The document discusses casts, including their definition, types, application process, and removal process. It defines a cast as a rigid external device used to immobilize and support fractures, deformities, and injuries. It describes various types of casts such as short arm, long arm, short leg, and shoulder spica casts. It provides a 12 step process for applying a plaster cast including prepping the patient and area, applying stockinette, cotton, and plaster, and molding and drying the cast. It also outlines the equipment and steps for cast removal using a saw and spreaders.
1) Casting is used to immobilize fractures and correct deformities by applying uniform pressure.
2) Plaster of Paris and fiberglass are common casting materials, with fiberglass preferred for distal limbs and children due to its lighter weight.
3) Ben, a 3-year old, wore a removable splint instead of a conventional cast to mend his fractured wrist, as removable splints are replacing casts.
This document discusses amputation, including its definition, causes, types, surgical principles, complications, pain management, psychological adjustment, dressing, skin care, and exercises. It defines amputation as the removal of part of a limb through one or more bones. The main causes include peripheral vascular disease, injuries, infections, tumors, and congenital anomalies. There are two main types - guillotine/open and closed amputations. Key goals after amputation are pain management, psychological counseling, preventing deformities, and regaining range of motion and strength.
- Skin traction involves applying traction directly to the skin to immobilize a body part. It can be used for short or extended periods using adhesive or non-adhesive devices.
- The purposes of skin traction include reducing fractures and dislocations, maintaining skeletal alignment, relieving muscle spasms, and immobilizing injured areas.
- Common types of skin traction include Buck's traction for femoral fractures, forearm skin traction, and head halter traction for neck injuries. Close monitoring is needed to prevent complications like skin breakdown, neurological issues, and deep vein thrombosis.
This document defines crutches and describes different types of crutch gaits and crutches. It discusses the purpose of walking aids, prerequisites for crutch use, and measurements for proper crutch fitting. Types of crutches described include axillary/underarm crutches, elbow/Lofstrand crutches, and forearm support crutches. Instructions are provided for different weight bearing statuses and ambulation techniques like stairs. Precautions and patient education topics are also outlined.
This document provides information on a 54-year-old female patient, Mrs. T, who was admitted with a left femur fracture after a fall at home. She has a history of hypertension. The learning objectives cover defining a fracture, identifying causes and symptoms, and understanding treatment and nursing care. The document details her vital signs, medications, x-ray results showing a distal third left femur fracture, and potential nursing diagnoses including pain management and fall prevention.
Splints and tractions are important tools in orthopaedics to support fractures and guide healing. Plaster of Paris is commonly used to make casts and splints due to its properties of being cheap, easily molded, strong yet light. It is used for both temporary stabilization and definitive fracture treatment. Traction methods include skin traction, adhesive skin traction, skeletal traction and various devices that apply traction through pins in bones. Traction is used to reduce fractures and dislocations, maintain reduction, reduce muscle spasm and control movement. Complications can arise from overtight bandages or pins causing injury.
This document summarizes a seminar on traction in orthopaedics. It discusses different types of traction including fixed traction using Thomas splints or halo-pelvic traction, as well as sliding traction. Skin traction is described using various methods like Buck's traction or Bryant's traction. Complications of halo-pelvic traction include cranial screw issues, pelvic rod problems, or neurological complications. The purpose of traction is to regain bone length and alignment, reduce fractures, relieve muscle spasms and pressure on nerves to aid in healing.
1) Casting is used to immobilize fractures and correct deformities by applying uniform pressure.
2) Plaster of Paris and fiberglass are common casting materials, with fiberglass preferred for distal limbs and children due to its lighter weight.
3) Ben, a 3-year old, wore a removable splint instead of a conventional cast to mend his fractured wrist, as removable splints are replacing casts.
This document discusses amputation, including its definition, causes, types, surgical principles, complications, pain management, psychological adjustment, dressing, skin care, and exercises. It defines amputation as the removal of part of a limb through one or more bones. The main causes include peripheral vascular disease, injuries, infections, tumors, and congenital anomalies. There are two main types - guillotine/open and closed amputations. Key goals after amputation are pain management, psychological counseling, preventing deformities, and regaining range of motion and strength.
- Skin traction involves applying traction directly to the skin to immobilize a body part. It can be used for short or extended periods using adhesive or non-adhesive devices.
- The purposes of skin traction include reducing fractures and dislocations, maintaining skeletal alignment, relieving muscle spasms, and immobilizing injured areas.
