Nursing Care for the person who has a Cast
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Nursing the person with a Cast Home Home Page Table of contents Learning outcomes Plaster or fiberglass cast? Caring for a drying cast Cast complications i. Nursing assessments ii. Nursing actions Teaching materials for persons with a cast Quiz Glossary Home Learning Outcomes 1. Compare & contrast plaster & fiberglass casts 2. Explain the care required while a plaster cast dries 3. For each complications associated with a cast describe i. nursing assessments required to detect ii. nursing actions to treat the complication 4. Be familiar with teaching materials available for persons who have a cast Home plaster casts inexpensive heavy sets in ~ 3 -1 5 minutes, then takes 24 - 72 h to dry (varies with thickness) messy to apply gives more support for ‘bad breaks’ Home fiberglass casts has durability of plaster but is lighter weight hardens within minutes is porous and there are fewer skin problems does not soften when wet - hair dryer quickly dries skin beneath Costs more Care required while the plaster cast dries once applied heat is given off for ~ 15 minutes & may be uncomfortable while the plaster sets, the cast will remain soft & touching may lead to indentations which may then create pressure spots until dry handle the cast with palms of hands only - not fingers do not rest cast on hard surfaces or sharp edges Home Drying a plaster cast Picture to be inserted Home Presentation on-line application of a fiberglass cast note the use of 1. Stockinette 2. Padding 3. Casting material Home Potential Complications hidden bleeding neurovascular compromise compartment syndrome skin &/or tissue breakdown hidden infection from wound &/or ulcer Home 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 Home 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 Home Typical appearance (& terminology to describe) @ 1000 hours Sanguineous Sero-sanguineous @ 1200 hours serous @ 1400 hours Home If you see bleeding Mark the outer edges of the bleeding area with time and date & then initial JW Example: Jan 10 - 1000 1200 JW 1400 JW Then ---- > Home 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 Home Document Narrative Notes 0845 dark red area ~ 3 cm diameter in narrative notes & indicate malleolus; P 88, R 24, size location vitals noted over outer aspect of BP 108/56; alert but pale; 0930 slight extension of bleeding; client states “feel fine” 1030 no further bleeding noted; P 80 BP 120/ 66 ; instructed to call other signs of nurse if further bleeding noted bleeding JWladyka RN Home Neurovascular Compromise Compression of nerves and blood vessels may be caused by swelling 2° to injured tissue impinging bone pieces swelling 2° to surgery restrictive pressure 2° the cast Home by doing C S M C colour plus • capillary refill (normal < 3 sec) • pulse in affected extremity – [whether present -- no need to count] • temperature of skin S sensation -- do not use a sharp object to assess M able to move extremity & digits Home Frequency of C S M assess q2h X 8, then q4h X 48, then q 8 h at first sign • elevate limb > heart • give analgesia • if symptoms persist notify MD stat as compartment syndrome may be occurring Home If swelling persists the physician will order the cast to be bivalved Note - Bivalving may be done by • a physician • an orthopedic technician • a specially trained nurse Home Burrell et al; 1586 Compartment Syndrome - a special form of neurovascular compromise muscles, nerves & blood vessels are enclosed in though inelastic fascia (or compartments) if the muscle within a compartment becomes swollen it cannot stretch & thus the nerves and blood vessels are compressed Home Signs & Symptoms deep, throbbing, unrelenting pain • not controlled by analgesics • often seems out of proportion to the injury swollen and hard muscle diminished capillary refill, cyanotic nailbeds, obscured pulse parasthesia, paralysis Home To reverse compartment syndrome A fasciotomy is performed Burrell et al; 1590 Home Skin &/or tissue breakdown Is most likely if the cast is resting too close to the tissue -particularly over boney prominences cast edges are sharp and irritating the skin Home Monitor Pressure Areas The cast over the area may become warm d/t inflammation beneath if there is skin breakdown there might be drainage if the area becomes infected there may be an odour Home Diagram to be added Windowing a cast Using cast cutting equipment an orthopedic tech MD, or specially trained nurse cuts out a piece of the plaster over the area of concern if required a dressing is applied Home Picture to be added Finishing a cast If the edges are not covered with stockinette, then you may need to cut small pieces of tape to smooth over the edges -- this is referred to petalling the cast Home Burrell et al; 1591 Teaching information r/t cast care Virtual Hospital: Iowa Health Book: Orthopaedics: Instructions for Patients Wearing a Cast Home Ready to try the quiz? I’m ready! Home Glossary Capillary refill Home References Burrell, Gerlach, Pless. Adult Nursing - Book IX. 2nd ed., Appleton Lang, 1997 Smeltzer, S.C. & B.G. Bare. Brunner & Suddarth’s Textbook of MEDICALSURGICAL NURSING. 8 TH ed., Lippincott, 1996. Dykes, P. (1993) Minding the five P’s of neurovascular assessment. AJN, 38 -39. Eden-Kilgour, S. (1993). Understanding neurovascular assessment. Nursing 93. 56-58. Home
