Specialized Nursing Care Procedures
Subtopic:
Orthopedic Nursing Care
Orthopedic care focuses on the prevention, diagnosis, and treatment of disorders affecting the musculoskeletal system. This intricate system, composed of muscles, tendons, ligaments, bones, and other connective tissues, is essential for human mobility and physical activity.
Conditions Managed in Orthopedic Care:
Musculoskeletal trauma: Injuries resulting from accidents, falls, or other external forces.
Sports injuries: Conditions arising from athletic activities, such as sprains, strains, and fractures.
Degenerative diseases: Age-related wear and tear on joints, like osteoarthritis.
Infections: Bone and joint infections requiring specialized treatment.
Tumors: Benign or malignant growths affecting the musculoskeletal system.
Congenital disorders: Musculoskeletal abnormalities present at birth.
Treatment Modalities in Orthopedic Care:
Orthopedic care utilizes a wide range of techniques, including:
Bandaging: Applying bandages to support, immobilize, or protect injured areas.
Traction: Using weights and pulleys to apply a pulling force to bones or joints.
Splints: Devices used to immobilize and support injured limbs.
Non-surgical procedures: Physical therapy, medications, and injections.
Surgical procedures: Operations to repair or reconstruct damaged tissues (e.g., ligament repair, joint replacement).
II. Bandaging: Principles and Techniques
Purposes of Bandages:
Retention: Secure dressings and splints in their proper positions.
Protection: Shield wounds from contamination and further injury.
Support: Provide stability to injured areas, such as sprains.
Compression: Apply pressure to control swelling or bleeding.
Immobilization: Restrict movement in fractures or after surgical procedures, sometimes using a plaster of Paris cast for enhanced stability.
Types of Bandages:
Triangular Bandages: Versatile bandages primarily used in first aid and emergency situations. Common applications include head bandages and slings for arm support.
Roller Bandages: Long strips of material used for various bandaging techniques, such as:
Circular: Wrapping around a limb in a circular manner.
Spiral: Overlapping turns that ascend the limb.
Recurrent: Used for bandaging stumps or the head.
Plaster of Paris (POP) Bandages: Made from gauze impregnated with plaster of Paris, these bandages harden to form a rigid cast, providing excellent immobilization for fractures.
Adhesive Bandages: Typically used for minor wounds, but specialized adhesive bandages can be used in specific fractures, such as clavicle fractures.
Gauze Bandages: Soft, absorbent bandages used for wound dressing and padding.
Crepe Bandages: Elastic bandages that provide varying degrees of compression depending on the tension applied during wrapping. They are widely used for support and compression.
General Rules of Bandaging:
Preparation: Use a tightly rolled bandage of appropriate width and material for the specific injury and body part.
Patient Positioning: Face the patient when bandaging limbs to ensure proper alignment and application.
Bandage Handling: Hold the roll (head) of the bandage uppermost for controlled unwinding.
Limb Alignment: Position the limb in its correct anatomical alignment before and during bandaging.
Hand Dominance: Use your dominant hand to hold and apply the bandage. For example, use your right hand when bandaging a left limb and vice versa.
Direction of Application: Bandage from the inner aspect of the limb to the outer aspect (inside to outside) and from the lower part of the limb to the upper part (below to upwards). Maintain even tension throughout the process.
Tension Control: Ensure the bandage is neither too tight, which could restrict blood flow, nor too loose, which would provide inadequate support.
Securing the Bandage: Finish with a straight turn, fold in the end, and secure it appropriately. Avoid placing fasteners over joints or the injury site.
Fastener Choice: Use safety pins or the provided fasteners to secure the bandage. In patients who are confused, agitated, or children, use tape instead of sharp objects.
Bandaging Patterns: Detailed Techniques
A. Figure-of-Eight Bandaging:
Preparation: Ensure the patient is comfortable and the affected limb is exposed.
Initial Wrap: Hold the bandage with the roll facing up. Wrap the bandage twice around the limb just below the joint to create an anchor.
Figure-of-Eight Pattern: Make alternating ascending and descending turns, crossing over the joint in a figure-of-eight pattern. Overlap each turn by one-half to two-thirds of the bandage’s width.
Anchoring Above the Joint: Wrap the bandage twice around the limb above the joint to secure it.
Fastening: Secure the end of the bandage with a clip or safety pin.
Elevation: Elevate the bandaged limb for 15-30 minutes after application to reduce swelling.
