Casts and tractions
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Transcript of Casts and tractions
Care of casts and
tractions
By: Joanna Marie Victoria Abanes
Importance of Casts:1. To immobilize and hold bone
fragments in reduction
2. To correct and prevent
deformities.
3. To support and stabilize
weakened joints.
4. To apply compression
pressure to
underlying soft
tissue.
5. To permit early
mobilization while
restricting movement
of a body part.
6. To reduce further
fracture.
Complications
of
clients with
Cast
Complications Definition Cause Signs and symptoms Management
1. Pressure ulcers
It is also known as decubitus ulcers , are localized injuries to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.
The pressure of cast on neurovascular and prominent bony structures.
Very painful “hot spot” under the cast
Mustiness or unpleasant odor over the affected area
Pain and tightness in the area
1. Check to ensure that the cast is not too tight and frequently monitor client’s neurovascular status, usually every hour for the first 24 hours after application.
2. Mobilize &reposition the patient every two hours.
3. Use protective devices (elbow protector).
Complications Definition Cause Signs and symptoms Management
4. Keep the skin
always clean
and dry.
5. A well-
balanced,
high-protein
diet is
recommended
as well as a
daily high-
potency
vitamin and
mineral
supplement.
Complications Definition Cause Signs and symptoms Management
2. Cast Syndrome
( Superior Mesenteric
artery syndrome)
It is an uncommon but serious complication , is most often seen in orthopedic clients who have been placed in a hip spica or body cast.
Occurs initially from compression of the 3rd portion of the duodenum between the superior mesenteric artery and aorta.
Abdominal distention
epigastricpainNausea
Vomiting
Feelings of bloating or tightness
Inability to take a deep breath
1. Placing a window in the abdominal portion of the cast or bivalving the cast may be sufficient to relieve pressure on the duodenum.
2. Nasogastricintubation may be done to decompress the intestine
3. Antiemeticsshould be used sparingly.
Bivalving
• Means cutting the cast
along both sides and then
splitting it to decrease
pressure on underlying
tissue.
Complications Definition CausesSigns and symptoms Management
3. Infection Is the invasion of a host organism's bodily tissues by disease-causing organisms, their multiplication, and the reaction of host tissues to these organisms and the toxins they produce.
Most often results from the breakdown of skin under the cast.
Cast is resting too close to the tissue --particularly over boney prominences
Cast edges are sharp and irritating the skin
Musty,unpleasant odor over cast or at the ends of castDrainage through cast or cast opening“hot spot” felt on cast over lesionIncreased pain
1. Cleanse the wound and remove as much contamination as possible from the skin, soft tissues, and bone. (Debridement and irrigation)
2. Try to avoid getting the cast wet during bathing, you can put a plastic bag over the cast and hold it in place with a rubber band.
Complications Definition CausesSigns and symptoms Management
3. If your skin itches underneath the cast, don't slip anything sharp or pointed inside the cast to try and itch the spot. Instead, try tapping the cast or blowing air from a hair dryer down into the cast.
Complications Definition Cause Signs and symptoms Management
4. Circulation impairmentand peripheral nerve damage
An inadequacy of blood flow. Inadequate blood flow to a particular area of the body can result in too little oxygen being delivered to that area, a condition known as hypoxia
It results commonly from pressure on peripheral nerves from tight casts
Cold skin temperature
decreased peripheral pulses
Slow capillary refill time
bluish skin
1. Perform
frequent
neurovascular
assessments.
- The area
distal to the
injury should
have no
change in
pigmentation
compared
with the other
parts of the
body.
- The skin
distal to the
injury is
warm.
- No numbness
or tingling
present
Complications Definition Cause Signs and symptoms Management
- Pulses are
strong and
easily
palpated
- Check
capillary refill
(least
reliable)
Blood returns to
usual color
within 3
seconds;
older adults:
5 seconds
2. Assess
sensation and
motion of the
peripheral
nerves.
Complications Definition Cause Signs and symptoms Management
Compartment Syndrome
It is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow.
It is caused by anything that decreases the compartment size, including external compression factors such as tight casts.
Diminished or absent pulses
Slow nail bed capillary refill time
Skin pallor, cyanosis or coolness
Increasing pain
Painful edema peripheral to cast
Pain on passive motionParesthesia(tingling/prickling sensation)
1. The affected
extremity
should be
kept at heart
level
2. Cold
applications
should be
avoided
3. Adequate
hydration is
important for
maintaining
the client’s
mean arterial
blood
pressure
4. A constrictive
bandage will
be removed
as ordered.