- Common types of skin traction include Buck's traction for femoral fractures, forearm skin traction, and head halter traction for neck injuries. Close monitoring is needed to prevent complications like skin breakdown, neurological issues, and deep vein thrombosis.
This document defines crutches and describes different types of crutch gaits and crutches. It discusses the purpose of walking aids, prerequisites for crutch use, and measurements for proper crutch fitting. Types of crutches described include axillary/underarm crutches, elbow/Lofstrand crutches, and forearm support crutches. Instructions are provided for different weight bearing statuses and ambulation techniques like stairs. Precautions and patient education topics are also outlined.
This document provides information on a 54-year-old female patient, Mrs. T, who was admitted with a left femur fracture after a fall at home. She has a history of hypertension. The learning objectives cover defining a fracture, identifying causes and symptoms, and understanding treatment and nursing care. The document details her vital signs, medications, x-ray results showing a distal third left femur fracture, and potential nursing diagnoses including pain management and fall prevention.
Splints and tractions are important tools in orthopaedics to support fractures and guide healing. Plaster of Paris is commonly used to make casts and splints due to its properties of being cheap, easily molded, strong yet light. It is used for both temporary stabilization and definitive fracture treatment. Traction methods include skin traction, adhesive skin traction, skeletal traction and various devices that apply traction through pins in bones. Traction is used to reduce fractures and dislocations, maintain reduction, reduce muscle spasm and control movement. Complications can arise from overtight bandages or pins causing injury.
This document summarizes a seminar on traction in orthopaedics. It discusses different types of traction including fixed traction using Thomas splints or halo-pelvic traction, as well as sliding traction. Skin traction is described using various methods like Buck's traction or Bryant's traction. Complications of halo-pelvic traction include cranial screw issues, pelvic rod problems, or neurological complications. The purpose of traction is to regain bone length and alignment, reduce fractures, relieve muscle spasms and pressure on nerves to aid in healing.
This document discusses cervical and lumbar traction for relieving neck and back pain. Cervical traction uses gentle pulling of the head to relieve pressure in the neck, while lumbar traction does the same for the lower back. Both can help with issues like muscle spasms, disc problems, and nerve impingement. There are many devices and techniques described that provide traction, including overhead pulleys, inflatable harnesses, inversion tables, and manual methods done by therapists. The effectiveness of traction is debated, but it may provide benefits for some individuals when used appropriately.
Crutches are assistive devices that help patients who cannot walk on their own due to injury or illness. Proper crutch use requires strengthening the shoulder and arm muscles. There are different gaits taught for crutch walking depending on a patient's mobility level and weight bearing status. Exercises are important to prepare patients for crutch walking by building muscle strength and preventing contractures. Nurses teach patients crutch safety and proper technique.
This document provides an overview of amputations, including:
- Indications for amputations include poor circulation, injury, infection, and tumors. The most common indication is poor circulation from conditions like diabetes or peripheral artery disease.
- Types of amputations include closed amputations where flaps are closed primarily and open amputations where flaps are not primarily closed. Levels of amputation depend on the condition and location of the injury or disease.
- Basic principles of amputation include using anesthesia, a tourniquet, fashioning adequate skin flaps, sectioning muscles and blood vessels, protecting cut nerve endings, and postoperative rehabilitation. Complications can include hematoma, infection, necrosis, contractures and phantom limb
This document discusses various assistive devices for mobility including canes, walkers, and crutches. It describes the indications for their use, including structural deformities, injuries, muscle weakness, and balance issues. Each device is then defined and the proper techniques for their use are outlined, such as holding a cane, moving walkers forward, and different crutch gaits. Instructions are provided for measuring clients and teaching them how to walk correctly with each assistive device.
Traction is a force applied manually or mechanically to reduce fractures or dislocations. There are different types of traction including skin traction, skeletal traction, balanced traction, and fixed traction. Skeletal traction involves pins or wires inserted into bones, while skin traction applies traction through adhesive strips on the skin. Traction has benefits of reducing pain and deformity but risks include pressure sores, nerve palsies, and infection. Proper application and monitoring is needed when using traction.
Amputation,Stump care, phantom limb pain and gait training in lower limbHarshita89
1) Phantom limb pain and sensations are perceptions ranging from slight tingling to sharp pain that amputees feel in a limb that is no longer physically attached. It is estimated to affect 49-83% of amputees.
