Nursing the Person with a CAST What is a FRACTURE?

Any disruption in the normal continuity of a bone caused by trauma, twisting as a result of muscle spasm or indirect loss of leverage or bone decalcification Interventions for a FRACTURE What is a CAST? A temporary device made of synthetic materials such as fiberglass, thermoplaster polymer or plaster of Paris PURPOSES Immobilization of bone and joints after a fracture or injury Prevention or correction of deformity Maintenance, support and protection of realigned bone Promotion of healing to allow early weight bearing for ambulation EQUIPMENTS

Cast Application Nsg Action 1.Spread the newpaper on the floor 2.Explain to patient that there will be feeling of warmth as the plaster is applied 3.Apply stockinette and roll cast padding on the extremity or part to be immobilized 4.While keeping the thumb under the forward edge of the bandage, submerge the plaster bandage vertically in water 5.Expel excess water Nursing Interventions Keep the cast and extremity elevated Allow a wet cast 24 to 48 hours to dry (synthetic casts dry in 20 mins)

Handle a wet cast with the palm of the hands until dry Turn the extremity unless contraindicated so that all sides of the wet cast will dry Cool setting on a hair dryer can be used to dry a plaster cast

Examine the skin and cast for pressure areas Monitor the extremity for circulatory impairment such as pain, swelling, discoloration, tingling, numbness, coolness or diminished pulse. Notify the physician immediately if circulatory compromise occurs Prepare for bivalving or cutting the cast if circulatory impairment occurs Monitor the client s temperature

Monitor for the presence of foul odor, which may indicate infection Monitor for drainage and circle the area of drainage on the cast If an open draining area exists on the affected extremity, the physician will make a cut-out portion of the cast or a window Instruct the client not to stick objects inside the cast Teach the client to keep the cast clean and dry Instruct the client in isometric exercises to prevent muscle atrophy

<span> </span> <span>plaster casts</span> Pinexpensive Pheavy

Psets in ~ 3 -1 5 minutes, then takes 24 - 72 h to dry (varies with thickness) Pmessy to apply Pgives more support for bad breaks <span> </span> <span>fiberglass casts</span> Phas durability of plaster but is lighter weight Phardens within minutes Pis porous and \ there are fewer skin problems Pdoes not soften when wet - hair dryer quickly dries skin beneath PCosts more COMPARTMENT SYNDROME What is Compartment Syndrome? An increased pressure within one or more compartments, causing massive compromise of circulation to an area Leads to decreased perfusion and tissue anoxia Within 4 to 6 hours after the onset of CS, neuromuscular damage is IRREVERSIBLE COMPARTMENT SYNDROME Assessment vUnrelieved or incresed pain vSwelling vPain with passive motion vInability to move joints vLoss of sensation (paresthesia) vPulselessness Intervention vNotify the physician immediately BLEEDING may occur beneath a cast if

there is trauma to the skin at the time of injury surgery is required to reduce the fracture this will be documented as ORIF open reduction & internal fixation To detect bleeding visualize the cast carefully. Give particular attention to areas over known wounds &/or incisions dependent areas - remember that liquid flow follows the line of gravity Typical appearance @ 1000 hours Follow-Up continue to monitor instruct client to call you if additional bleeding is noted &/or if s/he notices any other changes notify MD if bleeding continues there is a significant change in vital signs client condition changes

Document in narrative notes & indicate size location vitals other signs of bleeding TRACTION

Traction the application of a pulling force to a part of the body <span>Purpose</span><span>:</span> to minimize muscle spasms; to reduce, align, and immobilize fractures; to reduce deformity; and to increase space between opposing surfaces <span>PRINCIPLES OF EFFECTIVE TRACTION</span> Countertraction must be used to achieve effective traction. Countertraction is the force acting the opposite direction. Usually, the patient's body weight and bed position adjustments supply the needed countertraction. <span>Traction may be applied</span> to the skin (skin traction) directly to the bony skeleton (skeletal traction). Interventions to Clients on Traction Maintain proper body alignment Ensure that the weights hang freely and do not touch the floor Do not remove or lift the weights without a physician s order Ensure that pulleys are not obstructed and that ropes in the pulleys move freely Place knots in the ropes to prevent slipping <span>Skin Traction</span><span>:</span> Skin traction is used to control muscle spasms and to immobilize an area before surgery.

