The following is a sample nursing policy for c-spine immobilization.
Purpose:
To outline the procedure for applying immobilizing the upper spine, including application of a cervical collar and “boarding” the patient.
Policy:
Application of a cervical collar and placing the patient on a backboard may be indicated for trauma patients with mechanisms of injury that place the patient at risk for spinal injury. This will not be necessary for patients with all of the following:
no posterior midline cervical tenderness
no evidence of intoxication
normal level of alertness (GCS 15)
no focal neurological deficit
no painful distracting injuries
The MD or RN will maintain manual stabilization of the cervical spine until cervical collar is applied and patient is placed on backboard. * talk to the patient and tell them what you are doing- and not to move their head and neck
Place hands on both sides of patient’s head with thumbs along mandible and fingers holding back of head.
Assistants will help with the rest of the application of the cervical collar and backboard.
Perform a baseline CMS assessment of the extremities.
Remove jewelry from the neck and ears.
Choose an appropriately sized collar by measuring the distance (with fingers) between the top of the shoulder where the collar will rest and the chin. This same number of fingers will fit between the fastener on the collar and the bottom edge of the rigid plastic of the collar.
Cervical collar is assembled by snapping the fastener into the hole on the side of the collar
Adjustable rigid cervical collars are measured from the bottom edge of the rigid plastic to the red circle denoting the size of the collar (red circle will move up or down as size of the collar is adjusted)
Slide the back of the collar behind the right side of the neck until the Velcro tab is visible on the left side of the neck.
Slide the chin portion up the chest until the chin fits in the collar.
Secure the Velcro when the collar is on straight (nose, circle on chin portion of collar, and umbilicus are in alignment).
Place the patient on a slide board with all team members working in a smooth fashion which moves the patient’s spine as little as possible. Patients already in bed will be log rolled and slider board inserted. * Do not obtain a rectal temperature while the patient is turned unless the MD specifically requests this.
Recheck CMS.
The MD or RN can now remove hands from head.
Document both CMS checks and procedure in patient’s record.
Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.
Here are a few tips for providing the best care for you pediatric patients:
Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.
Forensic Nursing combines nursing science with the investigation of injuries or deaths that involve accidents, abuse, violence or criminal activity. Sexual Assault Nurse Examiners (SANE nurses) are one of the most recognized types of forensic nurses, but they have special training in one type of injury. Forensic nursing programs typically involve a broader set of skills, encompassing some or all of the following:
Interpersonal violence, including domestic violence, child and elder abuse/neglect, psychological abuse
Forensic mental health
Correctional nursing
Legal nurse consulting
Emergency/trauma services, including auto and pedestrian accidents, traumatic injuries, suicide attempts, work-related injuries, disasters
Patient care facility issues, including accidents/injuries/neglect, inappropriate treatments & meds
Public health and safety, including environmental hazards, alcohol and drug abuse, food and drug tampering, illegal abortion practices, epidemiology, and organ donation
Death investigation, including homicides, suicides, suspicious or accidental deaths, and mass disasters
Forensic nurses find that their additional training improves their basic nursing skills, and allows them to derive greater career satisfaction from helping patient in another rather unique way.
Approximately 37 training programs exist, ranging from certificate programs that require a specific number of hours of training, to degree programs (typically Masters level programs). Many of the certificate programs are available as online training.
