Cast And Bandage PDF

Prepared by Assist. Lect. Osama Salah  Outlines; Complications Definition of Purposes of Types of Casts Associated cast cast...

Prepared by Assist. Lect. Osama Salah  Outlines; Complications Definition of Purposes of Types of Casts Associated cast cast with Casts Nursing Assisting with Nursing Care Types of Cast Assessment for Casting— for Patient with Material patient with Plaster and Cast cast Fiberglass Uses of Elastic Applying an bandages Elastic Bandage  01 Definition Definition of cast A cast is an immobilizing device made up of layers of plaster or fiberglass (water- activated polyurethane resin) bandages molded to the body part that it encases.  02 Purposes of Cast  Purposes of cast 1. Promote healing process of a fractured or injured bone. By immobilizing the affected area, a cast helps to prevent further movement, displacement, or shifting of the bone fragments. 2. Fracture Stabilization: In the case of bone fractures, casts provide stability to the broken bone, allowing it to heal correctly. 3. Provide Support and maintain correct Alignment of joints and bones in various musculoskeletal conditions like joint dislocations, ligament injuries, and tendon injuries by providing the necessary support for healing.  Purposes of cast 1. Post-Surgery Recovery: After certain orthopedic surgeries, casts may be applied to protect the surgical site, provide support, and minimize movement during the initial healing period. 2. Correction of Deformities: In some cases, like clubfoot or certain congenital musculoskeletal abnormalities casts may be used to gradually correct bone or joint deformities.  03 Types of Casts Materials  3.1. Plaster of Paris (POP) Casts Plaster of Paris is one of the oldest and most traditional casting materials. It consists of a bandage impregnated with gypsum plaster powder. When mixed with water, plaster of Paris becomes a malleable material that hardens as it dries. POP casts provide good support and are relatively inexpensive but are heavier and less breathable compared to some other materials. they are heavy, not water resistant, and can take up to 24 to 72 hours to dry post-application  3.2. Fiberglass Casts: Fiberglass casts are lighter and more durable than plaster casts. They consist of layers of fiberglass fabric impregnated with a water-activated resin. Fiberglass casts are water-resistant, allowing patients to get them wet without compromising their structural integrity. These casts are available in various colors and are less likely to cause skin irritation. Reaching full rigidity within 30 minutes of application  3.3. Polyester Casts: Polyester casts are similar to fiberglass casts but are made with polyester fabric instead of fiberglass. They offer good strength and durability while being lightweight. Polyester casts are also water-resistant and available in various colors.  04 Types of Casts application  4.1. Cast of upper limb Short arm cast Gauntlet cast Long arm cast extends from below the extends from below the extends from upper level of elbow to the proximal elbow to the proximal palmar axillary fold to proximal palmar crease. crease, including the thumb palmar crease; elbow usually (thumb spica). immobilized at right angle.  4.2. Cast of lower limb Long leg cast Short leg cast Extends from below knee to base of Extends from upper thigh to the base of toes. toes; foot is at right angle in a neutral position. 4.3. Body Cast Encircles the trunk stabilizing the spine. 4.4. Spica Cast incorporates the trunk and extremity  4.4.1. Hip Spica cast encloses trunk and a lower extremity. Single hip spica One-and-a-half hip spica. Double hip spica Extends from nipple line to extends from upper Extends from nipple line or include pelvis and extends to abdomen, includes one upper abdomen to include include pelvis and one thigh. entire leg and extends to pelvis and extends to include the knee of the other both thighs and lower legs.  4.4.2. Shoulder spica A body jacket that encloses trunk, shoulder, and elbow.  05 Complications of cast Complications of cast Pressure ulcer Compartment syndrome Immobility 5.1. Pressure ulcers Pressure of cast on neurovascular and bony structures causes necrosis, pressure sores, and nerve palsies.  5.2. Compartment syndrome Compartment syndrome is a condition resulting from increased progressive pressure within a confined space, thus compromising the circulation and the function  5.2. Compartment syndrome Signs and symptoms of compartment syndrome include 1. Pain The first sign and is usually described as Deep, Constant, Poorly Localized, and out of proportion to the injury. The pain is not relieved by analgesia and worsens with stretching of the muscle group. The other signs occur late in the course of compartment syndrome 1. Paresthesia 2. Pallor 3. Pulselessness 4. poikilothermic 5. paralysis. 