Assessment: Regularly check the skin color, temperature, sensation, and capillary refill distal to the bandage to ensure adequate circulation. Ask the patient about any discomfort or pain.
B. Spiral Bandaging (Example: Ear Bandaging):
Fixing Turn: Begin with a circular turn around the head to anchor the bandage.
Ear Coverage: Bring the bandage under the affected ear, then straight over the head and down the back, leaving the other ear uncovered.
Repetitive Turns: Repeat these turns three to four times, gradually covering the affected ear.
Final Fixing Turn: Finish with another circular turn around the head.
Securing: Secure the bandage at the center of the forehead using a safety pin, clip, or tape.
Divergent Spica: This is a variation used to cover a dressing or wound at a fixed joint, like the knee, heel, or elbow. Start with two turns over the center of the joint. Then, make alternate turns above and below these initial turns, forming a widening pattern on either side of the joint.
C. Triangular Bandaging for Arm Sling:
Arm Positioning: Place the injured arm across the patient’s chest, with the fingers almost touching the opposite shoulder.
Bandage Placement: Position one corner of the triangular bandage over the uninjured shoulder, with the right-angled corner just beyond the elbow of the injured arm.
Supporting the Forearm: Tuck the upper half of the bandage’s base underneath the forearm and elbow of the injured arm.
Securing the Sling: Bring the corner ends across the back and tie them with a reef knot. The knot should rest in the hollow above the clavicle on the uninjured side.
Elbow Enclosure: Fold the right-angled corner and pin it to enclose the elbow securely.
Padding: Place a pad under the knot if it’s likely to cause pressure or discomfort.
D. Bandaging the Eye (Continued):
Initial Turns: Start on the affected side. Make a circular turn around the forehead (fixing turn). Then, bring the bandage from the back of the head under the ear, across the eye, covering the nasal side of the pad. Continue straight over the head and down the back.
Overlapping Turns: The next turn comes under the ear on the affected side, overlaps the previous eye turn, crosses the fixing turn at the same point as the first, then goes over the head and around to the front.
Securing: A safety pin should be placed at the center of the forehead to secure the bandage.
E. Capeline Bandage (Using a Double-Headed Roller Bandage):
Patient Positioning: Have the patient sit upright. Stand behind the patient.
Initial Placement: Place the center of the outer surface of the bandage at the center of the forehead.
First Turns: Bring each head of the bandage around the temples, above the ears, to the nape of the neck. Cross the ends at the nape.
Alternating Turns: Bring the upper bandage around the head horizontally. Bring the other head of the bandage vertically over the center of the scalp, from the back to the root of the nose.
Fixing the Vertical Turn: Bring the horizontal bandage over the forehead, covering and fixing the vertical bandage in place.
Scalp Coverage: Bring the vertical bandage back over the scalp, ensuring each turn covers 2/3 of the previous turn.
Crossing and Fixing: Cross the bandages again at the back. Fix the vertical turn with the horizontal bandage. Then, bring the vertical bandage back over the scalp to the opposite side of the central line, covering the other margin of its original turn.
Repetitive Turns: Repeat the backward and forward turns, alternating sides of the center. Each turn is fixed by the encircling horizontal bandage until the entire scalp is covered.
Final Securing: Make two circular turns around the head to secure the bandage. Fasten with a safety pin.
F. Recurrent Bandaging:
Patient Positioning and Initial Turn: Stand facing the patient. Begin with a fixing turn around the limb.
Upward and Downward Turns: Carry the bandage upward across the front of the limb at a 45-degree angle. Then, bring it around the back at the same level and downward over the front, crossing the first turn at a right angle.
Repetitive Turns: Repeat these upward and downward turns until the limb is adequately covered.
Overlap and Tension: Overlap each layer of bandage by one-half to two-thirds of its width. Wrap firmly but not tightly. Ask the patient if the bandage feels comfortable. Loosen it if there is any tingling, itching, numbness, or pain.
III. Splints: Immobilization and Support
Purpose of Splinting:
Splints are external devices used to immobilize musculoskeletal injuries, providing support, reducing pain, and preventing further damage. They are crucial for stabilizing fractures, sprains, and strains, allowing for proper healing.
Splints vs. Casts:
Splints: Non-circumferential devices that allow for swelling in the acute phase of injury.
Casts: Circumferential applications of plaster that provide rigid immobilization. Casts are typically applied after the initial swelling has subsided.
Indications for Splinting:
Temporary stabilization of acute fractures, sprains, or strains.
Immobilization of suspected occult fractures (e.g., scaphoid fracture).
