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CAST
IT IS A RIGID DEVICE APPLIED TO IMMOBILIZE THE INJURED BONES AND PROMOTE HEALING. IT IS APPLIED TO IMMOBILIZE THE JOINT ABOVE AND BELOW THE FRACTURED BONE SO THAT THE BONE WILL NOT MOVE DURING HEALING. THESE ARE APPLIED ON CLIENTS WHO HAVE RELATIVELY STABLE FRACTURES.
TYPES OF CASTS
SHORT-ARM CAST LONG-ARM CAST SHORT-LEG CAST LONG-LEG CAST WALKING CAST BODY CAST SHOULDER SPICA CAST HIP SPICA CAST DOUBLE HIP SPICA CAST
CASTING MATERIALS
PLASTER NONPLASTER
RATIONALE PROTECTS THE SKIN FROM CASTING MATERIALS. PROTECTS SKIN FROM PRESSURE FOLDS OVER EDGES OF CAST WHEN FINISHING APPLICATION; CREATES SMOOTH, PADDED EDGE; PROTECTS SKIN FROM ABRASION
RATIONALE PROTECTS SKIN FROM PRESSURE OF CAST PROTECTS SKIN AT BONY PROMINENCES PROTECTS SUPERFICIAL NERVES
3.
RATIONALE CREATES SMOOTH, SOLID, WELLCONTOURED CAST FACILITATES SMOOTH APPLICATION CREATES SMOOTH, SOLID, IMMOBILIZING CAST SHAPES CAST PROPERLY FOR ADEQUATE SUPPORT STRENGTHENS CAST
RATIONALE PROTECTS SKIN FROM ABRASION ALLOWS FULL RANGE OF MOTION OF ADJACENT JOINTS
RATIONALE CASTING MATERIALS BEGIN TO HARDEN IN MINUTES. MAXIMUM HARDNESS OF NONPLASTER CAST BEGINS IN MINUTES. MAXIMUM HARDNESS OF PLASTER CAST OCCURS WITH DRYING ( 24 TO 72 HOURS, DEPENDING ON ENVIRONMENT AND THICKNESS OF CAST) AVOIDS DENTING OF CAST AND DEVELOPMENT OF PRESSURE AREAS.
WITH A CAST CUTTER, A LONGITUDINAL CUT IS MADE TO DIVIDE THE CAST IN HALF. THE UNDERPADDING IS CUT WITH SCISSORS. THE CAST IS SPREAD APART WITH CAST SPREADERS TO RELIEVE PRESSURE AND TO INSPECT AND TREAT THE SKIN WITHOUT INTERRUPTING THE REDUCTION AND ALIGNMENT OF THE BONE. AFTER THE PRESSURE IS RELIEVED, THE ANTERIOR AND POSTERIOR PARTS OF THE CAST ARE SECURED TOGETHR WITH AN ELASTIC COMPRESSION BANDAGE TO MAINTAIN IMMOBILZATION. TO CONTROL SWELLING AND PROMOTE CIRCULATION, THE EXTREMITY IS ELEVATED ( BUT NO HIGHER THAN THE HEART LEVEL, TO MINIMIZE THE EFFECT OF GRAVITY ON PERFUSION OF THE TISSUES).
RATIONALE
CARDIOVASCULAR
COMPLICATION
ORTHOSTATIC HYPOTENSION DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM INCREASED WORKLOAD ON HEART
NURSING INTERVENTION
EXERCISES PLANTARFLEXION AND DORSIFLEXION FOOT EXERCISES QUADRICEPS AND GLUTEAL SETTING EXERCISES FREQUENT TURNING SLOW MOBILIZATION NO PILLOWS BEHIND THE KNEES ANTIEMBOLISM STOCKINGS
RESPIRATORY
COMPLICATION
DECREASED CHEST EXPANSION ACCUMULATION OF SECRETIONS IN RESPIRATORY TRACT
NURSING INTERVENTION
FREQUENT TURNING ENCOURAGE FREQUENT COUGHING AND DEEP BREATHING
INTEGUMENTARY
COMPLICATION
BREAKDOWN OF SKIN INTEGRITY (ABRASIONS, DECUBITUS ULCER) CAUSED BY FRICTION, PRESSURE, OR SHEARING FORCE
NURSING INTERVENTION
FREQUENT TURNIG AND REPOSITIONING REGULAR INSPECTION OF SKIN FOR SIGNS OF PRESSURE GENTLE MASSAGE OF SKIN, ESPECIALLY OVER BONY PROMINENCES
GASTROINTESTINAL
COMPLICATION
CONSTIPATION
NURSING INTERVENTION
FREQUENT MOVEMENT AND TURNING IN BED INCREASE FLUID INTAKE ADEQUATE DIETARY INTAKE WITH INCREASE IN HIGH-FIBER FOODS USE OF STOOL SOFTENERS AND LAXATIVES AS ORDERED
MUSCULOSKELETAL
COMPLICATION
ATROPHY AND WEAKNESS OF MUSCLES CONTRACTURES DEMINERALIZATION OF BONES (OSTEOPOROSIS)
NURSING INTERVENTION
EXERCISES ENCOURAGE PARTICIPATION IN ADL AS MUCH AS POSSIBLE PROPER POSITIONING AND REPOSITIONING OF JOINTS
URINARY
COMPLICATION
INCREASED CALCIUM EXCRETIONFROM BONE DESTRUCTION (CALCULI FORMATION) INCREASED URINE pH (ALKALINE) STASIS OF URINE IN KIDNEY AND BLADDER URINARY INFECTION
NURSING INTERVENTION
INCREASED FLUID INTAKE DECREASE IN CALCIUM INTAKE, ESPECIALLY MILK AND MILK PRODUCTS USE OF ACID-ASH FOODS USE OF COMMODE IF POSSIBLE
NEUROLOGIC
COMPLICATION
SENSORY DEPRIVATION AND ISOLATION
NURSING INTERVENTION
FREQUENT CONTACT BY STAFF ORIENTING MEASURES (CLOCK, CALENDAR) DIVERSIONAL ACITIVITIES (TV, RADIO, HOBBIES) INCLUSION OF CLIENT IN DECISION-MAKING ACTIVITIES
CARDIOVASCULAR
COMPLICATION
ORTHOSTATIC HYPOTENSION DEEP-VEIN THROMBOSIS AND PULMONARY EMBOLISM INCREASED WORKLOAD ON THE HEART
NURSING INTERVENTION
ACTIVE OR PASSIVE ROM EXERCISES
TRACTION
IS THE APPLICATIONOF A STRAIGHTENING OR PULLING FORCE TO RETURN OR MAINTAIN THE FRACTURED BONES IN NORMAL ANATOMIC POSITION.