Complications Definition Cause Signs and symptoms Management
5. A fasciotomymay be performed.
(an incision through the skin into the fascia of the muscle compartment allows tissue expansion and restores blood flow.)
Compartment
syndrome
Complications in
clients with
Tractions
Complications Definition Cause Signs and symptoms Management
Urinary Stasis and infection
Urinary stasis - It is the stoppage of the flow or discharge of urine, at any level of the urinary tract.
Urinary tract infection -
Incomplete emptying of the bladder related to positioning in bed.
The patientmay find use of the bedpan uncomfortable and may limit fluids to minimize the frequency of urination.
Cloudy urine, which may have a foul or strong odor
Low fever
Pain or burning with urination
Pressure or cramping in the lower abdomen
Strong need to urinate
1. Teach
patient to
consume
adequate
amounts of
fluids and to
void every 3
– 4 hours.
2. Antibiotic
therapy as
prescribed
by the
physician.
3. Keep genital
area clean.
Complications Definition Cause Signs and symptoms Management
Atelectasis and pneumonia
Atelectasis –partial or complete collapse of the lung.
Pneumonia - Lung inflammation caused by bacterial or viral infection.
-Patients in the hospital are often very sick and cannot fight off germs.
-The types of germs present in a hospital are often more dangerous than those encountered in the community.
Diaphoresis
Chest pain
Productive cough
Tachypnea
Tachycardia
Cyanosis
Crackles and Rhonchi upon auscultation
1. Auscultate
patient’s lungs
every 4 – 8
hours to assess
respiratory
status.
2. Teach patient
deep breathing
and coughing
exercises.
Complications Definition Cause Signs and symptoms Management
Constipation and Anorexia
Constipation -refers to bowel movements that are infrequent or hard to pass.
-is a common cause of painful defecation.
Anorexia – a lack or loss of appetite.
It is a result of the reducedgastric motility due to decreased activity level.
Lumpy of hard stools
Straining at defecation
Feeling of incomplete evacuation
Fewer than two bowel movements in a week
1. Increase fiber intake of patient.
2. Instruct patient to increase fluid intake.
3. Therapeutic measures:
- Stool softeners
- Laxatives- Enemas- Suppositories
4. Identify patient’s food preferences, as appopriate
Complications Definition Cause Signs and symptoms Management
Skin breakdown is caused by the sweat or drainage that develops during the wearing of a cast.
Results fromirritation caused by the contact of the skin with the tape or foam and shearing forces.
Redness
Discoloration
Blisters
Cracks
Rashes
Scabs
dry, raised or shiny skin
Feeling for hard, soft, warm or wet skin.
1. Closely monitor the status of the skin in contact with tape or foam to ensure that shearing forces are avoided.
2. Palpate the area of the traction tapes daily to detect underlying tenderness.
3. Provide back care at least every 2 hours.
Complications Definition Cause Signs and symptoms Management
Venous thrombo-embolism
It is the formation of a blood clot in one of the deep veins within the body, such as in the leg or pelvis.
It is a result of stasis of the blood flowing in the veins, increases coagulability, and injury to vessels.
Prolonged bed rest or immobility promotes stasis.
include pain or tenderness and swelling in the upper and lower extremities
increased warmth
Edema
erythema
presence of dilated veins
on the chest wall or leg.
1. Teach patient to perform ankle and foot exercises within the limits of the traction therapy every 1 to 2 hours when awake.
2. Encourage patient to drink fluids (to prevent dehydration and associated hemoconcentration which contribute to stasis.
Complications Definition Cause Signs and symptoms Management
Circulatoryimpairment
An inadequacy of blood flow. Inadequate blood flow to a particular area of the body can result in too little oxygen being delivered to that area, a condition known as hypoxia.
It results commonly from pressure on peripheral nerves.
Pallor or coolness of the patient’s extremities
Paresthesia
Slow capillary refill time
Complaints of increasing pain
1. Assess circulation of the foot or hand within 15 – 30 minutes and then every 1 – 2 hours.
(Neurovascular assessment)
2. Encourage the patient to perform active foot exercises every hour when awake.