Adult Health Test 1 Musculoskeletal Disorder part 3

Types of Casts

• Spica Cast: Used for immobilizing the femur and pelvis

  • Bilateral long leg hip spica cast: Covers both legs and the pelvis
  • One and a half hip spica cast: Covers one leg and the pelvis
  • Commonly used in pediatric patients

• Long Leg Cast: From above the knee to the ankle or foot

  • Used for knee, lower leg fractures, knee dislocation, or post-surgical care of the knee or leg

• Long Arm Cast: From the upper arm to the wrist

  • Used for upper arm fractures, elbow fractures, and post-elbow surgery

• Short Leg Cast: From mid-calf to the ankle or foot

  • Used for lower leg fractures, ankle fractures, severe sprains, and strains

• Short Arm Cast: Below the elbow to the wrist

  • Used for forearm and wrist fractures or wrist injuries

• Plaster Cast: Traditional cast type; requires 48 hours to dry

• Fiberglass Cast: Dries immediately

Cast Care

• Plaster Cast: Handle with palms, not fingers

  • Elevate on pillows for 24-48 hours to reduce swelling
  • Dry with air flow, avoid direct heat
  • Do not apply paint or other substances that block air circulation
  • Avoid weight bearing for 48 hours
  • May require "bivalving" for pressure relief if pain is present

• Fiberglass Cast: Handle with palms, not fingers

  • Can be rinsed with mild soap and water
  • Protect from soiling
  • Inspect skin for pressure or irritation
  • Ensure cast edges are smooth and not sharp

• Both Cast Types:

  • Frequent neurovascular checks (sensory, motor, temperature, color, capillary refill, pulses) are crucial
  • Neurovascular Checks: Assess every 15-30 minutes initially, then every 4 hours for the first few days
  • Do not use powder under the cast
  • Avoid scratching with sharp objects
  • Keep the limb elevated for the first 24-48 hours to help with healing

Hip Spica and Body Cast Care

• Turning: Do not use the cast bar to turn; use a fracture pan
• Body Cast: Do not elevate the head of the bed for patients with a body cast
  • Smaller and more frequent meals
  • Encourage breathing exercises (coughing, deep breathing) to prevent pneumonia

Traction

• Traction: Applying a pulling force to an extremity or bone

  • Aligns and stabilizes a fracture site
  • Reduces nerve pressure
  • Prevents deformities
  • Relieves muscle spasms

• Skin Traction: Short-term traction; weights attached to the skin.

  • Types of Skin Traction: Bryant's, Box, and Russell's traction
  • Bryant's Traction: Femur fractures in children under 2
  • Box Traction: Temporary traction for lower extremities, hip, minor spine fractures, muscle spasms
  • Russell's Traction: Femur, hip, and knee fractures

• Skeletal Traction: Long-term traction using pins or screws inserted through the bone

  • Types of Skeletal Traction: Overhead arm, lateral arm, Thomas splint with Pearson attachment
  • Thomas Splint with Pearson Attachment: Lower extremity fractures; bed should not be elevated above 25 degrees
  • Pin Care: Clean with chlorhexidine every shift to prevent infection (osteomyelitis)

Traction Care

• Maintaining Proper Alignment for Traction:
  • Ensure weights hang freely.
  • Do not lift weights when repositioning.
  • Weights should not touch the floor.
• Assessment: Monitor skin for pressure sores, friction, and infection
• Foot Drop: Monitor for foot drop, a potential nerve damage complication.

Cast Removal

• Cast Cutter: Vibrates to break, does not cut the patient; requires masking
• Appearance: Limb may appear weak and have dead skin
• After Removal:
  • Support the extremity carefully
  • Begin exercises to strengthen and improve mobility
  • Apply moisturizer to the skin
  • Avoid weight bearing until cleared by the provider.

Traction

• Traction is used to align broken bones and decrease muscle spasms to reduce pain.
• Traction type varies depending on the location of the fracture.
• Nurses should frequently assess patients in traction.
• Important considerations for traction: Do not adjust weights without a doctor's order. Always maintain ropes within pulley system and ensure they're not frayed. Always assess for neurovascular compromise (5 or 7 Ps). Encourage increased fluid intake, monitor for infection, assess pin sites, and provide skin care and massage.

Assistive Devices

• Assistive devices include braces, slings, abduction pillows, knee immobilizers, trochanter rolls, canes, crutches, walkers, and wheelchairs.
• Cane: Used on the strong side to enhance balance.
• Crutches: Positioned 2 inches below the armpit (axilla) to protect nerves/blood vessels.
• Crutch walking techniques: Two-point, three-point, four-point, and "D" (or "KD").
• Walkers: Move forward, don't drag.
• Roll-about walker: Suitable for patients with a broken leg, scooting.
• Wheelchairs: For those with mobility difficulties.

Orthopedic Devices

• Splints: Used to support or immobilize injured areas.
• Walking cast: Allows greater mobility/weight-bearing, dependent on the fracture and healing process.
• Inflatable air cast: Temporary support.
• Neck collars: Common for neck injuries (whiplash).
• Milwaukee brace: For spinal deformities; worn 23 hours a day, except for bathing.

Traumatic Injuries

• Contusions: Bruises; RICE (rest, ice, compression, elevation), elevation, and cold packs (first 36 hours).
• Sprains: Ligaments, tendons, muscles; RICE, no weight-bearing, possible casting.
• Strains: Muscles and tendons; ice, rest, compression.
• Whiplash: Hyperextension/flexion of the neck; pain, headache, blurred vision, weakness. Treatment includes analgesics, muscle relaxants, cervical spine traction, immobilization, exercises, and heat therapy.

Dislocations

• Dislocations: Bone displaced from normal position. Treat by realignment, pain management, splinting, and bandaging.

Carpal Tunnel Syndrome

• Carpal tunnel syndrome: Painful wrist/hand disorder; common in middle-aged women, pregnant women, those with repetitive movements, or diabetes.
  • Symptoms: Burning pain, tingling (relieved by hand shaking), altered grip, paresthesia, hypoesthesia, decreased sensation in thumb and index finger
  • Treatment: Splinting, physical therapy, occupational therapy, surgery in certain cases.

Bone Tumors

• Bone tumors: Benign or malignant.
  • Benign tumors: Pain from pressure on blood vessels/nerves.
  • Malignant tumors: Spread; bone fractures, anemia, pain.
  • Treatment: Surgery, wide excision, bone curettage, amputation (severe cases), radiation, chemotherapy.

Amputations

• Amputation: Surgical removal of a limb.
  • Pre-op care: Consent, NPO, IV, meds.
  • Post-op care: Bleed monitoring, neurovascular assessment, prone positioning (contracture prevention), stump shrinker for prosthesis fitting.
  • Phantom limb pain: Common first 6 months; managed with analgesics, TENS, other interventions.
  • Discharge education: Positioning, exercises, wrapping, ambulation, skin care, prosthesis care.