Skin traction is accomplished by using a weight to pull on traction tape or on a foam boot attached to the skin. The amount of weight applied must not exceed tolerance of the skin. Types of Skin Traction used for adults include Buck's extension traction Cervical head halter Pelvic belt Cervical Skin Traction Relieves muscle spasm and compression in the upper extremities and neck Uses a head halter and a chin pad to attach the traction Position the client with HOB elevated 30 to 40 degrees, and attach the weights to a pulley system over the HOB Buck s Skin Traction qUsed to alleviate muscle spasm and immobilizes a lower limb by maintaining a straight pull on the limb with the use of weights qA boot appliance is applied to attach the traction qNot more than 8 to 10 lb of weight should be applied qElevate the foot of bed to provide traction Pelvic Skin Traction Used to relieve lower back, hip, or leg pain and to reduce muscle spasm Apply the traction snugly over the pelvis and iliac crest and attach to weights Use measures as prescribed to prevent the client from slipping down in bed

No more than 2 to 3.5 kg (4.5 to 8 lb) of traction can be used on an extremity. Pelvic traction is usually 4.5 to 9 kg (10 to 20 lb), depending on the weight of the patient. Complication of Skin Traction: qSkin breakdown q qNerve pressure q qCirculatory impairment <span>Skeletal Traction</span><span>:</span> to treat fractures of the femur, the tibia, and the cervical spine. The traction is applied directly to the bone by use of a metal pin or wire Gardner Wells Traction Interventions Monitor color, motion, and sensation of the affected extremity Monitor the insertion sites for redness, swelling or drainage Provide insertion site care as prescribed Balanced Suspension Traction Used with skin or skeletal traction Used to approximate fractures of the femur, tibia, or fibula Produced by a counterforce other than the client Balanced Suspension Traction with Thomas Splint w/ Pearson attachment Interventions

Position the client in low Fowler s on either the side or the back Maintain a 20-degree angle from the thigh to bed Protect the skin from breakdown Provide pin care if pins are used with the skeletal traction Clean pin sites with sterile normal saline and hydrogen peroxide or povidone-iodine as prescribed <span>Nursing Process: The patient in Traction</span> <span>Assessment:</span> evaluate the body part to be placed in traction and neurovascular status (ie, color, temperature, capillary refill, edema, pulses, ability to move, and sensation) and compare it to the unaffected extremity. <span>Diagnosis:</span> Deficient knowledge related to the treatment regimen Anxiety related to health status and the traction device Acute pain related to musculoskeletal disorder Self-care deficit: feeding, bathing/hygiene, dressing/groom ing, and/or toileting related to traction Impaired physical mobility related to musculoskeletal dis order and traction <span>Potential complication:</span> <span>Pressure ulcer </span> <span>Pneumonia </span> <span>Constipation </span> <span>Anorexia </span> <span>Urinary stasis and infection </span> <span>Venous stasis with DVT</span> <span>Planning and Goals:</span> The major goals for the patient in traction may include understanding of the treatment regimen, reduced anxiety, maximum comfort, maximum level of self-care, maximum

mobility within the therapeutic limits of traction, and absence of complications <span>Nursing Intervention:</span> promoting understanding of treatment regimen: Reducing Anxiety. Achieve a maximum level of comfort. Achieving Maximum self care. Attaining maximum Mobility with traction. Monitoring and managing potential complication. <span>Evaluation:</span> Demonstrates knowledge of traction regimen Exhibits reduced anxiety States increased level of comfort Performs self-care activities Demonstrates increased mobility Experiences no complications