Severe soft tissue injuries requiring protection.
Definitive management of certain stable fractures.
Peripheral neuropathy requiring extremity protection.
Partial immobilization for minor soft tissue injuries.
Treatment of joint instability, including dislocations.
Equipment for Splint Application:
Sheet or towel for patient protection.
Stockinette or fabric under padding.
Undercast padding (cotton).
Plaster (8-10 sheets) or padded fiberglass.
Water bucket (cool water).
Elastic bandage.
Sling (for upper extremity injuries).
C-arm X-ray (if fracture reduction is performed).
General Steps for Splint Application:
Analgesia: Administer adequate pain relief before splint application.
Wound Care: Address any soft tissue injuries before splinting.
Stockinette Application: Apply a stockinette circumferentially, extending beyond the injured area.
Padding: Pad bony prominences with at least 1-2 cm of soft cast padding.
Circumferential Padding: Apply 2-3 layers of cast padding (0.25-0.5 cm) circumferentially.
Fracture Reduction (if needed): Restore bone length, rotation, and alignment.
Plaster/Fiberglass Activation: Saturate the plaster or fiberglass in water. Laminate the sheets.
Molding: Mold the material around the injured area, resisting deforming forces.
Non-Circumferential Application: Ensure the splint does not completely encircle the limb.
Stockinette Folding: Fold the stockinette over the edges of the splint.
Elastic Bandage Application: Apply an elastic bandage circumferentially around the splint.
Neurovascular Assessment: Reassess neurovascular status after splint application.
Patient Education: Counsel the patient on splint care and follow-up.
Common Upper Extremity Splints:
Coaptation splint
Sugar tong splint
Posterior long arm elbow splint
Ulnar gutter splint
Radial gutter splint
Volar or dorsal short arm splint
Thumb spica splint
Common Lower Extremity Splints:
Posterior long leg splint
Posterior short leg splint
Posterior short leg splint with stirrups
Complications of Splints:
Loss of fracture reduction
Skin irritation or breakdown
Joint stiffness
Thermal injury
Neurovascular compromise (e.g., acute carpal tunnel syndrome)
Compartment syndrome
IV. Traction: Principles and Types
Definition:
Traction is a therapeutic method used in fracture management that involves applying a continuous pulling force to a limb or body part using cords and weights.
Indications for Traction:
Correction of joint deformities.
Separation of joint surfaces to prevent the spread of infection (e.g., in tuberculosis of the hip or knee).
Prevention of muscle spasms.
Prevention of bone overriding and maintenance of bone alignment during healing.
Types of Traction:
Skeletal Traction: A pin, nail, or wire is surgically inserted through a bone distal to the fracture. Weights are attached to the pin to apply traction.
Skin Traction: Splints, bandages, or adhesive tapes are applied to the skin below the fracture. Weights are attached to these materials to create the pulling force. Examples:
Hamilton Russell traction
Gallows traction
Pulp Traction: Applied to the soft tissues of the fingers or toes.
Halo Traction: Used for cervical spine injuries. A metal ring (halo) is attached to the skull, and weights are applied to the halo.
Skull Tongs Traction: Another method for cervical spine injuries. Tongs are inserted into the outer layer of the skull, and weights are attached.
Fixators: Devices that provide rigid immobilization.
Internal fixators: Plates, screws, or rods placed inside the body during surgery.
External fixators: Pins are inserted through the skin and bone, and a frame outside the body connects the pins.
Skeletal Traction in Detail:
Mechanism: A pin, nail, or wire is passed through a bone.
Patient Population: Often used for strong, well-built individuals.
Common Pin Insertion Sites:
Condyles of the femur
Tubercles of the tibia
Calcaneus (heel bone)
Metallic Equipment Used in Skeletal Traction:
Steinmann’s pins: Rigid steel pins with a special stirrup that allows for adjustment of the pull direction.
Kirschner wire: Narrow steel wire that is not rigid unless pulled on by a stirrup. Less commonly used due to a higher risk of infection.
Preparation of the Patient for Skeletal Traction:
Explanation and reassurance.
Shaving (if needed).
Premedication (if prescribed).
Intravenous line insertion.
The patient is taken to the operating room with the leg in a Thomas splint with skin traction applied.
The Steinmann’s pin is inserted under general anesthesia.
A stirrup is attached to the pin.
The patient is returned to the ward.
