Question

An adolescent boy with a fracture of the left tibial bone is scheduled for a skin traction. A. Describe the principles underlying effective skin traction. B. Explain as a student of Advance Nursing how you will teach your client Breast Self Examination (BSE)

Answer 1

The principle underlying effective skin traction is:

1. Traction is the application of pulling force to a body part.
2. In skin traction, the traction tapes are applied to the medial and lateral aspects of the limb.
3. Weights are attached to the other end and allowed to hand freely. The maximum weight for skin traction should not exceed 6.7 kgs.
4. In skin traction, the traction force is spread over a large. As a result, it is more comfortable and efficient.
5. The force applied over the skin transmits to the superficial fascia. From the superficial fascia to the deep fascia and muscular septae.
6. This helps align the broken bones without the need of incision.

Self present examination should be carried out in the following ways.

Inspection:

1. Expose the breast and stand in front of the mirror.
2. Place your arms by the side and let your hands rest on your hips.
3. Now turn side ways and inspect the breast.
4. Now bend forward from the waist and see how the breast tissue falls.
5. Now raise both the arm overhead and see the movement of the breast.

Palpation:

1. Place a pillow below the right shoulder and lie down on the bed or mattress.
2. Place the right hand behind the head.
3. Palpate the breast with the tips of the 3 middle fingers of the left hand.
4. Divide the breast into 4 quadrant
   1. Upper outer quadrant
   2. Upper inner quadrant.
   3. Lower outer quadrant
   4. Lower inner quadrant
5. Roll the breast tissue with the tips of the fingers over the chest wall.
6. Examine each quadrant in this way.
7. Alternatively, the breast can be examined medial to lateral ( or vice versa) by moving the fingers up and down.
8. The breast can also examine in circular direction radiating from the nipple.
9. After examining the breast, examine the axilla for any lumps.
10. Repeat the same process in the standing position.
11. Examine the nipple - position, discharge
12. Through out the examination one should look for the following anomalies:
    1. Skin changes ( like a peal of orange)
    2. dimples in the breast tissue.
    3. Any visible or palpable lump in the breast tissue or axilla.
    4. Any ulceration.
    5. Imobility of the breast tissue with movement of the torso.
    6. Nipple eversion and discharge.