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Nursing the person. with a C a s t. 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.

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slide2

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
learning outcomes

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
slide4
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

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’

care required while the plaster cast dries
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

drying a plaster cast
Drying a plaster cast
  • Picture to be inserted
presentation on line application of a fiberglass cast
Presentation on-lineapplication of a fiberglass cast

to see click here

note the use of

1. Stockinette

2. Padding

3. Casting material

slide8

Potential Complications

  • hidden bleeding
  • neurovascular compromise
    • compartment syndrome
  • skin &/or tissue breakdown
  • hidden infection from wound &/or ulcer
bleeding may occur beneath a cast if
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 asORIF
      • open reduction & internal fixation
to detect bleeding
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
typical appearance terminology to describe
Typical appearance (& terminology to describe)
  • @ 1000 hours

Sanguineous

Sero-sanguineous

@ 1200 hours

serous

@ 1400 hours

if you see bleeding
If you see bleeding

Mark the outer edges of the bleeding area with time and date & then initial

Example:

JW

Jan 10 - 1000

1200

JW

1400

JW

Then ---- >

follow up
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
document
Document

in narrative notes & indicate

size

location

vitals

other signs of

bleeding

Narrative Notes

0845 dark red area ~ 3 cm diameter

noted over outer aspect of malleolus; P 88, R 24,

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

nurse if further bleeding noted

JWladyka RN

neurovascular compromise
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
by doing c s m
 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

frequency of c s m
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
if swelling persists
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

Burrell et al; 1586

compartment syndrome a special form of neurovascular compromise
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
signs symptoms
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
to reverse compartment syndrome
To reverse compartment syndrome

A fasciotomy is performed

Burrell et al; 1590

skin or tissue breakdown
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
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

Diagram to be added

Monitor Pressure Areas
windowing a cast
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

Picture to be added

finishing a cast
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

Burrell et al; 1591

teaching information r t cast care
Teaching information r/t cast care
  • Virtual Hospital: Iowa Health Book: Orthopaedics: Instructions for Patients Wearing a Cast
glossary
Glossary

Capillary refill

references
References

Burrell, Gerlach, Pless. Adult Nursing - Book IX. 2nd ed., Appleton Lang, 1997

Smeltzer, S.C. & B.G. Bare. Brunner & Suddarth’s Textbook of MEDICAL-SURGICAL 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.

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