2) There are two main types of pain after amputation - incisional stump pain localized around the scar, and phantom pain felt in the amputated limb itself. Phantom pain can be crushing or tearing.
3) While phantom sensations often occur right after amputation, phantom pain may affect 8-10% of amputees initially but can persist for years in some cases. Stump pain is usually described as pressing, throbbing or burning.
This document discusses cervical traction techniques for reducing cervical spine fractures and dislocations. It begins with an overview of the indications and advantages of cervical traction, including reducing fracture-dislocations to decompress the spinal cord. Two common devices for cervical traction are described - Gardner-Wells tongs and halo rings. Placement of pins and weights used are outlined for safe and effective closed reduction. Common fractures like facet dislocations and Hangman's fractures are also reviewed.
This document discusses different types of splints and traction used for immobilizing fractures. It describes ladder splints, Thomas splints, and Bohler's modification of the Braun splint. Thomas splints consist of a ring, medial bar, and lateral bar and are used to immobilize the lower limb. Bohler's modification uses pulleys to allow changing the angle of traction without adjusting the traction arrangement. The document also covers skin traction versus skeletal traction, application sites for each, and risks associated with traction use.
This document discusses prostatectomy procedures including simple and radical prostatectomy. Simple prostatectomy involves removing part of the prostate for benign conditions, while radical prostatectomy removes the entire prostate and surrounding tissues for prostate cancer. The document describes different approaches for radical prostatectomy including radical perineal, supra pubic, and retro pubic. Key instruments used in prostatectomy are also listed such as retractors, forceps, scissors, and hemoclip appliers.
1. An intercostal drain, or chest tube, is a flexible plastic tube inserted through the chest wall to drain fluid or air from the pleural space. It works using an underwater seal mechanism that allows drainage out while preventing fluid or air from entering.
2. Chest tube insertion involves local anesthesia, positioning the patient, and using sterile technique to insert the tube through the chest wall into the pleural space. Ultrasound is used to guide placement and ensure the tube does not injure organs.
3. Physiotherapy for a patient with a chest tube focuses on wound care, pain management, deep breathing exercises, early mobilization, and exercise to improve ventilation and recovery.
1. Rehabilitation after lower limb amputation involves pre-op, post-op, and long-term phases aimed at preventing complications, educating the patient, and improving functional mobility and independence.
2. The post-op phase focuses on managing pain, increasing range of motion and strength, promoting wound healing, and training the patient in mobility and prosthetic use.
3. Long-term rehabilitation involves community and vocational reintegration, lifelong prosthetic management, and psychological support through follow-ups and support groups.
The document discusses different types of prostheses used to replace missing limbs. It describes exoskeletal and endoskeletal prosthetic designs, and covers the basic components and classifications of prostheses. Myoelectric prostheses that use muscle signals and various types of feet - including SACH, Jaipur and dynamic response feet - are explained. The document provides details on prostheses for transtibial and transfemoral amputations, including PTB and quadrilateral socket designs and considerations for bilateral transfemoral amputees.
Orthotics are devices used to support or correct deformities and impairments of the foot, ankle, knee, and hip joints. A foot orthotic is customized to fit inside the shoe to correct foot alignment. An ankle-foot orthosis (AFO) consists of a shoe attachment, ankle control, and leg band to support the ankle. A knee-ankle-foot orthosis (KAFO) adds a knee control to an AFO. The most specialized orthosis is a total hip-knee-ankle-foot orthosis (THKAFO) which incorporates a hip joint and trunk band. Orthoses are customized to meet individual functional needs and goals.
The document discusses various aspects of traction including definition, history, types (skin vs skeletal), application techniques, risks, and clinical uses. Traction involves applying a pulling force to reduce fractures or dislocations. Skin traction spreads the force over a large area but limited weight. Skeletal traction applies force directly through pins or wires inserted in bones, allowing greater weights. Proper application and counter-traction are important to achieve effective reduction. Clinical applications include treatment of fractures of the femur, hip, spine and extremities. Risks include skin issues, infection and failure to maintain reduction.
This document defines kyphosis as an excessive backward curvature of the spine localized to the thoracic spine, known as a "rounded back" posture. It can be caused by conditions like arthritis, tuberculosis, or postural habits. Kyphosis is classified by severity from first to third degree based on effects like muscle imbalance or vertebral wedging. More severe kyphosis can compress spinal structures and restrict breathing. Rehabilitation focuses on stretching, strengthening, bracing, and manual mobilization to reduce the curvature and its impacts. Studies show manual mobilization and techniques applying passive transverse forces can help attenuate thoracic kyphosis, especially in elderly patients with osteoporosis.
