Module 13: Orthopedic Care - Cast Care and Traction Flashcards
1
Q
what is a fracture
A
- a break or disruption in the continuity of a bone
- displaced or not displaced
- closed
- skin is not broken
- open (compound)
- fragments of bone breath through skin
- graded according to severity
2
Q
common causes of a fracture
A
- trauma
- motor vehicle collisions
- pedestrian vs car
- motorbike collisions
- pedal bike injuries
- falls
- osteoporosis
3
Q
Immediate management of a Limb Fracture
A
- immobilize/splint (prevent inner movement)
- preserve body alignment
- elevate to prevent/ reduce deem
- cold pack 1st 24hrs
> decrease bleeding/ decrease edema/ decrease pain - neuromuscular assessment (CTEMPS)
- observe for signs and symptoms of shock
- compare affected and unaffected limb
4
Q
Fracture Treatment: Fixation
A
- attempt to attach fragment of broken bone together
- internal fixation
- surgery using rods, pins, screws, metal plates
- may be left in body indefinitely
- open reduction and internal fixation (ORIF)
5
Q
Fracture treatment: external fixation
A
- pins inserted above and below fracture
- pins attached to external frame
- at risk for pin site infection
6
Q
explain the purpose of a cast
A
- immobilization of a factor and surrounding tissue allowing for healing to occur
- maintains limb in a position of rest and alignment
- reduces pain, swelling, and muscle spasms
- remains in place until bone heals
7
Q
Describe required patient assessments when caring for a patient with a cast
A
assessing neurovascular status
- impairment caused by pressure on the nerve or vascular supply the affected extremity
- check distal to site
- is there adequate circulation?
- includes:
- pulses
- capillary refill
- skin colour and temperature
- sensation
- motor function
- pain
- assess q1h x 24 h then every shift or as pe agency policy and patient condition
- CWSM (circulation- includes colour, pulse, cap refill, warmth, sensation, movement)
Cast Application
Prior:
- Baseline Assessment
- neurovascular assessment
- vital signs
- analgesics administered if required as ordered
- clothing/rings removed from affected limb (store valuables)
- wash and dry skin
8
Q
plaster of paris
A
- made from rolls of dry muslin
- takes 24 hrs to dry and harden
- heavy
- can sustain heavier loads
- cannot get wet
9
Q
fiberglass
A
- made from rolls that are activated by water or light
- dry in 15-30 mins
- lighter and cooler
- more expensive
- outer part is waterproof
10
Q
air cast
A
- for foot fractures its commonly used
11
Q
Describe the ongoing care of a patient with a cast with regards to positioning, position changes, exercise and nutrition
A
- assess and treat pain
- inspect for sign of drainage or door - outline drainage
- neuromuscular assessment (CTEMPS)
- vital signs - signs of infection
- assess integrity and cleanliness of cast
- evaluate skin integrity under and around cast
- burning or heat sensation
- skin redness or excoriation around the edge of cast
- itchiness
- reduce swelling - elevate casted limb
- apply ice to outside of cast
12
Q
Cast Care: Bi-Valving
A
- medial and lateral cuts through the length of the cast to observe incision or if cast is too tight
- used to alleviate pressure from limb swelling
- cast then wrapped with tensors
- new cast will be applied when condition resolves
13
Q
Cast Care: windowing
A
- assure opening is cut in the cast in order to view the incision or area of pressure to check for circulatory impairment
- swore may be replaced and taped back in place
14
Q
Explain the common complications associated with casts
A
- compartment syndrome
- fat embolism
- deep vie thrombosis
- pulmonary emboli
- infection
- joint stiffness and contractures
- shock
15
Q
Compartment Syndrome
A
- compartments are enclosed spaces inside muscles
- blood becomes trapped in this space - pressure builds up
- pressure on tissues. nerves and blood vessels
- common causes: fractures, crush injuries
- can be due to external pressure - cast too tight
- S&S: 6 p’s
- pain, not relieved by opioids
- parenthesis
- paralysis
- pressure
- pallor
- pulseslessness
- symptoms:
- severe pain, unrelieved with opioids, edema, pallor, weak or absent pulse, cyanosis of limn, numbness, tingling, foot drop in affected leg
- irreversible damage can occur within 4-6 hours
- Treatment
- internal pressure - fasciotomy
- external - loosen dressing, cut cast
