Care of a Patient with Cast

Care of a Patient with CastGrace C. Espino RN, MAN

CastIs a rigid external immobilizing device that is molded to the contours of the body. Generally it permit mobilization of the patient while restricting movement of a body part.Cast is a rigid external immobilizing device that is molded to contours of the body.

2Uses:1. Immobilize a Fracture 2. Correct a deformityApply uniform pressure to underlying soft tissue4. Support and stabilize weakened Joint5. Provide alignment for bone fragment during healing process.

2. provide alignment for bone fragment during healing process.Deformity - clubfoot (a congenital condition of the foot, especially one in which the foot is twisted and turned inward).Casts may also be used to help rest a bone or joint to relieve pain that is caused by moving it (such as when a severe sprain occurs, but no broken bones).o promote healing and early weight bearing. To support, maintain and protect realigned bone. To prevent or correct deformity To immobilize3

Also called talipes equinovarusCast Materials:1. Plaster Composed of open weave cotton roll or strip covered with calcium sulfate crystals* (Plaster of paris)

Plaster of paris (anhydrous calcium sulfate) is a chalky white powder which is made up of gypsum sulfate. When mixed with water swells & forms into a hard cement.Plaster bandages consist of a cotton bandage that has been combined withplaster of paris, which hardens after it has been made wet. Plaster of Paris iscalcinedgypsum(roasted gypsum), ground to a fine powder by milling. When water is added, the more soluble form ofcalcium sulfatereturns to the relatively insoluble form, and heat is produced.2 (CaSO4 H2O) + 3 H2O 2 (CaSO4.2H2O) + Heat[1] plaster of Pariscalcium sulfate dihydrate, reduced to a fine powder; the addition of water produces a porous mass used in making casts and bandages to support or immobilize body parts.5Cast Materials2. Synthetic cast - FiberglassComposed of open weave fiber glass tape covered with polyurethane resin that is activated by water.

Polyurethane resins are an industrial product, most often used in the manufacture of inks, the formation of molds, in plastics and bonding materials. These resins are malleable, their properties of hardness and elasticity can be altered and, once set into a final form, do not change back to their original form.

Read more : http://www.ehow.com/info_8740430_polyurethane-resin.html

Radiolucent- Characterized by allowing passage of x-rays or other radiation; not radiopaque. RADIOLUCENT: partly or wholly permeable to radiation and especially X-rays6

24 hours regular arm cast; 36-72hrs for long body castwaterproofporous7Contraindications: PregnancySkin diseases Open & draining wounds Swelling Infection

8TypesLocation:Uses:Short arm cast:Applied below the elbow to the hand(palmar crease)Forearm or wrist fractures. Also used to hold the forearm or wrist muscles and tendons in place after surgery.Long arm cast:Applied from the upper arm to the hand (palmar crease)

Upper arm, elbow, or forearm fractures.Also used to hold the arm or elbow muscles and tendons in place after surgery.Arm cylinder cast:Applied from the upper arm to the wristTo hold the elbow muscles and tendons in place after a dislocation or surgery.Short arm cast if thumb is included it is known as thumb spica or gauntlet cast.Long arm cast the elbow usually is immobilized at a right angle.9

TypesLocation:Uses:Shoulder spica cast:A body jacket that encloses the trunk & shoulder, and elbowShoulder dislocations or after surgery on the shoulder area

TypesLocation:Uses:Minerva body jacket cast:Applied around the neck and trunk of the bodyAfter surgery on the neck or upper back area; Fracture of the cervical spine

Minerva body jacket is named after the goddess minerva (in Roman mythology, the goddess of wisdom and patron of arts, trade, and the art of war, who was born fully armed from the head of Jupiter). 12TypesLocation:Uses:Rissers castThe body jacket extends from the shoulders to beyond the iliac crests and hips with a large opening over the anterior chestScoliosis; thoracic spinal fractures

Risser, Joseph C., U.S. orthopedic surgeon, 1892-1942.13TypesLocation:Uses:Short leg cast:Applied to the area below the knee to the foot (to the base of the toes).Lower leg fractures, severe ankle sprains/strains, or fractures. Also used to hold the leg or foot muscles and tendons in place after surgery to allow healing.Leg cylinder cast:Applied from the upper thigh to the ankleKnee, or lower leg fractures, knee dislocations, or after surgery on the leg or knee areaLong leg castFrom the mid-upper thigh to the base of the toesUnstable fractures of the tibia, fibula, or ankle.

