MS Care
Modalities
Connie K. Cupples, MS,
MSN, RN
Care Modalities
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Casts – nonplaster & plaster
Traction – Skin & skeletal
External fixation devices – pins
Open reduction with internal fixation
Artificial joint replacement – hip, knee
Nursing Interventions
for Patient in a Cast
• Pain relief – elevate the part, cold
application & analgesics as ordered
(unrelieved pain may indicate
compartment syndrome)
• Improve mobility – ROM to all immobilized
joints
• Promote healing of skin abrasions – clean
and apply sterile dressing to areas,
observe for s/s of infection
Nursing interventions cont’d
• Maintain neurovascular function – early
recognition and reporting to MD of s/s of
unrelieved pain, pain on passive stretch,
paresthesia, motor loss, sensory loss,
coolness, pallor, slow capillary refill,
sensation of tightness (may indicate
compartment syndrome)
• Elevate extremity no higher than heart
level and call MD STAT
Potential Complications
for Patient in a Cast
• Compartment Syndrome – circulation and
function are compromised
• Pressure Ulcers – observe for s/s
• Disuse Syndrome – muscle atrophy occurs
Teaching the Patient
with a Cast Home Care
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Mobility aids & safety
Prescribed exercise
Elevate extremity to heart level
Keep cast dry & cushion rough edges
Don’t scratch under cast
Report indicators of complications
Avoid excessive use of injured extremity
Report broken cast
Management of Patient
in Arm Cast
• Elevate immobilized arm
• Sling used during ambulation
• Neurovascular checks – observe for
Volkmann’s contracture
Management of Patient
in a Leg Cast
• Elevate to heart level
• Apply ice for 1-2 days as prescribed
• Encourage recumbent position several times a
day
• Assess circulation and nerve function (peroneal
injury may cause footdrop)
• Teach use of assistive devices (transfer &
ambulating)
• Use of cast boot or reinforcement of cast if
weight-bearing is allowed
Nursing Interventions with a
Patient in a Body or Spica Cast
• Turn q 2h to unaffected side (3-4
persons)
• Prone position bid if not contraindicated
• Skin care
• Fracture bedpan with plastic pads
• Observe for cast syndrome –
psychological & physiological
Types of Hip Spica Casts
Managing Pt with Splints & Braces
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Teach pt how to apply device
Neurovascular checks
Assess comfort when using device
Encourage to wear as prescribed
Refer pt for adjustments as needed
Nursing Interventions for Pt With
an External Fixator
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Pt teaching prior to application
Elevate extremity
Monitor neurovascular status q 2-4 h
Assess pin site for s/s of infection
Pin care as prescribed
Encourage isometric and active exercises
Physical therapy referral may be ordered
Nursing Interventions
with Skin Traction
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Keep leg in proper alignment
Keep traction bandage free of wrinkles
Maintain countertraction
Do not turn but assist to shift position
Measures to prevent skin breakdown
Assess for nerve pressure
Circulation checks q 1-2 h
Encourage active foot exercises
Nursing Interventions with a Pt in
Skeletal Traction
• Ensure that weights hang freely & that ropes,
knots, and pulleys are correct
• Maintain proper body alignment & foot in
neutral position
• Prevent skin breakdown
• Bed changed from top to bottom
• Neurovascular checks q 4h
• Pin site care tid or as prescribed
• Encourage exercise within therapeutic limits
QUESTIONS
• What are three potential complications
that a patient in skeletal traction may
develop?
• Identify nursing interventions to prevent
the above complications.
Nursing Interventions for Pt. with
Total Hip Replacement
• Keep leg in abduction to prevent
dislocation of the prosthesis – use
abduction pillow to keep hips abducted
• When turning, keep hip abducted
• Turn from side to side unless surgeon
orders not to turn to affected side
• Teach pt to avoid flexion of affected hip
• Don’t elevate HOB more than 60 degrees
• Observe for s/s of dislocation
Teaching Pt to Avoid Hip
Dislocation
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Don’t cross legs
Keep knees apart
Sleep with pillow between legs
Don’t bend forward when seated
Don’t bend to pick up objects on floor
Use high-seated chair & raised toilet seat
Don’t flex hip while dressing
Use a “reaching device” to assist with activities
Nursing Interventions cont’d
• Observe wound drainage (expect 200500ml in 1st 24 h, 30ml or less in 48h)
• Measures to prevent DVT (fluids, exercise,
TEDs, SCDs, ambulate, heparin or
Lovenox as ordered)
• Prevent infection (antibiotics as ordered)
• Teach self care to prepare for discharge
• Continuity of physical therapy, use of
assistive devices
Post-op Nursing Interventions for
Pt with Total Knee Replacement
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Observe dressing for bleeding/drainage
Ice as ordered
Neurovascular checks
Pain meds as ordered
Active flexion of foot q1h while awake
Observe CAC in wound suction drainage
Continuous passive motion (CPM) device
Early ambulation with knee immobilizer
Physical therapy as ordered
QUESTIONS
• In the post-op care of the patient
undergoing orthopedic surgery, name 5
potential complications for which the
nurse would monitor.
• Give nursing assessments and
interventions to prevent these
complications.
GOOD BYE AND GOOD LUCK
• Have a blessed day!
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