UNIT 10 Cast care sling application and traction ENDS IN VIEW Process in assisting in the application of casts y First

you need to assess the patient s health status including conditions that affect wound healing such as diabetes, age, malnutrition, peripheral vascular disease and see if they are allergic to latex Assess condition of tissues where the cast is going to be including circulation (pulse color temperature) to extremities. Assess ROM, sensation and amount of subcutaneous fat. Note is there is any redness, rash, bruising. Assess patients pain Give pain med 30 min prior to application Prepare skin for application, ensuring it is clean and free from debris, trim long hair, explain to patient that they may feel warmth during application Submerge either the plaster rolls in water until the bubbles stop or submerge synthetic casting rolls in water for 15 secs. Squeeze to remove excess water Hold the body part to be casted in place for the Doc so they can begin to apply the cast Supply the dampened rolls of plaster until doc is finished. You should be able to put 2 fingers between cast and limb Supply walking cast or brace if prescribed by Doc Supply scissors to trim cast around thumb, hand and foot Explain that casts dry from the inside out and not to use heat lamps cause they could cause burns or fans because they could blow organisms into the cast and cause infection Reposition patient every 2 hours

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Neurovascular assessments of patients in casts FIVE P S y Pain determine the amount and severity of pain the person is in. Ask them to describe the pain. Manipulation may produce a dull aching pain. If pain is unrelenting or seems out of proportion it may signal compartment syndrome. A sudden increase in pain by indicate a thrombus formation Pallor observe the colour of tissue distal form the cast. Older adults will sometimes have a bluish tinged- this is normal. For the rest of the population pink indicates good circulation where blue indicates venous stasis. Pulselessness- palpitate the distal pulse of casted extremities note if the pulse is strong or weak and if it is present all together. A weak or absent pulse may indicate that there is poor

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circulation to the area. Assess cap refill nail should pink up in three seconds or less. Blanching on pressure with subsequent cap refill is indicative of arterial perfusion. Paresthesia- assess for numbness tingling, and abnormal sensations. Presence of these may indicate nerve damage and/or development of compartment syndrome. Paralysis- assess for motion-reduced or absent mov t may indicate nerve damage and/or development of compartment syndrome.

Technique for drying casts There was no real technique mentioned all that it said was that casts need to dry for the inside out. We are to place the damp plaster cast on cloth covered pillows 2-3 at least. This will help to prevent pressure points and cast deformation as the cast dries Turning and positioning patients while in bed is important as it helps reduce the incidence of pressure ulcers aids in circulation and decreases the development of renal calculi. Turning facilitates lung expansion and helps to remove secretions from the airways it also encourages patients to breathe deeply and cough. Bed rest will eventually decrease respirations and lead to alveolar collapse. A sling should be applied when looking to support splints, casts or injured upper extremities. How to apply the sling with a triangular bandage. y Position one end of the bandage over the shoulder of the unaffected arm y Take the remaining bandage put the rest of the material against their chest, then under and over the affected arm so that it is cradled y Position the pointed end of the cloth towards the elbow y Tie the two ends at the side of the neck y Fold the extra material over at the elbow and secure with a safety pin if required y Ensure full support of the splint or cast without impeding circulation

Types of skeletal traction y y y Bryant s traction- vertically held bilateral traction to the legs. Used in children under 2 for treatment of fractured femurs with a hip Spica cast Buck s extension- horizontally applied to one or 2 sides. This type of traction provides temporary immobilization of hip fracture. It also reduces muscle spasms, contractures and dislocations Dunlop s traction horizontal form of buck s extension for the humerus with an accompanying vertical buck s extension to the forearm. (This is hard to explain it is better if you read the book and look at the pictures pages 278). This type of traction helps heal fractures of the humerus Russell s traction see book page 277

a) The cast is loose-fitting, has rough edges, or smells funny. Describe which nursing assessments and which nursing interventions would be appropriate. The cast

should have a 2 finger width space but if it is looser than that it may have to be recasted if swelling has gone down. If the cast has rough edges it is suggested that the nurse petal the edge of the cast by overlapping strips of tape or moleskin over the edge, this will reduce pressure and friction. A cast that smells sour or musty is normal due to sweat and dead skin cells accumulating under the cast. A foul odor can mean infection.
b) The tips of the client s extremities distal to the cast are cool to the touch or swollen. Describe which nursing interventions would be appropriate. These are indicators of poor circulation, I would notify doctor and assess if cast should be loosened. Edema can result from trauma and venous stasis

c) The client in a full-body cast is experiencing nausea, vomiting, abdominal pain, and a feeling of fullness. Describe which nursing interventions would be appropriate. This is suggesting cast syndrome (superior mesenteric artery syndrome) where the duodenum is compressed b/w the superior mesenteric artery and the spine. The nurse should position the patient form supine to prone, give nothing by mouth, and notify Doc. Prepare to insert ng tube, or cut an abdominal window in the cast

d) A nurse asks you to report your assessment using the 5 Ps . (pain, pallor, pulselessness, paresthesia, and paralysis) Describe these in detail. See above

e) The nurse notes drainage on the cast of a client with a fractured femur. What assessments should the nurse complete and why? What type of drainage is it, how much drainage is there, is there foul odour is this new drainage.