5.2. Compartment syndrome The cast may have to be split and removed  5.3. complications of Immobility a) Nausea, vomiting, and abdominal distention, adynamic ileus, and possible intestinal obstruction. b) Acute anxiety reaction symptoms (i.e., behavioral changes and autonomic responses—increased respiratory and heart rate, elevated blood pressure [BP], diaphoresis) associated with confinement in a space. c) Thrombophlebitis and possible pulmonary emboli associated with immobility and ineffective circulation (e.g., venous stasis).  5.3. complications of Immobility a) Respiratory atelectasis and pneumonia associated with ineffective respiratory effort. b) Urinary tract infection—renal and bladder calculi associated with urinary stasis, low fluid intake, and calcium excretion associated with immobility. c) Anorexia and constipation associated with decreased activity. d) Psychological reaction (e.g., depression) associated with immobility, dependence, and loss of control.  06 Assisting with Casting— Plaster and Fiberglass Equipment Appropriate size cotton (for plaster) or synthetic (for fiberglass) cast padding such as Webril Stockinette, cut approximately 6 inches longer than the part to be casted Appropriate size plaster or sealed fiberglass rolls For plaster casts: bucket of warm water For plaster casts: roll of three-to-four-inch tape Protective clothing for yourself Disposable gloves (nonsterile) Special supplies: Shoulder immobilizer for arm fractures, crutches for lower limb fractures. Equipment  ACTION Rationale 1. Introduce yourself to the client. Assess current vascular status 2. Assess client’s ability to communicate during the Decreases client’s anxiety level and procedure promotes cooperation. 3. Prepare all equipment. Be sure all special equipment is available at the bedside or cast room 4. Protect the bed and client, if necessary, from water Promotes client comfort. and casting residue 5. Have the client in the proper position for reduction Facilitates the casting procedure. and casting  ACTION Rationale Keeps nurse’s hands and uniform 6. Wash hands. Wear gloves and clean and dry while working with protective clothing as needed wet and sticky substances. 7. For a plaster cast, place the plaster roll into the warm water on its end until the bubbles stop Preparing the plaster facilitates rising from the roll. Remove it from the water rapid and smooth application of and squeeze gently to remove the excess water. the cast. Hand the roll to the person applying the cast. 8. For a fiberglass cast, open the sealed fiberglass Facilitates rapid and rolls as needed, and hold the package so the smooth application of the person applying the cast can remove the roll cast  ACTION Rationale 9.Assist the person applying the cast. This person will: Position the part to be casted. stockinette over the skin Wrap the site with cast padding Place the fiberglass or plaster over the fracture extending the coverage above and Allows rapid placement of cast. below the fracture site Edges will be trimmed and finished and any supports or reinforcements to the cast will be applied See the picture below 10. Swelling may occur after the cast is placed. The Prevents neurovascular compromise, cast may be bivalved, or cut in half, to allow for discomfort, or infection swelling or to allow for treatment of infection. If this is done, wrap the cast in Ace wraps to hold it in place. 11. A window may be cut in the cast to relieve Prevents neurovascular compromise, pressure or to monitor the skin at that location discomfort, or infection. under the cast. 12. Elevate cast site when complete Prevents swelling 13. For plaster casts, leave the cast Facilitates drying process. uncovered while it is drying 14. Reassess vascular status. Prevents complications 15. Prepare client for post reduction x-ray as Assesses bone alignment necessary 16. Document where cast was placed, type of cast or splint, and vascular Records implementation of intervention and promotes status of the extremity. continuity of care. 17. Wash hands  07 Nursing intervention Assess neurovascular status a) Pain (pain out of proportion to injury is an indication for compartment syndrome). b) Swelling. c) Discoloration—pale or blue. d) Cool skin distal to injury. e) Tingling or numbness (paresthesia). f) Pain on passive extension (muscle stretch). g) Slow capillary refill; diminished or absent pulse. h) Paralysis. Assess skin integrity of casted extremity. Be alert for the following: a) Severe initial pain over bony prominences; this is a warning symptom of an impending pressure ulcer. b) Pain increases when ulceration occurs. c) Odor d) Drainage on the cast Carefully assess for positioning and potential pressure sites of the casted extremity. a) Lower extremity—heel, malleoli, dorsum of foot, head of fibula, anterior surface of patella. b) Upper extremity—medial epicondyle of humerus, ulnar