Nursing care for patients with braces
A brace is an external fixation device placed outside the body to restrict a certain movement of the body, thereby assisting surgical treatment or directly used for non-surgical treatment. By adding pressure points on top of external fixation, it can become an orthopedic brace used for correcting body deformities. There are many types of braces, but there are several similarities. That is: suitable size, stable fixation, lightweight, comfortable, and good breathability. And it is sturdy and durable, with a low price. Can be customized.
Purpose of clinical use of braces:
1. Local fixation: For example, small splints or Thomas frames are used to fix the local area of the fracture, causing the fracture end to be misaligned and leading to fracture healing.
2. Prevention and correction of deformities: For example, treatment and correction of deformities using hallux valgus.
3. Support and protection function: For example, thigh braces can support and protect limbs during walking. Leather waist or steel lumbar spine orthopedic braces can support and protect the spine, etc.
4. Improve function, support weak muscles, replace or enhance disabled muscles: for example, unilateral or bilateral calf braces can help prevent deformities in weak, paralyzed anterior or posterior tibialis muscle groups.
Commonly used clinical braces
1, Trunk brace:
Hip abduction is a double thigh brace Used for congenital hip dislocation.
2 steel thoracolumbar spine orthopedic brace, used to support spinal control of flexion and extension activities.
2, Upper limb brace
1 upper limb Thomas frame, used for traction and fixation of the upper limb
Two upper limb extension stands are designed to lift the upper limbs for abduction, external rotation, and elbow flexion.
3 elbow joint protection frame, used to protect the elbow joint and restrict movement.
4 wrist joint dorsiflexion splint, used to prevent deformities in rheumatoid arthritis.
3, Lower limb brace
Thomas' framework Used for traction and fixation of lower limbs
2 Brown's frame, used to raise and pull the lower limbs.
Nursing care of patients with knee valgus orthopedic braces
1. General nursing
1.1 Consider the patient comprehensively, not just focusing on the affected area. To understand and care for patients from their personal and family aspects, and to explain all treatment plans to patients and their families, in order to obtain their cooperation and cooperation. Encourage patients to engage in functional activities, pay attention to preventing bedsores, urinary tract stones, and pulmonary complications. Air and sunbathing can promote blood circulation and increase appetite. Patients can also feel mentally happy in environments with sufficient sunlight and air.
1.2 Work therapy creates conditions for patients to engage in productive activities that keep them mentally and physically engaged, in order to eliminate the feeling of disability.
During childhood, learning may be delayed due to prolonged restrictions on activities. Hospitals with conditions should have dedicated teachers to assist children in their learning. Enable children to keep up with their studies even after recovering from illness. During the rest period of treatment, various children's activities can also be organized to increase knowledge without leaving the group.
1.4 Pay attention to preventing complications
The use of braces must be appropriate and maintained in a timely manner to maintain good fixation and posture. Preventing pressure ulcers, vascular and nerve compression injuries, secondary deformities, and other complications can generally be prevented or avoided.
2. Common complications of wearing braces and their prevention and care
1. Vascular compression injury
If pressure is applied to blood vessels, it can cause circulatory disorders and affect blood supply. When observing, it is necessary to pay attention to the color, temperature, sensation, motor function, and presence of necrotic odors of the skin on the limbs at all times. It is necessary to observe frequently, detect them in a timely manner, and relieve stress in a timely manner.
2. Neurological damage
Due to improper braces, certain superficial nerves can be compressed, especially those adjacent to the bone processes, making them more susceptible to injury. The symptoms of nerve compression are sensory abnormalities, such as numbness, tingling sensation, muscle weakness, and even paralysis. For example, the common peroneal nerve is a superficial nerve that surrounds the neck of the fibula. If not properly protected, it can easily be compressed and cause foot drop deformity.
Pressure ulcers are often caused by improper size and tightness of braces. Sometimes the local skin can also be worn or broken due to moisture or dirt. Patients with malnutrition, emaciation, and anemia have low skin resistance and are prone to pressure ulcers. Paralyzed patients are prone to pressure ulcers when using splints or braces due to their inability to move freely and poor skin resistance. Patients with urinary and fecal incontinence often have their perineum exposed to wet stains and their skin easily crushed. Therefore, to prevent pressure ulcers, it is necessary to pay attention to the fitting of braces, carefully protect the skin when wearing, and keep the skin dry, clean, not compressed, and not rubbed. Support devices must also be maintained with care. Cracks in leather braces can scratch the skin and form pressure sores. Also pay attention to checking whether the support has any damage that may affect its fixation and wearing effect. Identify issues and promptly fix them to maintain their fixed function. Be careful not to let debris or other objects fall into the brace to prevent skin compression.
Skin care for patients wearing braces: Early symptoms of skin compression include local pain or itching, followed by numbness. If not checked and treated in a timely manner, the skin will lose sensation and pressure ulcers will further develop. If there is compression on the area where the brace is worn, the first sign is redness of the skin, which then progresses to skin rupture and ulceration. Children crying and restless at night are important signs of pressure ulcers, and night nurses should pay attention and report it. The purpose of caring for the skin is to promote local blood circulation and prevent local compression ischemia, so attention should be paid to local decompression. At the same time, it is necessary to protect the skin from cleanliness and dryness. Skin that can be touched under pressure should be washed with soap and water, and wet with clean hands. Apply soap and massage the skin until it turns red and the wet soap dries on the skin. If possible, it is best to use your hands
Palm massage. Then thoroughly dry the skin and apply talcum powder. Too much talcum powder should be avoided to prevent it from aggregating into clumps and forming compression when exposed to moisture. If the patient can touch the compressed area themselves,
Patients can be guided to massage the affected area every half hour,
For example, the upper ring of the Thomas brace is pressed on the crease of the buttocks, and the patient can often pull the compressed skin under the ring to relieve pressure. Attention should be paid to the fact that leather may harden and crack when exposed to alcohol. When massaging the skin with alcohol near a bracket wrapped in leather, extra caution should be taken. For those who first use braces, it is best to massage the skin of the compressed area every 4 hours, and gradually reduce the number of massages afterwards. If the skin becomes red due to pressure or friction, the number of massages should be increased and the area should be protected to avoid further pressure. Frequent repositioning can prevent pressure ulcers caused by prolonged local compression. If the position is limited to the support and cannot be flipped, a pillow or similar object can be used to lift the compressed area to relieve pressure. In summary, the following precautions should be taken when wearing braces:
(1) The measuring system of the brace fits perfectly;
(2) Proper use of braces;
(3) Pay attention to the care of the skin and braces.
2.4 Secondary deformities
Due to poor sleeping position on braces or discomfort caused by improper braces, patients may adopt adaptive and incorrect postures, which can lead to deformities over time. It is necessary to observe and correct them promptly. Long term bedridden patients can use a support frame to prevent foot drop and regularly turn over. The issues and nursing points discussed above should be clearly explained to patients and their families for those who are not hospitalized. If any problems are found, they should contact the hospital in a timely manner.
