When providing care for a child in balanced suspension skeletal traction using a Thomas splint and Pearson attachment to the right femur, which intervention is most important for the nurse to implement?
A.
Change position every 2 hours.
B.
Monitor peripheral pulses and sensation in the right leg.
C.
Cleanse pin sites as prescribed.
D.
Assess skin for redness and signs of tissue breakdown.
The correct answer is:
B. Monitor peripheral pulses and sensation in the right leg.
Explanation: In a child receiving balanced suspension skeletal traction, it is crucial to monitor the neurovascular status of the affected limb. This includes checking peripheral pulses, capillary refill, sensation, and movement in the right leg. Monitoring for signs of neurovascular compromise, such as decreased pulses, altered sensation, or increased pain, is essential to prevent complications like compartment syndrome, which can lead to permanent damage.
The other options are also important but are secondary to ensuring adequate circulation and nerve function:
- A. Change position every 2 hours: Helps prevent pressure ulcers and maintain comfort but is not as critical as neurovascular monitoring.
- C. Cleanse pin sites as prescribed: Important for preventing infection at the pin sites.
- D. Assess skin for redness and signs of tissue breakdown: Necessary to prevent pressure ulcers and other skin issues but comes after ensuring the limb’s neurovascular integrity.