Requirements for Setting Up Skeletal Traction:
Trolley:
Top shelf:
Extension cord
6-8 metal pulleys
Cotton wool in a gallipot
Receiver for forceps and scissors
Gallipot of gauze
Antiseptic lotion (e.g., iodine)
Bottom shelf:
Thomas splint
Knee piece for Thomas splint
Foot piece for Thomas splint
Strong slings, safety pins
Weights (e.g., sandbags of the prescribed weight)
Bed elevators (e.g., bed blocks)
Strapping
At the Bedside:
Balkan beam
Fracture boards
Specific Care for a Patient on Skeletal Traction:
Pin Site Care:
Monitor for signs of inflammation, discharge, or pin movement.
Report any abnormalities to the physician.
Traction Maintenance:
Ensure cords and pulleys are free and smooth-running.
Cords should be long enough and not touch the toes.
Cords should not be knotted or kinked.
Weights should be secure and hanging freely.
Skin Traction:
Skin traction is a non-invasive method of applying a pulling force to an injured limb. It involves securing splints, bandages, or adhesive tapes to the skin directly below the fracture site. Once these materials are in place, weights are attached to them. A pulley system connected to the hospital bed is then used to exert a controlled pull on the affected body part, guiding it into the correct position for healin
Preparation of the Patient for Skin Traction:
Explanation and Consent:
Thoroughly explain the procedure to the patient and their relatives, addressing any concerns or misconceptions about the traction apparatus.
Obtain informed consent from the patient or their legal guardian.
Bed Preparation:
Ensure the bed has a firm base to provide adequate support. Use fracture boards if necessary.
Use a comfortable mattress to enhance patient comfort during prolonged bed rest.
Skin Assessment and Preparation:
Provide privacy for the patient.
Wash the affected leg thoroughly and dry it completely.
Carefully inspect the skin for any abrasions or skin lesions. Report any abnormalities to the physician immediately.
If necessary, shave the leg, taking extreme care to avoid causing any skin damage.
Apply tincture of benzoin compound to the skin. This helps prevent allergic reactions to the adhesive tape and improves its adhesion.
Protect bony prominences (e.g., malleoli, fibular head) with adhesive felt, latex foam, or orthopedic wool to prevent pressure sores.
Bed Positioning and Comfort:
Arrange bed linens in separate packs for the trunk and the limb that will not be in traction.
Maintain patient warmth and ensure the bed is tidy at all times. This contributes to the patient’s overall well-being and morale.
If both legs are in traction, use a bed cradle to prevent the bedclothes from interfering with the traction’s effectiveness.
If an overhead beam is available, attach a trapeze. This allows the patient to lift themselves, helping prevent pressure sores and hypostatic pneumonia.
Bed blocks may be necessary if the patient’s own weight is used as counter-traction.
Management of a Patient with Skin Traction:
Acute Management:
Order Verification:
Ensure the orthopedic team has documented the order for skin traction, including the specific weight (in kilograms) to be applied.
Equipment Preparation:
Top Shelf of Trolley:
Shaving tray
Receiver containing:
Pair of dressing forceps
Two dissecting forceps
Bowl containing swabs
Extension plaster
Pair of scissors
Crepe bandages
Tape measure
Skin pencil
Bottom Shelf of Trolley:
Receiver for used swabs
Spreader
Cord
Brown wool or sorbo pads
Tincture of benzoin compound
Dressing mackintosh and towel
Small blanket to cover the limb
Balkan beam
Bed blocks
Bedside:
Handwashing equipment
Screens
Bucket for used equipment
Weights in various kilograms
On the Bed:
Pulleys
Fracture board
Pain Management:
A femoral nerve block is the preferred method of pain control. It should be administered in the emergency department before the patient is admitted to the ward.
Diazepam and oxycodone should be prescribed and used in conjunction with the femoral nerve block.
Distraction and Education:
Explain the procedure to both the parents and the patient before starting.
Plan appropriate distraction techniques using play therapy, parental involvement, or other nursing staff support.
Application of Traction:
Ensure the correct amount of water has been added to the traction weight bag according to the medical orders.
Fold the foam stirrup around the heel, ankle, and lower leg of the affected limb.
Apply the bandage starting at the ankle and moving up the lower leg using a figure-of-eight technique. Secure the bandage with sleek tape.
Place the rope over the pulley and attach the traction weight bag.
If needed, trim the rope to ensure the traction weight bag is suspended in the air and does not rest on the floor.
Ongoing Management:
Skin Integrity:
Monitor for pressure areas on the patient’s legs, heels, elbows, and buttocks, which are prone to developing due to immobility and bandages.
