Podcast
Questions and Answers
What should a nurse do hourly for the first 24 hours after a patient receives traction?
What should a nurse do hourly for the first 24 hours after a patient receives traction?
Which of the following is acceptable when managing traction?
Which of the following is acceptable when managing traction?
For a patient using crutches, where should the crutches be positioned?
For a patient using crutches, where should the crutches be positioned?
What is one of the first-line treatments for a sprain?
What is one of the first-line treatments for a sprain?
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Which device is commonly used to support neck injuries?
Which device is commonly used to support neck injuries?
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What is the primary purpose of a walking cast?
What is the primary purpose of a walking cast?
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Carpal tunnel syndrome most commonly affects which demographic?
Carpal tunnel syndrome most commonly affects which demographic?
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Which method is NOT used for treating dislocations?
Which method is NOT used for treating dislocations?
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What should be monitored in the first six months post-amputation?
What should be monitored in the first six months post-amputation?
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What is a consequence of malignant bone tumors?
What is a consequence of malignant bone tumors?
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What is the primary purpose of a spica cast?
What is the primary purpose of a spica cast?
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Which type of traction is most suitable for femur fractures in children under 2 years old?
Which type of traction is most suitable for femur fractures in children under 2 years old?
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What is a significant care requirement for plaster casts?
What is a significant care requirement for plaster casts?
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Which of the following is NOT a characteristic of fiberglass casts?
Which of the following is NOT a characteristic of fiberglass casts?
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Which type of traction uses screws or pins inserted through the bone?
Which type of traction uses screws or pins inserted through the bone?
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What action should be avoided when caring for a patient with a traction setup?
What action should be avoided when caring for a patient with a traction setup?
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What is one potential appearance of a limb after the removal of a cast?
What is one potential appearance of a limb after the removal of a cast?
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What is the purpose of performing frequent neurovascular checks on a limb in a cast?
What is the purpose of performing frequent neurovascular checks on a limb in a cast?
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In which situation would a body cast be most appropriate?
In which situation would a body cast be most appropriate?
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What is an important instruction for a patient with a fiberglass cast?
What is an important instruction for a patient with a fiberglass cast?
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Study Notes
Types of Casts
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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
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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
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Long Arm Cast: From the upper arm to the wrist
- Used for upper arm fractures, elbow fractures, and post-elbow surgery
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Short Leg Cast: From mid-calf to the ankle or foot
- Used for lower leg fractures, ankle fractures, severe sprains, and strains
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Short Arm Cast: Below the elbow to the wrist
- Used for forearm and wrist fractures or wrist injuries
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Plaster Cast: Traditional cast type; requires 48 hours to dry
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Fiberglass Cast: Dries immediately
Cast Care
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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
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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
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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
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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
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Traction: Applying a pulling force to an extremity or bone
- Aligns and stabilizes a fracture site
- Reduces nerve pressure
- Prevents deformities
- Relieves muscle spasms
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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
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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
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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
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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
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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
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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
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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.
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Description
Explore the various types of casts used in orthopedic treatment, including spica, long leg, and short arm casts. This quiz also covers the care required for plaster and fiberglass casts. Perfect for students in healthcare or those interested in medical practices.
