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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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With a c a s t

Nursing the person

with a C a s t


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


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


With a c a s t

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


With a c a s t

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 beneath

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 beneath

  • 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 beneath

  • Virtual Hospital: Iowa Health Book: Orthopaedics: Instructions for Patients Wearing a Cast


Ready to try the quiz
Ready beneathto trythe quiz?

I’m

ready!


Glossary
Glossary beneath

Capillary refill


References
References beneath

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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