Place a rolled-up towel or pillow under the heel to relieve pressure.
Encourage the patient to reposition themselves. Perform pressure area care every four hours.
Remove the foam stirrup and bandage once per shift to relieve pressure and assess the skin’s condition.
Keep the sheets dry.
Document the skin’s condition in the progress notes and care plan.
Regularly assess and document the pressure injury prevention score and plan.
Traction Care:
Ensure the traction weight bag is hanging freely and does not rest on the bed or floor.
Replace frayed ropes immediately.
Ensure the rope is properly positioned in the pulley tracks.
Keep the bandages free of wrinkles.
Tilt the bed to maintain counter-traction.
Neurovascular Observations:
Perform neurovascular checks hourly and record the findings in the medical record.
If the bandage is too tight, it can impair blood circulation.
Monitor for swelling of the femur to detect compartment syndrome.
If neurovascular compromise is detected, remove the bandage and reapply it less tightly. If circulation does not improve, notify the orthopedic team immediately.
Pain Assessment and Management:
Regularly assess the patient’s pain to ensure appropriate analgesic administration.
Paracetamol, diazepam, and oxycodone should be prescribed and administered as needed.
Use pre-emptive analgesia before procedures like pressure area care to minimize discomfort.
Assess and document the effectiveness of pain management strategies.
Activity and Education:
Encourage the patient to sit up in bed and engage in quiet activities like crafts, board games, and watching TV.
Utilize play therapy for long-term traction patients.
Non-pharmacological distraction and activities can improve patient comfort.
Allow the patient to move in bed as tolerated for hygiene purposes.
Refer patients who will be in traction for several weeks to the education department.
Transport to Operating Room:
Transport the patient to the operating room while maintaining traction to minimize pain and maintain alignment.
Special Considerations:
The foam stirrup, bandage, and rope are for single-patient use only.
Potential Complications:
Skin breakdown/pressure areas: Due to prolonged immobility and pressure from bandages.
Neurovascular impairment: Compromised circulation, oxygenation, and nerve function in the affected limb.
Compartment syndrome: Increased pressure within a muscle compartment, leading to compromised blood flow and nerve function.
Joint contractures: Stiffness and loss of range of motion in joints due to immobility.
Constipation: Resulting from immobility and the use of opioid analgesics.
Pulp Traction
Pulp traction is a specialized form of traction used for managing displaced fractures of the phalanges (finger or toe bones), metacarpals (hand bones), and metatarsals (foot bones). A suture is passed through the pulp (soft tissue) of the affected finger or toe. This suture is then connected to an extension wire, which is incorporated into a plaster cast.
Skull Tongs Traction
Skull tongs traction is a method used to immobilize the cervical spine (neck) in cases of unstable fractures or dislocations.
Types of Skull Tongs:
Crutchfield tongs
Gardner-Wells tongs (more commonly used due to a perceived lower risk of pullout)
Procedure:
The patient is prepared both psychologically and physically. Informed consent is obtained.
The procedure may be performed in the operating room under anesthesia.
The tongs are surgically inserted into the outer table of the skull bone.
A connector or half-halo brace is attached to a hook, from which traction can be applied using weights.
Post-Procedure Care for Skull Tongs Traction:
Bed and Positioning:
The patient is placed on a special bed with a specialized mattress and therapeutic frames to ensure proper spinal alignment and comfort.
The patient is positioned supine (lying flat on their back) with a small pillow supporting the head.
The head of the bed is elevated to provide counter-traction, which helps maintain the desired alignment of the cervical spine.
The bed is equipped with castors to facilitate easy movement for X-rays or other necessary procedures.
Long-Term Considerations:
Patients often remain in skull tongs traction for extended periods. Therefore, the same precautions and care principles applied to other types of skeletal traction are essential.
Perform activities of daily living (ADLs) for the patient, as they will have difficulty performing these tasks independently.
Prevent infection at the tong insertion sites by regularly cleaning the area with an appropriate antiseptic solution.
Address the patient’s psychosocial needs. Provide diversional activities to combat restlessness and boredom, which are common in patients with prolonged immobilization.
Teach the patient range-of-motion (ROM) exercises for their unaffected limbs to prevent stiffness and maintain muscle strength.
Ensure the patient receives a nutritious diet to promote healing and overall well-being.
Halo Traction:
Halo traction is similar to skull tongs traction in that it stabilizes and supports fractured cervical vertebrae. However, it differs in its design and allows for greater patient mobility.
