Casts, splints, and braces PDF

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Summary

Professor Martinez, Casts, splints, and braces...

Description

Patient in a Cast, Splint, or Brace Braces (Orthoses)

Casts 

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SPLINTS

A cast is a rigid external immobilizing that is molded to the contours of the body. A cast is used to specifically to immobilize a reduced fracture, to correct deformity, to apply uniform pressure to underlying soft tissue, or to support weakened joints. Types of Cast: 1. SHORT ARM 2. LONG ARM 3. SHORT LEG CAST 4. LONG LEG CAST 5. WALKING CAST 6. BODY CAST 7. SHOULDER SPICA CAST 8. HIP SPICA CAST DO NOT ITCH

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Many injuries that were previously treated with casts may now be treated with other immobilization devices. Contoured splints of plaster or pliable thermoplastic materials may be used for conditions that do not require rigid immobilization.

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Splints require special skin care

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Splints need to immobilize and support the body part in a functional position and it must be well padded to prevent pressure, skin abrasion, and skin breakdown.

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Short term Use

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Used to provide support, control, movement, and prevent additional injury. Custom fitted to various body parts of the body Indicated for longer use than splints

General Nursing Management of a Patient in a Cast, Splint, or Brace Before you apply, the nurse completes an assessment of general health, signs and symptoms, emotional status, understanding of the need for the device, and condition of body part to be immobilized.  Do NEURO CHECK  Physical Assessment include: NEUROVASCUALAR STATUS of the body part and degree and location of swelling, bruising, and skin abrasions.  Most pain can be relieved elevating the involved part, cold packs, and analgesics. NURSING ALERT A patient’s unrelieved pain must be immediately reported to the Physician to avoid necrosis and paralysis. Never ignore complaints of PAIN from the patient in a cast because of possibility of problems (ulcer formation, tissue perfusion)  Pain associated with Edema resolves with elevation  Pain associated with Compartment Syndrome is relentless and s not controlled by modalities such as elevation, cold packs and analgesics.  Pain decreases when ulceration occurs  Every joint that is not immobilized should be excercised and moved through its ROM to maintain function. EX. Arm cast encourage finger excercises  While the cast is on a nurse observes for infection, odors, and drainage. 

 Monitoring and Managing Potential Complications

1. Compartment Syndrome  Edema is a natural response of the tissue to trauma.  Main complaint is cast or brace TOO TIGHT  Vascular insufficiency and nerve compression due to unrelieved swelling can result in compartment syndrome.  Occurs when there is increased tissue pressure within a limited space  To relieve pressure, cast must be bivalve while maintaining alignment, and extremity must be elevated no higher than heart level. 2. Disuse Syndrome  Muscle Atrophy is a cause of immobilization  Patient needs to learn how to tense or contract muscles without moving the part.  Muscle setting exercises are important in maintaining muscles essential for walking.  Isometric (performed hourly with patient) exercises help this

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Nursing Management of the Patient with an Immobilized upper Extremity

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Encourage movement of all fingers or toes (Circulation) The 5 “Ps” (Pulselessness, Parlysis…) DO NOT scratch or stick anything under cast Cushion rough edges Normal Findings: minimal edema, minimal discomfort, pink color, warm skin

3. Pressure Ulcer 

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Lower extremities sites most susceptible to pressure ulcer are the heel, malleoli, dorsum of the foot, head of fibula, and patella. Upper Extremities: medial epicondyle of humerus and ulna styloid. Usually patient reports pain and tightness A warm area on the cast suggests tissue erythema Nurse monitors patients for pressure ulcers development To inspect area (Cast must be removed)

ADD SLIDE ABOUT NURSING MANAGEMENT Unaffected arm must resume all OF CASTS activities Frequent rest periods provided due to fatigue with of activities To control Swelling, the immobilized arm is elevated A SLING may be used to ambulate Encourage to remove sling and elevate arm Circulatory disturbances in the hand may become apparent with cyanosis, swelling, and inability to move the fingers. Neurovascular check may be done freq. If a cast is used for immobility, compartment syndrome is managed in part by bivalving (cutting) the cast and releasing the constricting cast and

Nursing Management of Immobilized lower Extrem.

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 Nursing Managem ent of Patient with a Body or Spica Cast

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Promoting Home and Community Care

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dressing. The patients leg may be supported on pillows to hart level to control swelling, and ice packs should be applied as prescribed over the fracture site Elevate leg when seated Assume a recumbent position several times a day Observe color, temp, and capillary refill of exposed toes NURSING ALERT Injury to the peroneal nerve as a result of pressure is a cause of foot drop. Consequently, the patient drags the foot when ambulating Casts that encase the trunk and portions of two extremities require special nursing strategies. Body Casts are for the Spine Nursing Resp. preparing and positioning the patient, assisting with skin care and hygiene, and monitoring cast syndrome. Nurse turns the patient toward the uninjured side Q2h Avoid twisting the patient within the cast Turn the patient to prone position BID Inspect skin for irrigation With decrease physical activity GI decreases, intestinal gases accumulate, intestinal pressure increases, and ileus may occur. NURISNG ALERT The nurse monitors the patient in a large body cast for potential cast syndrome, noting bowel sounds every 4 to 8 hours and reports distension, nausea, and vomiting Use assistive devices Explain to patient what is happening once cast is removed and during the removal process They feel pressure during removal Muscles will appear atrophy Skin is vulnerable to injury (No scratching)...