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Cast Care and Traction
Transcript of Cast Care and Traction
and External Fixation Casts A cast is a rigid external immobilizing device that is molded to the contours of the body.
Casts are used to:
immobilize a reduced fracture
to correct a deformity
support and stabilize weakened joints
apply uniform pressure to underlying soft tissue Types of casts & care Fiberglass:
composed of water-activated polyurethane materials
lighter in weight, stronger, more durable than plaster
newly applied fiberglass casts should not be placed on plastic surface due to endothermic reaction after application
casts can be dented while setting so should be well supported and avoid hard surfaces and sharp edges
some use waterproof lining which permits patient to swim, shower, or engage in hydrotherapy but must be drained to prevent skin breakdown Splints and Braces Splints:
made of plaster or pliable thermoplastic material
used for conditions that do not require rigid immobilization, when swelling may be anticipated, and for those that need special skin care
must be well padded to prevent pressure, skin abrasion, and skin breakdown
usually indicated for short-term use Plaster:
less costly & achieve better mold than fiberglass; not as durable and take longer to dry
also cause exothermic reaction and crystallization produces a rigid dressing in 15-20 min.
requires 24-72 hrs to dry completely
fresh cast should be exposed to circulating air and not be covered with clothing, linen, etc Braces:
used to provide support, control movement, and prevent additional injury
usually indicated for longer use than splints Assessment Before:
Assess general health, emotional status, understanding of the need for the device, & condition of the body part to be immobilized, neurovascular status, degree & location of swelling, bruising, & skin abrasions
information about prescribed treatment & what to expect promotes the patients active participation in & compliance with the treatment program
the nurse must evaluate pain, asking the patient to indicate the exact site & to describe the character & intensity to help determine its cause During:
Assess for potential complications that commonly occur because the cast is not easily removable
Compartment syndrome: occurs when there is increased pressure within a limited space that compromises circulation & function of tissue within confined area. To relieve the pressure, the cast must be bivalved (cut in half longitudinally) and elevate the extremity no higher than heart level.
Pressure ulcers: patient reports pain & tightness in the area, and may experience a warm area on the cast or brace. Drainage may stain the cast & emit an odor. Pain will be decreased when ulceration occurs .Report these findings to the physician.
Disuse syndrome: atrophy & loss of strength. To prevent this, the patient needs to tense or contract muscles without moving the part (isometric exercise) After:
Body part will be weak stiff, and may appear atrophied. The skin may appear dry & scaly and needs to be washed gently & lubricated with emollient lotion.
Support is needed when the cast is removed.
Exercises prescribed to help the patient regain joing motion are explained & demonstrated.
Elevation of the extremity may be required to control swelling until normal muscle tone is established.
Five P's: Pain, pallor, pulselessness, paresthesia, & paralysis External Fixation used to manage open fractures with soft tissue damage.
provide stable support for severe comminuted fractures while permitting active treatment of damaged soft tissues
indicated in complicated fractures of humerus, forearm, femur, tibia, and pelvis
fracture is reduced, aligned, and immobilized by series of pins inserted in the bone. Pin position is maintained through attachment to a portable frame. Nursing Management of External Fixation Prepare patient psychologically for application of device. Reassure discomfort is minimal & early mobility is anticipated & promotes acceptance of the device
Elevate extremity to reduce swelling
Monitor neurovascular status every 2-4 hrs & assess pin site for redness, drainage, tenderness, pain, & loosening of pins. Monitor for compartment syndrome
Some serous drainage is expected.
Clean each pin site separately 1-2 times per day with cotton tipped appicator soaked in chlorhexidine solution.
Notify physician of loose pins/clamps & signs of infection Traction application of a pulling force to a part of the body
used to minimize muscle spasms; to reduce, align, & immobilize fractures; to reduce deformity; to increase space between opposing surfaces
must be applied in the correct direction & magnitude to obtain its therapeutic effects
amount of weight used may be changed to achieve desired effect as muscle & soft tissue relax
primarily a short-term intervention until other modalities (external/internal fixation) are possible
must be continuous to be effective in reducing & immobilizing fractures
skeletal traction is never interrupted
weights are not removed unless intermittent traction is prescribed
any factor that may effect or alter the line of pull must be eliminated (poor alignment, obstructed ropes, weights in improper position, knots in ropes) Types of Traction Skin traction
Bucks extension traction
Balanced suspension traction
Manual traction Effects are evaluated with x-ray studies. Adjustments are made if necessary. Nursing Interventions The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs.
Promptly investigate every report of discomfort expressed by the patient.
Inspect pin site at least every 8 hours for signs of inflammation & evidence of infection.
The nurse must monitor for signs of DVT and frequently assess color, peripheral pulses, capillary refill time, & temperature of fingers & toes. Nursing Diagnoses Acute pain related to fractures, joint degeneration, swelling, or inflammation
Risk for ineffective therapeutic regimen management R/T insufficient knowledge or lack or available support & resources
Impaired physical mobility R/T pain, swelling, and possible presence of immobilization device
Risk for situational low self-esteem and/or disturbed body imag R/T impact of musculoskeletal disorder Learning Objectives Know the difference between fiberglass and plaster casts and care for casts
Know the difference between splints & braces
Learn proper care for external fixation devices and pin site care
Learn how to assess patient before, during, and after cast placement
How to recognize signs of skin breakdown, nerve damage, and signs of infection
Understand how and why traction is used **See handout for types & proper care of traction devices. *If there is an open wound or open fracture, the patient may require a tetanus booster if the wound was dirty & if the last known booster was more than 5 years ago. Brunner & Suddarth Textbook of Medical Surgical Nursing pgs. 2024-2035