A patient has Buck's traction applied. So, what should the nurse do to prevent foot drop in that patient?

Uttarakhand CHO - 2021

Medical & Surgical Nursing

Medium

Appeared in: Uttarakhand CHO - 2021

Explanation

Foot drop is a common complication of prolonged bed rest and traction, caused by the foot remaining in a plantar-flexed position.
This position leads to the shortening of the Achilles tendon and can cause compression of the peroneal nerve, resulting in weakness or paralysis of the muscles that lift the foot (dorsiflexion).
Ensuring proper body position is the most comprehensive intervention. This includes keeping the patient's body aligned and, most importantly, maintaining the affected foot in a neutral (90-degree) position using supportive devices like footboards or splints.
This directly counteracts the forces causing foot drop, making it the primary preventive measure.

Option A: Placing a pillow under the heels does not prevent foot drop. While it can help alleviate pressure on the heel itself, it does not correct the ankle's plantar flexion and may even worsen it if not positioned carefully. It can also increase pressure in the popliteal space behind the knee, risking circulatory or nerve impairment.
Option B: Tucking the sheets tightly at the foot of the bed is contraindicated. The pressure from the bedding forces the feet into plantar flexion, which is the direct cause of foot drop. Linens should be kept loose or a bed cradle should be used.
Option C: While isometric exercises are beneficial for maintaining muscle tone and preventing muscle atrophy in an immobilized limb, they do not provide the constant support needed to prevent the foot from dropping into plantar flexion. Positioning is a passive intervention, whereas exercise is active; the foot requires constant passive support.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prevention of complications associated with orthopedic traction, specifically foot drop in a patient with Buck's traction to guide bedside assessment, documentation, and the next nursing action.
Preventing foot drop is a critical nursing responsibility as it can lead to a permanent gait disturbance and disability, significantly impacting a patient's mobility and quality of life after recovery.
Nurses must perform regular neurovascular assessments on patients in traction, checking for the '6 Ps': Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia (inability to regulate temperature).
What if? If the patient reports numbness and tingling on the top of their foot and has difficulty pulling their toes up towards their head (weak dorsiflexion), the nurse should suspect peroneal nerve compression. The immediate action is to assess the traction setup, relieve any external pressure (like tight boots or bedding), reposition the foot to neutral, and notify the provider immediately.

How to Approach the Question

First, identify the key concept in the question: preventing 'foot drop' in a patient with 'Buck's traction'.
Recall the pathophysiology of foot drop: it's caused by prolonged plantar flexion (foot pointing down) and/or pressure on the peroneal nerve.
Analyze each option to see if it addresses this cause.
Option A (pillow under heels) is for pressure sores, not foot position.
Option B (tucking sheets) actively causes the problem by pushing the foot down.
Option C (isometric exercises) helps muscles but doesn't provide the constant positional support needed.

Concept Tested & Keywords

Concept Tested: Prevention of complications associated with orthopedic traction, specifically foot drop in a patient with Buck's traction.
Stem keywords: Buck's traction, prevent foot drop, nurse
Lead-in keywords: what should the nurse do
Clinical cues: The patient is in Buck's traction, which is a form of skin traction that immobilizes the leg and carries a risk of neurovascular complications.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 pp. 127-129, 125-127