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Questions and Answers
What is the likely indication of unrelieved pain or pain out of proportion following cast application?
What is the purpose of petalling and windowing in cast care?
What is the primary goal when managing suspected cases of acute compartment syndrome?
What is the common cause of acute compartment syndrome in tibial fracture patients?
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What is the consequence of increased pressure within a confined space, such as a cast?
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Why is it important to observe for signs of systemic infection in cast care?
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What is the purpose of bi-valving in acute compartment syndrome management?
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What is the benefit of elevating the affected limb in cast care?
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What is the consequence of immobilizing a joint that is not affected by the cast?
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Why is it important to position the affected limb at the level of the heart in acute compartment syndrome management?
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Study Notes
Cast and Cast Care
- A cast is a rigid external device molded to the body's contours for immobilization.
- Purposes: immobilize fractures, correct/deformities, apply pressure to tissues, and stabilize joints.
Types of Casts
- Short-arm Cast: Extends from below the elbow to the palmar crease.
- Short-arm Thumb Spica Cast: Similar to short-arm cast but includes the thumb.
- Long-arm Cast: Extends from the axillary fold to proximal palmar crease, immobilizing elbow at a right angle.
- Short-leg Cast: Extends from below the knee to the base of the toes with foot in neutral position.
- Long-leg Cast: Extends from upper thigh to the toes, with slight knee flexion.
- Walking Cast: A reinforced short or long leg cast for mobility.
- Shoulder Spica Cast: For shoulder dislocations, encircles trunk, shoulder, and arm.
- Unilateral Hip Spica Cast: For thigh fractures, extends from the chest to the affected foot.
- One-and-one-half Hip Spica Cast: Similar to unilateral but includes bar for immobility of both legs.
- Bilateral Hip Spica Cast: For pelvis or thigh fractures; can be short or long leg.
Cast Materials
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Plaster of Paris: Requires clean, room temperature water; molds well, but is heavy and non-water-resistant. Takes 24-72 hours to dry.
- Wet plaster: damp, dull gray, musty smell.
- Dry plaster: hard, shiny white, resonant, and odorless.
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Fiberglass: Non-absorbent, tepid water for activation; waterproof and dries in 30 minutes, but harder to mold.
- Facilitates radiographic imaging better than plaster.
- Inform patients about the warmth sensation during application.
Nursing Responsibilities for Cast Application
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Pre-Procedure:
- Conduct baseline assessments (skin, neurovascular status).
- Provide necessary wound care and administer tetanus shots if indicated.
- Orient patient/family on the purpose and expectations of cast.
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Post-Procedure:
- Monitor the immobilized area for the 6 Ps: Pain, Paresthesia, Pulselessness, Pallor, Poikilothermia, Paralysis.
- Elevate extremity at heart level to enhance perfusion and prevent edema.
- Evaluate pain characteristics: differentiate between pain relief from immobilization and pain from edema.
- Watch for systemic infection signs like odor or discharge.
Cast Care Techniques
- Petalling: Smoothing rough cast edges with adhesive tapes to prevent irritation.
- Windowing: Removing a part of the cast for observation or to assess pulse.
Acute Compartment Syndrome
- Occurs due to increased internal pressure that compromises blood flow.
- Common causes include tight casts, burns, infiltrated IVs, or postoperative hematomas.
- Management involves:
- Bi-valving: splitting the cast.
- Position limb at heart level, avoiding elevation to maintain arterial flow.
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Description
This quiz covers the purposes and types of orthopedic immobilization devices, including casts, used in nursing care. It explores their application in fracture immobilization, deformity correction, and joint stabilization.
