1. Home with a C a s t Nursing the person

2. Home Learning outcomes Plaster or fiberglass cast? Caring for a drying cast Cast complications i. Nursing assessments ii. Nursing actions Teaching materials for persons with a cast Quiz Glossary Home Page Table of contents

3. Home Learning Outcomes 1. Compare & contrast plaster & fiberglass castsplaster & fiberglass casts 2. Explain the care required while a plaster cast dries 3. For each complications associated with a cast describecomplications i. nursing assessments required to detect ii. nursing actions to treat the complication 4. Be familiar with teaching materials available for persons who have a castteaching materials

4. Home fiberglass casts  has durability of plaster but is lighter weight  hardens within minutes  is porous and  there are fewer skin problems  does not soften when wet - hair dryer quickly dries skin beneath  Costs more plaster casts  inexpensive  heavy  sets in ~ 3 -1 5 minutes, then takes 24 - 72 h to dry (varies with thickness)  messy to apply  gives more support for ‘bad breaks’

5. Home Care required while the plaster cast dries n once applied heat is given off for ~ 15 minutes & may be uncomfortable n while the plaster sets, the cast will remain soft & touching may lead to indentations which may then create pressure spots n until dry  handle the cast with palms of hands only - not fingers do not rest cast on hard surfaces or sharp edges

6. Home Drying a plaster cast n Picture to be inserted

7. Home Presentation on-line application of a fiberglass castapplication of a fiberglass cast note the use of 1. Stockinette 2. Padding 3. Casting material to see click here 

8. Home hidden bleeding neurovascular compromise compartment syndrome skin &/or tissue breakdown hidden infection from wound &/or ulcer Potential Complications

9. Home Bleeding may occur beneath a cast if n there is trauma to the skin at the time of injury n surgery is required to reduce the fracture this will be documented as ORIF –open reduction & internal fixation

10. Home To detect bleeding n visualize the cast carefully. Give particular attention to areas over known wounds &/or incisions dependent areas - remember that liquid flow follows the line of gravity

11. Home Typical appearance (& terminology to describe) @ 1400 hours @ 1200 hours n @ 1000 hours Sanguineous Sero-sanguineous serous

12. Home If you see bleeding Mark the outer edges of the bleeding area with time and date & then initial Example: Jan 10 - 1000 1200 1400 JW Then ---- >

13. Home Follow-up n continue to monitor n instruct client to call you if additional bleeding is noted &/or if s/he notices any other changes n notify MD if bleeding continues there is a significant change in vital signs client condition changes

14. Home Document in narrative notes & indicate n size n location n vitals n other signs of bleeding 0845 dark red area ~ 3 cm diameter noted over outer aspect of malleolus; P 88, R 24, BP 108/56; alert but pale; 0930 slight extension of bleeding; client states “feel fine” 1030 no further bleeding noted; P 80 BP 120/ 66 ; instructed to call nurse if further bleeding noted JWladyka RN Narrative Notes

15. Home Neurovascular Compromise Compression of nerves and blood vessels may be caused by n swelling 2° to injured tissue n impinging bone pieces n swelling 2° to surgery n restrictive pressure 2° the cast

16. Home  by doing C S M C colour plus  capillary refill (normal < 3 sec)capillary refill pulse in affected extremity –[whether present -- no need to count] temperature of skin S sensation -- do not use a sharp object to assess M able to move extremity & digits

17. Home Frequency of C S M n assess q2h X 8, then q4h X 48, then q 8 h n at first sign elevate limb > heart give analgesia if symptoms persist notify MD stat as compartment syndrome may be occurring  

18. Home If swelling persists n the physician will order the cast to be bivalved Note - Bivalving may be done by a physician an orthopedic technician a specially trained nurse Burrell et al; 1586

19. Home Compartment Syndrome - a special form of neurovascular compromise n muscles, nerves & blood vessels are enclosed in though inelastic fascia (or compartments) n if the muscle within a compartment becomes swollen it cannot stretch & thus the nerves and blood vessels are compressed

20. Home Signs & Symptoms n deep, throbbing, unrelenting pain not controlled by analgesics often seems out of proportion to the injury n swollen and hard muscle n diminished capillary refill, cyanotic nailbeds, obscured pulse n parasthesia, paralysis

21. Home To reverse compartment syndrome A fasciotomy is performed Burrell et al; 1590

22. Home Skin &/or tissue breakdown Is most likely if the n cast is resting too close to the tissue -- particularly over boney prominences n cast edges are sharp and irritating the skin

23. Home Monitor Pressure Areas n The cast over the area may become warm d/t inflammation beneath n if there is skin breakdown there might be drainage n if the area becomes infected there may be an odour Diagram to be added

24. Home Windowing a cast Using cast cutting equipment n an orthopedic tech n MD, or n specially trained nurse cuts out a piece of the plaster over the area of concern if required a dressing is applied Picture to be added

25. Home Finishing a cast n If the edges are not covered with stockinette, then you may need to cut small pieces of tape to smooth over the edges -- this is referred to petalling the cast Burrell et al; 1591

26. Home Teaching information r/t cast care n Virtual Hospital: Iowa Health Book: Orthopaedics: Instructions for Patients Wearing a Cast Virtual Hospital: Iowa Health Book: Orthopaedics: Instructions for Patients Wearing a Cast

27. Home Ready to try the quiz? I’m ready!

28. Home Glossary Capillary refill

29. Home References Burrell, Gerlach, Pless. Adult Nursing - Book IX. 2nd ed., Appleton Lang, 1997 Smeltzer, S.C. & B.G. Bare. Brunner & Suddarth’s Textbook of MEDICAL- SURGICAL NURSING. 8 TH ed., Lippincott, 1996. Dykes, P. (1993) Minding the five P’s of neurovascular assessment. AJN, 38 -39. Eden-Kilgour, S. (1993). Understanding neurovascular assessment. Nursing 93. 56-58.