This document provides definitions and information about orthotics. It defines orthotics as externally applied devices that modify the structural and functional characteristics of the neuromuscular and skeletal systems to enable better use of the body part. The document then discusses principles, functions, indications, prescription processes, and nomenclature of various orthotic devices for the spine, upper limbs, lower limbs, knees, and hips. Examples and purposes of different orthotic devices are provided for each body region.
The document discusses crutch walking and the proper use of crutches. It defines crutches as assisting patients to walk while providing support. Crutches increase base of support, maintain center of gravity, redistribute weight bearing, compensate for weak muscles, and decrease pain. Proper crutch use requires muscle strength, correct crutch selection, balance, proper gait patterns, and instructions. There are two main types of crutches: standard axillary crutches and forearm crutches. The document outlines correct stance and four different crutch walking gaits.
Chest physiotherapy involves techniques like percussion, vibration, and postural drainage to mobilize pulmonary secretions in patients who have difficulty coughing them up. It is indicated for conditions involving thick secretions like cystic fibrosis or bronchiectasis. The techniques are contraindicated in situations involving bleeding or instability. Assessment involves a physical exam and reviewing medications and imaging before techniques are applied in specific positions targeting different lung lobes and segments to drain secretions into larger airways.
Orthosis are devices used to support weak joints and correct deformities. They work by applying three point pressure and distributing weight across a wide surface area. Common orthosis include ankle foot orthosis (AFO) which support the ankle and foot, knee ankle foot orthosis (KAFO) which stabilize the knee and lower leg, and hip knee ankle foot orthosis (HKAFO) which provide support from the hip to the foot. Orthosis are made of plastic or metal and their design depends on the joints needing support and the individual's condition.
The document provides information on dressings, bandages, fractures, dislocations, and splinting. It discusses the purpose of dressings in controlling bleeding and absorbing fluids. It describes different types of dressings and bandages, including adhesive dressings for small wounds and various bandage application methods. The document outlines signs and symptoms of fractures and dislocations, and emphasizes immobilizing suspected fractures with splints until medical treatment.
The document provides information about plaster of Paris casts, including their history, composition, application process, types, and care. Some key points:
- Plaster of Paris casts were first used in 1852 and set via an exothermic reaction as calcium sulfate rehydrates.
- Proper application involves padding, applying wet plaster in layers with 50% overlap, holding any reductions, and allowing the cast to fully dry.
- Common cast types include slabs, full casts, spica casts, and braces. Factors like the fracture and joint positions determine the type.
- Signs of compromised circulation like swelling, numbness, or pain require immediate medical attention. Keeping the cast dry
This document discusses cervical and lumbar traction for relieving neck and back pain. Cervical traction uses gentle pulling of the head to relieve pressure in the neck, while lumbar traction does the same for the lower back. Both can help with issues like muscle spasms, disc problems, and nerve impingement. There are many devices and techniques described that provide traction, including overhead pulleys, inflatable harnesses, inversion tables, and manual methods done by therapists. The effectiveness of traction is debated, but it may provide benefits for some individuals when used appropriately.
Crutches are assistive devices that help patients who cannot walk on their own due to injury or illness. Proper crutch use requires strengthening the shoulder and arm muscles. There are different gaits taught for crutch walking depending on a patient's mobility level and weight bearing status. Exercises are important to prepare patients for crutch walking by building muscle strength and preventing contractures. Nurses teach patients crutch safety and proper technique.
This document provides an overview of amputations, including:
- Indications for amputations include poor circulation, injury, infection, and tumors. The most common indication is poor circulation from conditions like diabetes or peripheral artery disease.
- Types of amputations include closed amputations where flaps are closed primarily and open amputations where flaps are not primarily closed. Levels of amputation depend on the condition and location of the injury or disease.
- Basic principles of amputation include using anesthesia, a tourniquet, fashioning adequate skin flaps, sectioning muscles and blood vessels, protecting cut nerve endings, and postoperative rehabilitation. Complications can include hematoma, infection, necrosis, contractures and phantom limb
This document discusses various assistive devices for mobility including canes, walkers, and crutches. It describes the indications for their use, including structural deformities, injuries, muscle weakness, and balance issues. Each device is then defined and the proper techniques for their use are outlined, such as holding a cane, moving walkers forward, and different crutch gaits. Instructions are provided for measuring clients and teaching them how to walk correctly with each assistive device.
