MANAGING

A
PATIENT
IN CAST
 CAST
•IT IS A RIGID DEVICE APPLIED TO
IMMOBILIZE THE INJURED BONES
AND PROMOTE HEALING.
•IT IS APPLIED TO IMMOBILIZE THE
JOINT ABOVE AND BELOW THE
FRACTURED BONE SO THAT THE
BONE WILL NOT MOVE DURING
HEALING.
•THESE ARE APPLIED ON CLIENTS
WHO HAVE RELATIVELY STABLE
FRACTURES.
TYPES OF CASTS
SHORT-ARM CAST
LONG-ARM CAST
SHORT-LEG CAST
LONG-LEG CAST
WALKING CAST
BODY CAST
SHOULDER SPICA CAST
HIP SPICA CAST
DOUBLE HIP SPICA CAST
 CASTING
MATERIALS
PLASTER
NONPLASTER
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
2. SUPPORT IT MINIMIZES
EXTREMITY OR MOVEMENT;
BODY PART TO MAINTAINS
BE CASTED. REDUCTION AND
ALIGNMENT;
INCREASES
COMFORT
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
2. POSITION AND FACILITATES
MAINTAIN PART CASTING;
TO BE CASTED REDUCES
IN POSITION INCIDENCE OF
INDICATED BY COMPLICATIONS
PHYSICIAN (eg, MALUNION,
DURING NONUNION,
CASTING CONTRACTURE)
PROCEDURE.
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
3. DRAPE PATIENT. AVOIDS UNDUE
EXPOSURE;
PROTECTS
OTHER BODY
PARTS FROM
CONTACT WITH
CASTING
MATERIALS.
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
4. WASH AND DRY REDUCES
PART TO BE INCIDENCE OF
CASTED. SKIN BREAKDOWN
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
2. PLACE KNITTED PROTECTS THE SKIN
MATERIAL (eg, FROM CASTING
stockinette) OVER MATERIALS.
PART TO BE PROTECTS SKIN FROM
CASTED. PRESSURE
1. APPLY IN SMOOTH
AND
FOLDS OVER EDGES
NONCONSTRICTIVE OF CAST WHEN
MANNER FINISHING
2. ALLOW ADDITIONAL APPLICATION;
MATERIAL CREATES SMOOTH,
PADDED EDGE;
PROTECTS SKIN
FROM ABRASION
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
2. WRAP SOFT, PROTECTS SKIN FROM
NONWOVEN ROLL PRESSURE OF CAST
PADDING PROTECTS SKIN AT
SMOOTHLY AND BONY
EVENLY AROUND PROMINENCES
PART. PROTECTS
1. USE ADDITIONAL
PADDING OVER
SUPERFICIAL
BONY NERVES
PROMINENCES TO
PROTECT
SUPERFICIAL
NERVES (eg, HEAD
OF FIBULA AND
OLECRANON
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
2. APPLY PLASTER OR CREATES SMOOTH, SOLID,
NONPLASTER CASTING WELL-CONTOURED CAST
MATERIAL EVENLY ON FACILITATES SMOOTH
BODY PART APPLICATION
1. CHOOSE CREATES SMOOTH, SOLID,
APPROPRIATE WIDTH
OF BANDAGE
IMMOBILIZING CAST
2. USE CONTINOUS SHAPES CAST PROPERLY
MOTION, FOR ADEQUATE
MAINTAINING SUPPORT
CONSTANT CONTACT STRENGTHENS CAST
WITH BODY PART
3. USE ADDITIONAL
CASTING MATERIALS
(SPLINTS) AT JOINTS
AND AT POINTS OF
ANTICIPATED CAST
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
2. FINISH CAST PROTECTS SKIN
1. SMOOTH EDGES FROM ABRASION
2. TRIM AND ALLOWS FULL
RESHAPE WITH RANGE OF
CAST KNIFE
MOTION OF
AND/OR CUTTER
ADJACENT JOINTS
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
9. REMOVE PREVENTS
PARTICLES OF PARTICLES FROM
CASTING LOOSENING AND
MATERIALS SLIDING
FROM SKIN UNDERNEATH
CAST
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
2. SUPPORT CAST CASTING MATERIALS
DURING HARDENING BEGIN TO HARDEN IN
1. HANDLE HARDENING MINUTES. MAXIMUM
CAST WITH PALMS OF HARDNESS OF
HANDS NONPLASTER CAST
2. SUPPORT CAST ON BEGINS IN MINUTES.
FIRM, SMOOTH MAXIMUM HARDNESS
SURFACE OF PLASTER CAST
3. DO NOT REST CAST OCCURS WITH DRYING (
ON HARD SURFACES 24 TO 72 HOURS,
OR ON SHARP EDGES DEPENDING ON
4. AVOID PRESSURE ON ENVIRONMENT AND
CAST THICKNESS OF CAST)
AVOIDS DENTING OF CAST
AND DEVELOPMENT OF
PRESSURE AREAS.
 GUIDELINES FOR APPLYING A
CAST
NURSING ACTION RATIONALE
11. PROMOTE DRYING OF FACILITATES DRYING.
CAST.
1. LEAVE CAST
UNCOVERED AND
EXPOSED TO AIR
2. TURN PATIENT
EVERY 2 HOURS
SUPPORTING MAJOR
JOINTS
3. FANS MAY BE USED
TO INCREASE AIR
FLOW AND SPEED
DRYING.
PROCEDURE FOR BIVALVING A
CAST
THE FOLLOWING PROCEDURE IS FOLLOWED WHEN A CAST IS
BIVALVED.

