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Edit Comment Close Premium member Presentation Transcript Slide 1: CARE OF THE PATIENT WITH CAST PRESENTED BY MS. KIRAN RANDHAWADEFINITION: 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 mobilizationContd…: Contd… To correct & prevent deformities To support & stabilize weak jointsTYPES 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 angleSlide 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 extremitiesContd…: Contd… THUMB SPICAS -Immobilize fractures of the carpel of the navicular,thumb metacarpal,& phalangesCASTING 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 knitSlide 18: PATIENT PREPARATION BEFORE THE APPLICATION OF CASTContd…: Contd… Skin preparation:cleaning of abrasions before cast application Skin drying using powder or alcohol Inspection of skin for open or bruised areasContd…: Contd… Explanation to the patient about cast application Relieving pain & apprehensionSlide 21: GENERAL CARE OF THE PATIENT IN A CASTIMMEDIATE CARE & PATIENT TEACHING: IMMEDIATE CARE & PATIENT TEACHING Clear all the doubts of the patient regarding its size & appearance. Frequent checkupsSlide 23: SPECIFIC CAST MANAGEMENT CONSIDERATIONSARM 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 contractureContd…: Contd… Sling -to prevent strain on the shoulder muscles -to give comfort & support by spreading weight evenlyContd…: Contd… -materials used permits circulation of air in & around cast ExerciseContd…: Contd… Psychological implications Discharge planningNURSING INTERVENTIONS (LEG CAST) : NURSING INTERVENTIONS (LEG CAST) Positioning -comfortable settling into bed -supporting the cast with extra pillows & trochanter rolls Exercises -active & passive exercisesContd…: Contd… Psychological considerations -learning to sleep in supine position -moral support Assisting the patient into a wheel chairContd…: Contd… Preparation for ambulation & weight bearing -pull ups on the trapeze & lifting weights Discharge teachingsNURSING INTERVENTIONS (HIP SPICA CAST): NURSING INTERVENTIONS (HIP SPICA CAST ) Patient education Preparing the bed with extra pillows supporting the entire castContd…: Contd… Turning procedures -requires 2-3 peoples -handle the damp cast with the palms of the hands -turn the patient all at onceContd…: Contd… -roll him towards the unoperated side in case of unilateral cast -check for pressure areas after turningContd…: Contd… -never turn the patient with abduction barContd…: Contd… Skin care -check for skin irritation -cast edges Protecting the cast Psychological considerationsCOMPLICATIONS: COMPLICATIONS Compartment syndrome Cast syndrome Pressure ulcersSlide 39: NURSING MANAGEMENTNURSING ASSESSMENT: NURSING ASSESSMENT Assess neurovascular status of extremity with cast Assess skin integrity of the casted areaSlide 41: Nursing diagnosis :Ineffective tissue perfusion (extremity) related to swelling & constrictive bandage or cast. Goal:maintaining adequate tissue perfusionINTERVENTIONS: 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 programContd…: Contd… If symptoms of cast syndrome develops, report immediately to the physician -place patient in a prone position -use nasogastric suctionContd…: Contd… -maintain electrolyte balance by IV -Prepare the patient for the removal of cast Provide & encourage diversional activitiesSUMMARISATION: SUMMARISATION Definition Purposes Types Casting materials Patient preparation before the cast applicationContd…: Contd… General care Specific cast management of the patient with -arm cast -leg cast -hip spica castContd…: Contd… Complications Nursing managementBIBLIOGRAPHY: BIBLIOGRAPHY SMELTZER S.C,BOSE B;”TEXTBOOK OF MEDICAL SURGICAL NURSING”;10 TH EDITION;LIPPINCOTT WILLIAMS & WILKINS PUBLICATIONS;P P :1017-1028Contd…: 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 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.