Mechanism: Pins are inserted into the skull, similar to skull tongs. However, a halo ring is attached to these pins. A vertical frame extends from the halo ring and connects to a vest worn by the patient.
Mobility: This setup allows the patient to move out of bed and even ambulate while maintaining cervical spine immobilization.
Important Note: The halo frame and vest should never be removed because any movement of the vertebrae could cause spinal cord injury.
Fixators:
Fixators are metallic devices used to stabilize bones, particularly in fracture management.
Types of Fixators:
External Fixation Devices:
Description: A frame composed of metal rods that connect to skeletal pins inserted through the skin and into the bone. These rods provide traction and maintain alignment between the pin sites.
Complexity: External fixators can range from simple designs with two or three connecting rods to complex configurations with multiple rods arranged at various angles to stabilize multiple bone fragments.
Advantages:
Suitable for immobilizing multiple bone fragments.
Preferred when open wounds are present, as they minimize the risk of infection compared to casts.
Internal Fixation Devices:
Description: Metallic devices (plates, screws, rods) placed surgically inside the body. They can be used to replace damaged or diseased bones or to treat certain types of fractures.
Duration: Internal fixators can be temporary or permanent, depending on the specific indication. For example, a device used to replace a missing femoral head might be permanent.
General Nursing Care of a Patient on Traction:
Traction Application Timing: Traction should preferably be applied during the daytime.
Bed Preparation: The patient should be nursed on a bed with fracture boards to provide a firm and stable surface.
Bed Elevation: Elevate the foot or head of the bed, depending on the traction site (skull or limbs), to maintain proper alignment and counter-traction.
Weight Management: Do not lift, move, or remove the traction weights unless specifically instructed by the physician. Ensure the cords are always pulling and the weights are not resting on the bed or floor. Traction is usually maintained continuously (24 hours a day) because sudden cessation can irritate joints, cause displacement of fractures, and be very painful for the patient.
Cord and Pulley Maintenance: Ensure the cords run freely over the pulleys. Lubricate the pulleys regularly to prevent friction.
Circulation Monitoring: Regularly assess the color of the patient’s toes (if the traction is on a limb) to ensure adequate circulation.
Specific Care for Skeletal Traction:
Pin Site Care:
Keep the pin insertion sites clean and dry.
Use tincture of benzoin compound to seal the wound and prevent infection.
Observe the screws on either side of the pin for free movement. Lubricate them with oil if necessary.
Place a cork on the sharp end of the pin to prevent injury and accidental removal.
Patient Assistance:
Provide the patient with an overhead lifting pole and chain to help them lift themselves in bed.
When using a bedpan, have the patient lift themselves using the pole, or provide assistance if they are unable to do so.
Change the bottom sheet from head to toe to avoid disrupting the traction.
Hygiene and Pressure Area Care:
Assist the patient with bathing, particularly areas they cannot reach (e.g., back, legs). Perform bathing daily.
Pay careful attention to pressure areas, especially around the ring of a Thomas splint (if used).
Nutrition:
Encourage a nutritious diet rich in vitamins and minerals, particularly iron (e.g., milk, liver).
Exercise:
Teach the patient muscle-strengthening exercises to be performed daily.
Encourage movement of unaffected joints (e.g., knee and ankle if the leg is in traction).
Psychological Care:
Provide regular reassurance and emotional support.
Offer diversional activities (e.g., indoor games) to keep the patient occupied and prevent boredom.
Care of Plaster of Paris (P.O.P) Casts:
Elevation:
Elevate the limb with the cast on a pillow to reduce swelling.
Elevate the foot of the bed to further assist with reducing swelling.
Cast Care:
Wipe off any plaster powder from the toes.
Expose the cast to room temperature to allow it to dry completely and harden.
Neurovascular Assessment:
Circulation:
Observe the toes for good blood supply (color should be pink, and capillary refill should be brisk).
Check the temperature of the toes using the back of your hand (they should be warm).
Observe for any swelling of the toes.
Nerve Function:
Ask the patient to move their toes regularly.
Perform half-hourly checks for pressure on nerves.
Assess for pain, which could indicate pressure.
Check for loss of sensation or movement in the toes.
Check for numbness or tingling, which could indicate nerve compression.
Bleeding:
Inspect the cast for any blood stains, which could indicate bleeding.
Physiotherapy:
Breathing Exercises: Encourage deep breathing exercises to prevent respiratory complications.
Limb Movement: Encourage movement of the unaffected part of the limb within the cast to maintain muscle strength and joint mobility