facilitamos la incorporación a los puestos de trabajo a los nuevos enfermeros/as que llegan a nuestros Servicios (AU)

The setup and care of a patient in Buck's traction.

Buck's traction is certainly one of the more common traction setups seen in orthopaedic patient care today. However, just because it is common doesn't mean we can take it for granted. Specific setup techniques as well as patient evaluation methods must be understood if the traction is to accomplish its task. The goal of this article is to go through some of the basics in techniques and perhaps explain why this traction is so commonly used.

Principles of traction.

Traction has been the mainstay of orthopaedic management for thousands of years, with its use recorded by the Aztecs and ancient Egyptians. In more recent times, however, the advances in surgical reductions of fractures and muscutoskeletal disruptions, coupled with the economic imperatives of reducing hospital bed stay days has seen a reduction the use of prolonged periods of traction.

Challenges of traction in critical care: a case study.

Traction can sometimes seem like an overwhelming challenge in the critical care setting not only to the patient and family, but also to the nurse. Critical care nurses must know the principles, purposes, methods, and patient care considerations necessary to be able to provide appropriate care and teaching for the patient in traction. This article describes these principles and then illustrates them through a case study. The case describes a patient who experiences multiple trauma and focuses on the nurse's role in the care of this patient in traction.

A joint protocol for home skeletal traction.

Cost-effective delivery of quality patient care is a major focus of the orthopaedic advanced practice nurse's practice. Long-term skeletal traction therapy for select fractures of the pelvis remains a treatment option for certain patients. The purposes of this article are to describe the development of a joint proposal for home skeletal traction therapy and to analyze the cost savings involved by reviewing a case study of a home traction patient.

Halo skeletal traction pin site care: toward developing a standard of care.

Halo skeletal traction may be used to immobilize a patient's head and neck following a cervical fracture. Prevention of infectious reactions around the pin sites of halo traction is a priority in rehabilitation nursing practice. Although prophylactic treatment of skeletal pin sites is a generally accepted practice, there is great diversity of opinion and very limited systematic investigation as to how the sites should be treated. In this article, the author reviews the literature on pin site care and suggests a protocol based on the current literature.

Care of the school-aged child in 90/90 traction.

Children in the school-aged period are those most likely to sustain a fractured femur. One method of treatment for this age group is immobilization of the fracture in 90/90 traction. Specific needs of these children are discussed, and related nursing problems are identified. The physiologic and psychosocial aspects of nursing care are also addressed. Emphasis is placed on the developmental tasks inherent in this age group. Mastery of illness and hospitalization are central issues for the school-aged child and can be facilitated through the efforts of nursing and hospital staff. A therapeutic play program is also a beneficial adjunct to treatment and nursing care.