TYPES OF TRACTION
1. STRAIGHT OR RUNNING TRACTION 2. BALANCED SUSPENSION TRACTION
STRAIGHT TRACTION
THE PULLING FORCE IS APPLIED IN A STRAIGHT LINE TO THE INJURED BODY PART RESTING ON THE BED
BUCKS TRACTION
IT IS THE MOST COMMON TYPE OF STRAIGHT TRACTION. THE LOWER PORTION OF THE INJURED EXTREMITY IS PLACED IN A CRADLE-LIKE SLEEVE. THIS SLEEVE IS HARNESSED TO ITSELF AND A WEIGHT IS HUNG FROM THE BOTTOM OF THE TRACTION FRAME. IT IS A FORM OF SKIN TRACTION.
SKIN TRACTION
ADVANTAGE: THE RELATIVE EASE OF USE AND ABILITY TO MAINTAIN COMFORT DISADVANTAGE: THE WEIGHT REQUIRED TO MAINTAIN NORMAL BODY ALIGNMENT OR FRACTURE ALIGNMENT CANNOT EXCEED THE TOLERANCE OF THE SKIN, ABOUT 6 lb PER EXTREMITY.
IN SKIN TRACTION, REMOVE WEIGHTS ONLY WHEN INTERMITTENT SKIN TRACTION HAS BEEN ORDERED TO ALLEVIATE THE MUSCLE SPASM.
TYPES OF TRACTION
1. SKIN TRACTION 2-3.5 kg 2. SKELETAL TRACTION 3. BALANCED SUSPENSION TRACTION 7 -12 kg 4. THOMAS SPLINT AND PEARSON ATTACHMENT 5. MANUAL TRACTION
IN SKIN TRACTION, FREQUENTLY ASSESS SKIN FOR EVIDENCE OF PRESSURE, SHEARING OR PENDING SKIN BREAKDOWN.
IN SKIN TRACTION, PROTECT PRESSURE SITES WITH PADDING AND PROTECTIVE DRESSINGS AS INDICATED.
MANUAL TRACTION
THE HAND DIRECTLY APPLIES THE PULLING FORCE
SKELETAL TRACTION
IT IS THE APPLICATION OF A PULLING FORCE THROUGH PLACEMENT OF PINS INTO THE BONE. THE CLIENT RECEIVES A LOCAL ANESTHETIC , AND THE PIN IS INSERTED IN A TWISTING MOTION INTO THE BONE THIS TYPE OF TRACTION SHOULD BE APPLIED IN A STERILE CONDITION BECAUSE OF THE RISK OF INFECTION ONE OR MORE PULLING FORCE IS MAY BE APPLIED
IN SKELETAL TRACTION, NEVER REMOVE THE WEIGHTS. MAY REQUIRE MORE FREQUENT ANALGESIC ADMINISTRATION.
SKELETAL TRACTION
ADVANTAGE: MORE WEIGHT CAN BE USED TO MAINTAIN THE PROPER ANATOMIC ALIGNMENT IF NECESSARY DISADVANTAGE: INCREASED ANXIETY, INCREASED RISK OF INFECTION, INCREASED DISCOMFORT
FREQUENT SKIN ASSESSMENTS SHOULD INCLUDE PIN CARE PER POLICY. REPORT SIGNS OF INFECTION AT THE PIN SITES.
ASSIST IN REPOSITIONING. THE AREA OF THE FRACTURE MUST BE STABILIZED WHEN THE CLIENT IS REPOSITIONED.
MAINTAIN THE LINE OF PULL: A. CENTER THE CLIENT ON THE BED. B. ENSURE THAT WEIGHTS HANG FREELY AND DO NOT TOUCH THE FLOOR.
DO NOT WEDGE THE CLIENTS FOOT OR PLACE IT FLUSH WITH THE FOOT-BOARD OF THE BED.
ORTHOPEDIC SURGERIES
OPEN REDUCTION INTERNAL FIXATION ARTHROPLASTY HEMIARTHROPLASTY JOINT ARTHROPLASTY OR REPLACEMENT TOTAL JOINT ARTHROPLASTY OR REPLACEMENT MENISCECTOMY AMPUTATION BONE GRAFT TENDON TRANSFER FASCIOTOMY
JOINT REPLACEMENT