care of patient with cast

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Slide 1:

CARE OF THE PATIENT WITH CAST PRESENTED BY MS. KIRAN RANDHAWA

DEFINITION:

DEFINITION A Cast is a rigid external immobilizing device that is molded to contours of the body.

PURPOSES:

PURPOSES To immobilize & hold bone fragments in reduction To apply uniform compression of soft tissues To permit early mobilization

Contd…:

Contd… To correct & prevent deformities To support & stabilize weak joints

TYPES OF CAST:

TYPES OF CAST A.Short arm cast -Extends from below the elbow to the palmar crease -secured around the base of thumb

:

B.Long arm cast -Extends from the upper level of the axiliary folds to the proximal palmar creases. -elbow is immobilized at a right angle

Slide 7:

C.Short leg cast -extends from below the knee to the base of the toes. -the foot is flexed at right angle in a neutral position.

:

D.Long leg cast -extends from the junction of the upper & middle third of the thigh to the base of the toes. -knee may be slightly flexed.

Slide 9:

E.Walking cast -a long leg cast reinforced for strength.

Slide 10:

F.Spica cast -spiral reverse that goes between an appendage & the main part of the body,thereby immobilizing the joint between the two.

TYPES OF SPICA CAST:

TYPES OF SPICA CAST HIP SPICAS -encloses the trunk & a lower extremity. -applied for fractures of the femur. -three varieties:

Contd…:

Contd… Single spica :lower trunk &affected leg One & one half hip spica :lower trunk & affected leg Double spica :lower extremities & both extremities

Contd…:

Contd… THUMB SPICAS -Immobilize fractures of the carpel of the navicular,thumb metacarpal,& phalanges

CASTING MATERIALS:

CASTING MATERIALS PLASTER OF PARIS -cheap & durable -most widely used -chalky white powder,anhydrous calcium sulphate made from gypsum crystals.

Contd…:

Contd… -strength of the plaster depends on the crystals interlocking.

Contd…:

Contd… SYNTHETICS -fiber glass -thermoplastics -polyester/cotton knit

Slide 18:

PATIENT PREPARATION BEFORE THE APPLICATION OF CAST

Contd…:

Contd… Skin preparation:cleaning of abrasions before cast application Skin drying using powder or alcohol Inspection of skin for open or bruised areas

Contd…:

Contd… Explanation to the patient about cast application Relieving pain & apprehension

Slide 21:

GENERAL CARE OF THE PATIENT IN A CAST

IMMEDIATE CARE & PATIENT TEACHING:

IMMEDIATE CARE & PATIENT TEACHING Clear all the doubts of the patient regarding its size & appearance. Frequent checkups

Slide 23:

SPECIFIC CAST MANAGEMENT CONSIDERATIONS

ARM CAST:

ARM CAST The patient whose arm is immobilized in a cast must readjust to many routine tasks.The unaffected arm must assume all the upper extremity activities.

NURSING INTERVENTIONS:

NURSING INTERVENTIONS Patient education Assessing for compression complications -Volkmann’s contracture

Contd…:

Contd… Sling -to prevent strain on the shoulder muscles -to give comfort & support by spreading weight evenly

Contd…:

Contd… -materials used permits circulation of air in & around cast Exercise

Contd…:

Contd… Psychological implications Discharge planning

NURSING INTERVENTIONS (LEG CAST) :

NURSING INTERVENTIONS (LEG CAST) Positioning -comfortable settling into bed -supporting the cast with extra pillows & trochanter rolls Exercises -active & passive exercises

Contd…:

Contd… Psychological considerations -learning to sleep in supine position -moral support Assisting the patient into a wheel chair

Contd…:

Contd… Preparation for ambulation & weight bearing -pull ups on the trapeze & lifting weights Discharge teachings

NURSING INTERVENTIONS (HIP SPICA CAST):

NURSING INTERVENTIONS (HIP SPICA CAST ) Patient education Preparing the bed with extra pillows supporting the entire cast

Contd…:

Contd… Turning procedures -requires 2-3 peoples -handle the damp cast with the palms of the hands -turn the patient all at once

Contd…:

Contd… -roll him towards the unoperated side in case of unilateral cast -check for pressure areas after turning

Contd…:

Contd… -never turn the patient with abduction bar

Contd…:

Contd… Skin care -check for skin irritation -cast edges Protecting the cast Psychological considerations

COMPLICATIONS:

COMPLICATIONS Compartment syndrome Cast syndrome Pressure ulcers

Slide 39:

NURSING MANAGEMENT

NURSING ASSESSMENT:

NURSING ASSESSMENT Assess neurovascular status of extremity with cast Assess skin integrity of the casted area

Slide 41:

Nursing diagnosis :Ineffective tissue perfusion (extremity) related to swelling & constrictive bandage or cast. Goal:maintaining adequate tissue perfusion

INTERVENTIONS:

INTERVENTIONS Elevate the extremity above the level of the heart. Avoid resting cast on hard surfaces or sharp edges. Handle moist cast with palms of hands.

Contd…:

Contd… Turn the patients every two hours while cast dries. Assess neurovascular status hourly during the first 24 hours. If symptoms of neurovascular compromise occurs:

Contd…:

Contd… -notify health care provider immediately. -bivalve the case-split cast on each side over its length. -cut the underlying padding. -spread cast sufficiently.

Contd…:

Contd… If symptoms of pressure area occur,cast may be “windowed”.

Slide 46:

Nursing diagnosis :Impaired physical mobility related to condition & casting. Goal:minimizing the effects of mobility

INTERVENTIONS:

INTERVENTIONS Encourage the patient to move about as normally as possible. Encourage compliance with prescribed exercises. Reposition & turn patient frequently.

Contd…:

Contd… Avoid pressure behind knees. Use antiembolism stockings as prescribed. Administer prophylactic anticoagulants.

Slide 49:

Nursing diagnosis :risk for injury related to potential complications. Goal:preventing complications ;

INTERVENTIONS:

INTERVENTIONS Encourage balanced nutritional intake -assess patients food preferences -provide fibers -monitor bowels & use a bowel program

Contd…:

Contd… If symptoms of cast syndrome develops, report immediately to the physician -place patient in a prone position -use nasogastric suction

Contd…:

Contd… -maintain electrolyte balance by IV -Prepare the patient for the removal of cast Provide & encourage diversional activities

SUMMARISATION:

SUMMARISATION Definition Purposes Types Casting materials Patient preparation before the cast application

Contd…:

Contd… General care Specific cast management of the patient with -arm cast -leg cast -hip spica cast

Contd…:

Contd… Complications Nursing management

BIBLIOGRAPHY:

BIBLIOGRAPHY SMELTZER S.C,BOSE B;”TEXTBOOK OF MEDICAL SURGICAL NURSING”;10 TH EDITION;LIPPINCOTT WILLIAMS & WILKINS PUBLICATIONS;P P :1017-1028

Contd…:

Contd… BLACK G.M HAWKS J.H;”MEDICAL SURGICAL NURSING”;7 TH EDITION;ELSEVIER PUBLICATIONS;P P :2289-2299 BARBARA C. L. ‘‘MEDICAL- SURGICAL NURSING’’,3 rd ed,MOSBY PUBLICATIONS,Pp-1405-1410.

Slide 58:

THANKS