• WITH A CAST CUTTER, A LONGITUDINAL CUT IS

MADE TO DIVIDE THE CAST IN HALF.
• THE UNDERPADDING IS CUT WITH SCISSORS.
• THE CAST IS SPREAD APART WITH CAST
SPREADERS TO RELIEVE PRESSURE AND TO
INSPECT AND TREAT THE SKIN WITHOUT
INTERRUPTING THE REDUCTION AND ALIGNMENT
OF THE BONE.
• AFTER THE PRESSURE IS RELIEVED, THE ANTERIOR
AND POSTERIOR PARTS OF THE CAST ARE SECURED
TOGETHR WITH AN ELASTIC COMPRESSION
BANDAGE TO MAINTAIN IMMOBILZATION.
• TO CONTROL SWELLING AND PROMOTE
CIRCULATION, THE EXTREMITY IS ELEVATED ( BUT
NO HIGHER THAN THE HEART LEVEL, TO MINIMIZE
THE EFFECT OF GRAVITY ON PERFUSION OF THE
TISSUES).
CARE OF THE PATIENT WITH A
BODY OR SPICA CAST
NURSING ACTION RATIONALE
1.
 PREVENTING
COMPLICATIONS OF
IMMOBILITY BASED ON THE
SYSTEM
 CARDIOVASCULAR
• COMPLICATION • NURSING
– ORTHOSTATIC INTERVENTION
HYPOTENSION – EXERCISES
– DEEP VEIN – PLANTARFLEXION AND
THROMBOSIS AND DORSIFLEXION FOOT
PULMONARY EMBOLISM EXERCISES
– INCREASED WORKLOAD – QUADRICEPS AND
ON HEART GLUTEAL SETTING
EXERCISES
– FREQUENT TURNING
– SLOW MOBILIZATION
– NO PILLOWS BEHIND
THE KNEES
– ANTIEMBOLISM
STOCKINGS
 RESPIRATORY
• COMPLICATION • NURSING
– DECREASED CHEST INTERVENTION
EXPANSION – FREQUENT
– ACCUMULATION OF TURNING
SECRETIONS IN – ENCOURAGE
RESPIRATORY FREQUENT
TRACT COUGHING AND
DEEP BREATHING
 INTEGUMENTARY
• COMPLICATION • NURSING
– BREAKDOWN OF INTERVENTION
SKIN INTEGRITY – FREQUENT TURNIG
(ABRASIONS, AND
DECUBITUS ULCER) REPOSITIONING
CAUSED BY – REGULAR
FRICTION, INSPECTION OF
PRESSURE, OR SKIN FOR SIGNS OF
SHEARING FORCE PRESSURE
– GENTLE MASSAGE
OF SKIN,
ESPECIALLY OVER
BONY
PROMINENCES
 GASTROINTESTINAL
• COMPLICATION • NURSING
– CONSTIPATION INTERVENTION
– FREQUENT MOVEMENT
AND TURNING IN BED
– INCREASE FLUID INTAKE
– ADEQUATE DIETARY
INTAKE WITH INCREASE
IN HIGH-FIBER FOODS
– USE OF STOOL
SOFTENERS AND
LAXATIVES AS
ORDERED
 MUSCULOSKELETAL
• COMPLICATION • NURSING
– ATROPHY AND INTERVENTION
WEAKNESS OF – EXERCISES
MUSCLES – ENCOURAGE
– CONTRACTURES PARTICIPATION IN
– DEMINERALIZATION ADL AS MUCH AS
OF BONES POSSIBLE
(OSTEOPOROSIS) – PROPER
POSITIONING AND
REPOSITIONING OF
JOINTS
 URINARY
• COMPLICATION • NURSING
– INCREASED INTERVENTION
CALCIUM – INCREASED FLUID
EXCRETIONFROM INTAKE
BONE – DECREASE IN
DESTRUCTION CALCIUM INTAKE,
(CALCULI ESPECIALLY MILK
FORMATION) AND MILK
– INCREASED URINE PRODUCTS
pH (ALKALINE) – USE OF ACID-ASH
– STASIS OF URINE IN FOODS
KIDNEY AND – USE OF COMMODE
BLADDER IF POSSIBLE
– URINARY INFECTION
 NEUROLOGIC
• COMPLICATION • NURSING
– SENSORY DEPRIVATION INTERVENTION
AND ISOLATION – FREQUENT CONTACT BY
STAFF
– ORIENTING MEASURES
(CLOCK, CALENDAR)
– DIVERSIONAL
ACITIVITIES (TV, RADIO,
HOBBIES)
– INCLUSION OF CLIENT
IN DECISION-MAKING
ACTIVITIES
 CARDIOVASCULAR
• COMPLICATION • NURSING
– ORTHOSTATIC INTERVENTION
HYPOTENSION – ACTIVE OR PASSIVE
– DEEP-VEIN ROM EXERCISES
THROMBOSIS AND
PULMONARY
EMBOLISM
– INCREASED
WORKLOAD ON THE
HEART
 THE PATIENT WITH
SPLINTS OR BRACES
THE PATIENT WITH AN
EXTERNAL FIXATOR
 MANAGING
THE PATIENT IN
TRACTION
 TRACTION
IS THE APPLICATIONOF A
STRAIGHTENING OR PULLING
FORCE TO RETURN OR MAINTAIN
THE FRACTURED BONES IN
NORMAL ANATOMIC POSITION.
TYPES OF TRACTION
1. STRAIGHT OR RUNNING
TRACTION
2. BALANCED SUSPENSION
TRACTION
STRAIGHT TRACTION