TypesLocation:Uses:Unilateral hip spica cast: Applied from the chest to the foot on one legThigh fractures.Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healingOne and one-half hip spica cast:Applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both legs to keep the hips and legs immobilized.Thigh fracture.Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healingBilateral long leg hip spica cast:Applied from the chest to the feet.A bar is placed between both legs to keep the hips and legs immobilized.Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

TypesLocation:Uses:Short leg hip spica cast:Applied from the chest to the thighs or kneesTo hold the hip muscles and tendons in place after surgery to allow healing

TypesLocation:Uses:Abduction boot cast:Applied from the upper thighs to the feet. A bar is placed between both legs to keep the hips and legs immobilized.To hold the hip muscles and tendons in place after surgery to allow healing

Basic Cast care:Leave a freshly applied cast uncovered for the 1st 24h; let it air dry. Use a fan placed 18 to 24 inches from the cast to aid in drying in the 1st 24 hours.Handle wet cast with palms of hands, not fingers*Avoid getting the cast wet. If becomes wet, dry it using a hair dryer on a cool setting to avoid burns.Keep the cast dry; do not cover it with linen, plastic or rubber because it causes condensation w/c dampens the cast and the skin; to facilitate dryingHandle wet cast with palms of hands, not fingers to prevent indentation in the cast that will put pressure on the skin inside.Elevate casted extremity above heart level at least 48h to facilitate venous return & minimize swelling.Do not attempt to scratch the skin under the cast; do not insert objects to scratch itching skin to prevent skin breakdown. Cool air from a hair dryer may alleviate an itch.Encourage movement of fingers or toes every hour to decrease swelling; prevent stiffness; increase circulation;

20Basic Cast care:Elevate casted extremity with pillows above the heart level at least 48h*Caution client not to insert objects to scratch the skin under the cast*. Encourage movement of fingers or toes every hour* Ensure that the edges of the cast are padded. Inspect the skin around the edges frequently.

Elevate casted extremity above heart level at least 48h to facilitate venous return & minimize swelling.Do not attempt to scratch the skin under the cast; do not insert objects to scratch itching skin to prevent skin breakdown. Cool air from a hair dryer may alleviate an itch.Encourage movement of fingers or toes every hour to decrease swelling; prevent stiffness; increase circulation;

21Petal the cast edges

Cut 4x2 (10x5cm) strips.Rough cast edges can be cushioned with by petalling them with adhesive tape to reduce roughness. Cut 4 x 222Basic Cast care:

Applying ice pack to minimize swelling & pain23Basic Cast care:Advise client not to write or draw on a fiberglass cast. Fiberglass is porous.Reposition patient every 2 hours. Provide back and skin care .

Fiberglass is porous - permitting the movement of fluids or gases through it by way of pores or other passages.

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If bleeding or drainage is noted on the cast. Circle areas where blood has seeped through the cast. Note the date & time on the cast.*

25Windowing a castUsing cast cutting equipment an orthopedic techMD, or specially trained nurse cuts out a piece of the plaster over the area of concern if required a dressing is applied

Basic Cast care:Perform skin and neurovascular assessment every 2 hrsAssess circulation, sensation, and movementFive Ps

Paresthesia-an unusual or unexplained tingling, pricking, or burning sensation on the skin27Basic Cast care:

Checking mobilityBasic Cast care:

Assessing capillary refillBasic Cast care:

Assessing sensation in exposed fingers Basic Cast care:Assess for signs of infection; Monitor temperature; assess for foul odor from the cast; increased pain, or extreme warmth (hot spot) over an area of the cast.31Basic Cast care:Check for pain, edema, inability to move body parts distal to the cast, pallor, pulses, and abnormal sensations.32Collaborative Problems/Potential ComplicationsCompartment syndromePressure ulcerDisuse syndromeDelayed union or nonunion of fracture(s)33Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow. Any swelling in a compartment will lead to increased pressure in that area, which will press on the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the arm or leg willno longerwork. It may need to be amputated. Compartment syndrome causessevere pain that does not go away when you take pain medicine or raise the affected area. In more severe cases, symptoms may include:Decreased sensationNumbness and tinglingPaleness of skinSevere pain that gets worseWeakness

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Compartment syndrome

Occurs when there is increased tissue pressure within a limited space that compromises the circulation and the function of the tissue within the confined area.To relieve the pressure, the cast must be bivalved.Signs & Symptomsdeep, throbbing, severe pain not controlled by analgesics often seems out of proportion to the injuryswollen and hard musclediminished capillary refill, cyanotic nailbeds, obscured pulseparasthesia, paralysis

Bivalving a CAST

Disuse syndromeMuscle atrophy and loss of strengthIsometric muscle contraction (patient must learn to tense or contract muscles) to reduce muscle atrophy and maintain muscle mass & strength.Leg cast push down the knee Arm cast make a fistMuscle-setting exercises:Quadriceps- setting exercises:Position supine with leg extendedpush knee back onto the mattress by contracting the anterior thigh muscles.Hold the position for 5 to 10 secondsRelaxRepeat 10 times each hour when awake

Muscle-setting exercises:Gluteal setting exercise:Position supine with legs extendedContract muscles of the buttocksHold the contraction for 5 to 10 secondsRelaxRepeat 10 times each hour when awake.Cast Removalcasts are removed when they need to be changed and reapplied or when the injury has healed sufficiently that the cast is no longer necessary. A cast is removed prematurely if complications develop.Most casts are removed with an electric cast cutter, an instrument that looks like a circular saw .

Proper use of an electric cast cutter, however, leaves the skin intact.

Cast removal. The padding is manually cut. The cast is bivalved with an electric cast cutter. (The cast is split. (When the cast is removed, The unexercised muscle is usually smaller and weaker. The joints may have a limited range of motion. The skin usually appears pale and waxy and may contain scales or patches of dead skin. The skin is washed as usual with soapy warm water, Applying lotion to the skin adds moisture and tends to prevent the rough skin edges from catching on clothing.