A nurse is planning care for a client who has a halo fixation device. which of the following actions

Moving around in a halo can be difficult, especially for children with short stature. Some may need a walker. Others may not be able to be mobile due to the halo’s weight. Pain medication may also affect balance and physical strength. Comfort levels typically increase with changing positions from lying to standing and walking.

If your child is able, walking around the house should become part of the daily routine during the postoperative period, if allowed by your doctor. Safety is paramount to prevent falls and slips, especially while going up and down stairs and navigating uneven ground. Any obstacles around the house should be addressed.

It is a good idea to take time and move at a normal pace while wearing a halo. Any movement that causes pain or uneasiness should be avoided. Avoid bending forward to grab objects, such as items that have fallen to the floor; consider using an adaptive device to help reach and pick things up.

Playing in a Halo

Precautions and activities may change based on healing and length of time in the halo. Some safe play ideas for children include:

• Filling a large plastic box with dried beans and cups and spoons (no sandboxes)
• Painting, drawing and coloring
• Fingernail painting

If you find your child has more energy at a certain time of day, focus on using these moments to their fullest.

Eating in a Halo

To avoid choking for small children, cut the following foods into very small pieces: grapes and other fruit, hot dogs and spaghetti. Older children, adolescents and adults should avoid chewing gum or laughing while eating. Be conscious of chewing thoroughly before swallowing.

Try to avoid dropping food or fluids into the vest while eating or drinking. Crackers, crispy or flaky foods, and potato chips are susceptible to this. To help prevent spilling, place a towel or bib over the vest.

A straw may also be useful for young children who tend to tilt their head back while drinking liquids. They will not be able to do this while wearing a halo.

Visiting restaurants during the postoperative period is allowed. However, for both children and adults, give special consideration to the possibility of choking.

Sleeping in a Halo

It may take some time to get used to sleeping in a halo, and your child will require assistance getting into the bed. Nighttime suggestions include sleeping in a reclining chair and lying on the back with a small pillow or foam wedge. Eventually, sleeping on a side or on the stomach may be possible.

When getting up, it is important to not sit upright and bend at the waist. This places a great amount of stress on the entire brace.

Instead:

• Roll onto your side at the edge of the bed.
• Bend the legs up from the waist.
• Drop the legs off the edge of the bed, pushing sideways with the elbow and hand at the same time to elevate to a sitting position.

See a demonstration of how to sit up

Someone should sleep in the same room as the person with the halo, or use an audio/video monitor to prevent issues such as choking.

Getting Dressed in a Halo

Shirts may need to be modified to fit around the halo and vest by cutting them to enlarge the head opening. Families with children in halos have found the addition of snaps very helpful. Velcro may also assist with clothing adaptations.

In cooler months, a jacket will be needed outside for warmth. If necessary, alter jackets the same way as shirts.

Undergarments may include a stockinette, which is like a T-shirt underneath the vest. It is placed at the time of the vest and halo application. The vest may also be lined with sheepskin. Do not place additional clothing under the vest.

The doctor will assess your child’s ability to walk. Shoes and boots with low heels and traction are best for safety. If your child has a change in balance, it may increase the likelihood of slipping and falling. Remember to be especially careful during the winter months on icy and/or wet surfaces. Walking in a well-lit mall is one way to exercise and reduce the risk of slipping or falling during rainy or cold weather.

Traveling in a Halo

Riding in cars is acceptable, especially related to doctor’s appointments. Long rides may need to be avoided due to fatigue and distance. If your child has a problem with traveling to doctor’s appointments, notify the surgeon.

It’s advised not to leave the country, take cruises or ride motorcycles while wearing a halo brace. These forms of travel are best left for when the halo is removed and healing has fully occurred, with the surgeon’s approval. Avoid rough or off-road traveling.

Hygiene in a Halo

Soaking in a tub and showering are not possible while wearing a halo brace, so sponge baths are a must.

Do not allow water or soap to enter the vest, as this can create a breeding ground for bacteria. All exposed areas below and around the vest can be cleaned. Use a soft cloth to remove any skin moisture around and underneath the vest edges.

Nothing should come between the skin and the sheepskin of the vest, including powders, talc, perfumes, lotions and ointments.

Discuss your child’s hair care with the doctor. Some doctors will allow certain types of hair care products, but others may ask that they be avoided. Ask your physician if dry shampoo can be used.

Halo Pin Care

Cleaning pin sites is the No. 1 precaution that families can take to avoid infection and pin loosening. Pin inspection should become routine, preferably twice a day: once in the morning and again before bed. The doctor will let you know which type of pin-site care they recommend.

Many physicians will advise cleaning halo pins with half-strength hydrogen peroxide and normal saline using a clean cotton swab for each pin. Take care to avoid re-dipping used cotton swabs into the cleaning solution.

Examine the pins and insertion sites for crusting, drainage, redness, tenderness or swelling. If these symptoms occur, notify your doctor immediately.

Skin Care

Check skin twice a day for any areas of redness, drainage or discoloration. Notify your child’s doctor immediately if you see any of these symptoms.

Inspect all areas around the vest, especially where the vest edges meet the skin. A flashlight works well in rooms with poor lighting. Notify your doctor if there are any areas of rubbing, because this can lead to skin breakdown.

Psychological Aspects of Caring for a Child in a Halo

Remember that children respond to attitude. Always be calm and encouraging around your child. The outcome is much more positive with an optimistic attitude and outlook from both parents and the child. It is important to have a strong support system in place with family, friends and your medical team. This will be a trying period to live through, but a manageable one with proper planning and emotional support.

Depression in caregivers may occur during this time. It may be mild, but in some cases symptoms may feel overwhelming. If you suspect depression, contact your doctor immediately.

Some children feel socially isolated in addition to experiencing eating and sleeping disturbances. Increase social interactions at times like this. Try to have friends or family around to combat isolation and increase joy.

Parents of toddlers should be aware of their child’s temperament, especially during the “terrible twos.” Avoid temper tantrums expressed by throwing oneself on the floor if possible.

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