THE PULLING FORCE IS

APPLIED IN A STRAIGHT LINE
TO THE INJURED BODY PART
RESTING ON THE BED
 BUCK’S TRACTION

IT IS THE MOST COMMON TYPE OF

STRAIGHT TRACTION. THE LOWER
PORTION OF THE INJURED
EXTREMITY IS PLACED IN A
CRADLE-LIKE SLEEVE. THIS SLEEVE
IS HARNESSED TO ITSELF AND A
WEIGHT IS HUNG FROM THE
BOTTOM OF THE TRACTION FRAME.
IT IS A FORM OF SKIN TRACTION.
 SKIN TRACTION
ADVANTAGE: THE RELATIVE EASE
OF USE AND ABILITY TO MAINTAIN
COMFORT
DISADVANTAGE: THE WEIGHT
REQUIRED TO MAINTAIN NORMAL
BODY ALIGNMENT OR FRACTURE
ALIGNMENT CANNOT EXCEED THE
TOLERANCE OF THE SKIN, ABOUT
6 lb PER EXTREMITY.
IN SKIN TRACTION,
REMOVE
WEIGHTS ONLY
WHEN
INTERMITTENT
SKIN
TRACTION
HAS BEEN
ORDERED TO
ALLEVIATE THE
MUSCLE SPASM.
 BALANCED
SUSPENSION TRACTION
IT INVOLVES MORE THAN ONE
FORCE OF PULL. SEVERAL FORCES
WORK IN UNISON TO RAISE AND
SUPPORT THE CLIENT’S INJURED
EXTREMITY OFF THE BED AND PULL
IT IN A STRAIGHT FASHION AWAY
FROM THE BODY.
 BALANCED
SUSPENSION TRACTION
ADVANTAGE: IT INCREASES
MOBILITY WITHOUT THREATENING
JOINT CONTINUITY
DISADVANTAGE: THE INCREASED
USE OF MULTIPLE WEIGHTS MAKES
THE CLIENT MORE LIKELY TO SLIDE
IN THE BED.
TYPES OF TRACTION
1. SKIN TRACTION – 2-3.5 kg
2. SKELETAL TRACTION
3. BALANCED SUSPENSION
TRACTION –
7 -12 kg
4. THOMAS SPLINT AND PEARSON
ATTACHMENT
5. MANUAL TRACTION
 TYPES OF SKIN
TRACTION
1. BUCK’S EXTENSION
TRACTION
2. RUSSEL TRACTION
3. CERVICAL TRACTION
4. PELVIC TRACTION- 4.5-9
kg
SKIN TRACTION, FREQUENTLY ASSESS SKIN FOR EVIDENCE OF PRESSUR
SHEARING OR PENDING SKIN BREAKDOWN.
IN SKIN TRACTION, PROTECT PRESSURE SITES WITH PADDING AND
PROTECTIVE DRESSINGS AS INDICATED.
MANUAL TRACTION

