DISLOCATION OF THE RIGHT KNEE JOINT & PLASTER OF PARIS

 DISLOCATION OF THE RIGHT KNEE JOINT

 Ms. Mwaanga, 25 years old, is admitted to an Orthopaedic ward with a dislocation of

the right ankle following a fall while descending the stairs. A closed manipulation has been

done, and a plaster of Paris (POP) was applied.

a. Define dislocation, 5 %

b. State five (5) signs and symptoms of a dislocated joint. 15 %

c. i. Explain two types of tractions 10 %

ii. Describe the nursing management of Ms. Mwaanga from the time of

admission until discharge. 50 %

d. Outline five (5) complications of a dislocation. 20 %

DISLOCATION OF THE RIGHT KNEE JOINT

(a) Dislocation: A dislocation is when the bone becomes separated from the joint it

meets, or it pops out of its socket OR A dislocation is a separation of two bones

where they meet at a joint

(b) 1. Pain due to irritation

2. Swelling due to abnormal accumulation of fluids

3. inability to move and bear weight

4. Skin discoloration visibly out of place, or misshapen

5. Accompanied by numbness or tingling at the joint or beyond it

6. Limited in movement

(c) i. Two (2) types of traction

a. Skin traction

 Traction is the application of a pulling force to a part of the body. Skin

traction is applied on the skin to control muscle spasms and immobilize on

the area before surgery. Skin traction is accomplished by weight pulling on

traction tape or a foam boot attached to the skin.

 The amount of weight applied must not exceed the tolerance of the skin. Not

more than 2 to 3.5 Kg of traction can be used on an extremity. Pelvic traction

is generally 4.5 to 9 Kg depending on the weight of the patient.

b. Skeletal Traction

 Skeletal traction is directly applied to the bone. This method is most frequently used

to treat fractures of the femur, the tibia, the humerus, and the cervical spine. The

traction is applied to the bone by use of a metal pin or wire e.g. Steinmann pin or

Kirschner wire is inserted through the bone distal to the fracture. Nerves, blood

vessels, muscles, tendons, and joints should be avoided when inserting the pin.

 Skeletal traction frequently uses 7 to 12 Kg to achieve the therapeutic effect. Weight

applied must overcome the shortening spasms of the affected muscles. As the

muscles relax, traction weight is reduced to prevent fracture-dislocation and to

promote healing

ii. Nursing Management of Ms. Mwaanga

Objectives

To relieve pain

To prevent complications

To promote healing

To Reduce anxiety

Anxiety-related to traction device

 I will explain to the patient that traction is needed to align the bones and control

muscle spasms to allay anxiety

 I will reinforce any information given to the patient before traction commences to

allay anxiety

 I will allow the patient to ask questions and answer them truthfully to promote

cooperation

 I will spend most of the time with the patient to reduce the feeling of isolation and

confinement

 I will offer diversional therapy e.g. Books, magazines if the patient is able to read,

radio, or TV if available, these will reduce feelings of helplessness and foster coping.

Pain

 I will nurse the patient on a fracture bed with a firm mattress to promote good limb

alignment.

 I will support the immobilized limb with sandbags to keep it in a good position

 I will handle the patient gently when changing the position without causing much

pain on the affected parts.

 I will monitor the weight of traction to avoid undue pressure on the patient

 I will give prescribed analgesics like Panadol 1000 mg orally, TDS 3/5 to relieve pain

 I will encourage the patient to be taking deep breathing exercises to promote full

lung expansion and prevent chest infections

 I will change the position of the patient every 2-4 hours or whenever necessary to

prevent pressure sores

 I will extend and flex the affected limb to promote blood circulation and good

muscle tone

 I will Massage the affected limb gently to promote blood circulation

 I will encourage early ambulation when the traction is removed to prevent

contractures

 I will Involve relatives in the care to enhance cooperation and continued care after

discharge

Observation

 I will observe closely for any complications of traction such as pressure ulcers where

traction for continuity of care

 I will ensure that traction allows blood circulation to promote recovery

 I will monitor vital signs and detect any abnormalities such as high temperature of

about 40 DEGREES, this could be an indication of systemic infection.

Nutrition:

 I will give a normal balanced diet to the patient such as carbohydrates, proteins, and

energy-giving food ad vitamins for body cell repair and normal functioning of body

systems.

 I will give adequate fluids for hydration and to prevent constipation.

Hygiene:

 I will do a daily bed bath to remove dirty and general comfort

 I will change soiled linen whenever necessary to promote hygiene

Elimination:

 I will give the patient a urinal and bedpan whenever needed

 I will monitor urine output for any abnormality also to a certain kidney function

Health Education

 Explain reasons for traction to impart knowledge

 Explain correct body alignment or positioning especially of the affected limb

 Advise patient not to disturb traction by reducing traction weight

 When traction is removed teach him how to use cratches.

 Refer the patient to physiotherapy

 Explain the importance of review date and compliance to advice such as avoiding playing

football until fully recovered

(d) Explain five complications

1. Pressure ulcers

 Can be prevented by avoiding friction on pressure points, repositioning the patient

frequently and to use protective devices e.g. elbow protectors to relieve pressure.

 Do pressure area care

 Keep the patient dry all the time

2. Pneumonia

 Teach and encourage the patient to be doing deep breathing exercises and coughing

for full lung expansion and adequate perfusion.

 Monitor the respiratory status of the patient.

3. Constipation and Anorexia

 Provide high fiber diet and fruits to stimulate gastric motility

4. Urinary stasis and infection

 Patient to be taking a lot of fluids

 The urinary bladder should be completely emptied.

5. Venous stasis and deep veins thrombosis

 Teach and perform the patient ankle and foot exercises within the limits of the

traction therapy

 Encourage patients to be taking a lot of fluids to prevent dehydration.

 Monitor the patient for signs of DVT