styloid. c) Plaster jackets or body spica casts—sacrum, anterior and superior iliac spines, vertebral borders of scapulae. Nursing interventions 1) Check circulation, movement, and sensation Note color and temperature of skin. Pinch finger or toe and watch for capillary refill within 2 to 4 seconds. Ask client to wiggle fingers or toes. Ask client to tell you if he feels you touching the extremity 2) Assess skin. Tell client not to put objects under the cast. Use powders or creams only outside the cast. Nursing interventions 1) Assess pain or soreness. Reposition the extremity q2h. Elevate the extremity and apply Ice compresses 2) Assess cast for intact edges. If edges are crumbling or shedding, or if the cast has been bivalved or windowed, use tape to petal the edges. Do not allow the cast to get wet. Teach the client how to cover the cast when bathing or showering  Nursing interventions 1) Instruct client and caregiver about symptoms to report to the physician or qualified practitioner: An increase in swelling. A tingling or burning sensation. An inability to move muscles around the cast. A foul odor around the edges of the cast. Any drainage, which may show through the cast. Any cracks or breaks in the cast. 2) Assess for infection. Check for foul odor under cast. Check for drainage on cast. Mark drainage and date on cast  Which cast care instructions would the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. 4. Expect tingling and numbness in the extremity. 5. Use a hair dryer set on a warm to hot setting to dry the cast. 6. Use a soft, padded object that will fit under the cast to scratch the skin under the cast.  Prepared by Assist. Lect. Osama Salah Introduction An elastic bandage is a Stretchable, Woven Strip Of Fabric typically used to wrap around injured or swollen areas of the body. It provides compression and support to reduce swelling, relieve pain, and prevent further injury. Elastic bandages are commonly used for sprains, strains, and soft tissue injuries, and can also secure splints or dressings in place Benefits Of Bandage Secure dressings Secure dressings inin place place stabilize anextremity stabilize an extremity support or immobilize a body part Maintain circulation Decrease swelling Immobilize joints secure equipment, such as They can also be used to to prevent edema and to traction, to a body part. support fractured ribs. support varicose veins. Elastic bandages can also be used to support the knee, ankle, elbow, and wrist for conditions such as strains and sprains. The type and size will vary with the body part or area to be covered. For bandaging the ARM, select 5 cm or 7.5 cm or 10 cm. For bandaging the Leg, 10 cm or 12 cm or 15 cm widths.  ACTION Rationale 1.Make sure that the body part on which the bandage is to be applied is completely well rested. 2. Wash hands. 2. Reduces the transmission of microorganisms. 3. Explain purpose and need for bandages to client. 3. Facilitates cooperation. 4. Assess the skin to be covered for Redness, 4. Avoids increasing injury or infection. Swelling, Or Open Lesions. Avoids improper alignment and Assist that the client is in a correct position for promotes healing. Promotes decrease in application, e.g., if supporting a fracture, arm, or edema or proper support for varicose other body part, it must be correctly aligned. veins. If elastic wrap is for edema of the lower extremity or for varicose veins, the client’s leg must be elevated.  ACTION Rationale 5. Apply the bandage. 5. Proper application maintains consistent Hold roll of elastic bandage in dominant hand and bandage tension, conforms to body part, use the other hand to lightly hold beginning of promotes stabilization of body part, and bandage at distal body part. promotes venous return Continue transferring from hand to hand as bandage is wrapped. Toes or fingertips must be visible to allow follow-up assessment. Apply bandage from Distal Point Toward Proximal boundary using variety of turns to cover various shapes of body parts. Unroll and very slightly stretch bandage, overlap turns, and secure first bandage before applying additional rolls. Apply additional rolls without exposing any skin surface.  ACTION Rationale A Figure-eight Pattern is also useful to cover and immobilize joints Use a Circular Pattern to bandage digits or wrists. Use Spiral Turns to apply a bandage to cover areas such as slender wrists or the forearms. If securing equipment in place, such as Buck’s traction, use a circular pattern around the leg and traction. Spiral reverse turns are used to cover parts of the body that are the shape of an inverted cone, such as the thigh or forearm. Recurrent turns are used to bandage the head or the stump of an amputated limb.  ACTION Rationale 6. Secure in place with tape, pins or hooks 6. Prevents loose ends and unraveling provided with bandage. of dressing