THE HAND DIRECTLY

APPLIES THE PULLING
FORCE
SKELETAL TRACTION
• IT IS THE APPLICATION OF A
PULLING FORCE THROUGH
PLACEMENT OF PINS INTO THE
BONE.
• THE CLIENT RECEIVES A LOCAL
ANESTHETIC , AND THE PIN IS
INSERTED IN A TWISTING MOTION
INTO THE BONE
• THIS TYPE OF TRACTION SHOULD
BE APPLIED IN A STERILE
CONDITION BECAUSE OF THE RISK
OF INFECTION
•ONE OR MORE PULLING FORCE IS
MAY BE APPLIED
• IN SKELETAL TRACTION, NEVER REMOVE THE
WEIGHTS.
• MAY REQUIRE MORE FREQUENT ANALGESIC
ADMINISTRATION.
SKELETAL TRACTION

ADVANTAGE: MORE WEIGHT

CAN BE USED TO MAINTAIN
THE PROPER ANATOMIC
ALIGNMENT IF NECESSARY
DISADVANTAGE: INCREASED
ANXIETY, INCREASED RISK OF
INFECTION, INCREASED
DISCOMFORT
FREQUENT SKIN ASSESSMENTS SHOULD INCLUDE PIN CARE PER POLIC
REPORT SIGNS OF INFECTION AT THE PIN SITES.
ASSIST IN REPOSITIONING. THE AREA OF THE FRACTURE MUST BE
STABILIZED WHEN THE CLIENT IS REPOSITIONED.
MAINTAIN THE LINE OF PULL:
B. CENTER THE CLIENT ON THE BED.
C. ENSURE THAT WEIGHTS HANG FREELY AND DO
NOT TOUCH
THE FLOOR.
PERFORM NEUROVASCULAR ASSESSMENTS FREQUENTLY.
DO NOT WEDGE THE CLIENT’S FOOT OR PLACE IT FLUSH WITH
THE FOOT-BOARD OF THE BED.
MANAGING THE PATIENT
IN UNDERGOING
ORTHOPEDIC SURGERY

JOINT REPLACEMENT
TOTAL HIP REPLACEMENT
 ORTHOPEDIC
SURGERIES
OPEN REDUCTION
INTERNAL FIXATION
ARTHROPLASTY
HEMIARTHROPLASTY
JOINT ARTHROPLASTY OR REPLACEMENT
TOTAL JOINT ARTHROPLASTY OR
REPLACEMENT
MENISCECTOMY
AMPUTATION
BONE GRAFT
TENDON TRANSFER
FASCIOTOMY
JOINT REPLACEMENT
TOTAL HIP REPLACEMENT
 METHODS FOR AVOIDING HIP
DISLOCATION AFTER SURGERY
• KEEP THE KNEES APART AT ALL TIMES
• PUT A PILLOW BETWEEN THE LEGS WHEN
SLEEPING.
• NEVER CROSS THE LEGS WHEN SEATED.
• AVOID BENDING FORWARD WHEN SEATED IN A
CHAIR.
• AVOID BENDING FORWARD TO PICK UP AN
OBJECT ON THE FLOOR.
• USE A HIGH-SEATED CHAIR AND A REAISED
TOILET SEAT.
• DO NOT FLEX THE HIP TO PUT ON CLOTHING
SUCH AS PANTS, STOCKINGS, SOCKS, OR SHOES.