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).


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.


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.


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


- 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.


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.


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


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.


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.


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


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.


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.


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.

Documents

Casts and tractions