Traction is a force applied manually or mechanically to reduce fractures or dislocations. There are different types of traction including skin traction, skeletal traction, balanced traction, and fixed traction. Skeletal traction involves pins or wires inserted into bones, while skin traction applies traction through adhesive strips on the skin. Traction has benefits of reducing pain and deformity but risks include pressure sores, nerve palsies, and infection. Proper application and monitoring is needed when using traction.
Amputation,Stump care, phantom limb pain and gait training in lower limbHarshita89
1) Phantom limb pain and sensations are perceptions ranging from slight tingling to sharp pain that amputees feel in a limb that is no longer physically attached. It is estimated to affect 49-83% of amputees.
2) There are two main types of pain after amputation - incisional stump pain localized around the scar, and phantom pain felt in the amputated limb itself. Phantom pain can be crushing or tearing.
3) While phantom sensations often occur right after amputation, phantom pain may affect 8-10% of amputees initially but can persist for years in some cases. Stump pain is usually described as pressing, throbbing or burning.
This document discusses cervical traction techniques for reducing cervical spine fractures and dislocations. It begins with an overview of the indications and advantages of cervical traction, including reducing fracture-dislocations to decompress the spinal cord. Two common devices for cervical traction are described - Gardner-Wells tongs and halo rings. Placement of pins and weights used are outlined for safe and effective closed reduction. Common fractures like facet dislocations and Hangman's fractures are also reviewed.
This document discusses different types of splints and traction used for immobilizing fractures. It describes ladder splints, Thomas splints, and Bohler's modification of the Braun splint. Thomas splints consist of a ring, medial bar, and lateral bar and are used to immobilize the lower limb. Bohler's modification uses pulleys to allow changing the angle of traction without adjusting the traction arrangement. The document also covers skin traction versus skeletal traction, application sites for each, and risks associated with traction use.
This document discusses prostatectomy procedures including simple and radical prostatectomy. Simple prostatectomy involves removing part of the prostate for benign conditions, while radical prostatectomy removes the entire prostate and surrounding tissues for prostate cancer. The document describes different approaches for radical prostatectomy including radical perineal, supra pubic, and retro pubic. Key instruments used in prostatectomy are also listed such as retractors, forceps, scissors, and hemoclip appliers.
1. An intercostal drain, or chest tube, is a flexible plastic tube inserted through the chest wall to drain fluid or air from the pleural space. It works using an underwater seal mechanism that allows drainage out while preventing fluid or air from entering.
2. Chest tube insertion involves local anesthesia, positioning the patient, and using sterile technique to insert the tube through the chest wall into the pleural space. Ultrasound is used to guide placement and ensure the tube does not injure organs.
3. Physiotherapy for a patient with a chest tube focuses on wound care, pain management, deep breathing exercises, early mobilization, and exercise to improve ventilation and recovery.
1. Rehabilitation after lower limb amputation involves pre-op, post-op, and long-term phases aimed at preventing complications, educating the patient, and improving functional mobility and independence.
2. The post-op phase focuses on managing pain, increasing range of motion and strength, promoting wound healing, and training the patient in mobility and prosthetic use.
3. Long-term rehabilitation involves community and vocational reintegration, lifelong prosthetic management, and psychological support through follow-ups and support groups.
The document discusses different types of prostheses used to replace missing limbs. It describes exoskeletal and endoskeletal prosthetic designs, and covers the basic components and classifications of prostheses. Myoelectric prostheses that use muscle signals and various types of feet - including SACH, Jaipur and dynamic response feet - are explained. The document provides details on prostheses for transtibial and transfemoral amputations, including PTB and quadrilateral socket designs and considerations for bilateral transfemoral amputees.
Orthotics are devices used to support or correct deformities and impairments of the foot, ankle, knee, and hip joints. A foot orthotic is customized to fit inside the shoe to correct foot alignment. An ankle-foot orthosis (AFO) consists of a shoe attachment, ankle control, and leg band to support the ankle. A knee-ankle-foot orthosis (KAFO) adds a knee control to an AFO. The most specialized orthosis is a total hip-knee-ankle-foot orthosis (THKAFO) which incorporates a hip joint and trunk band. Orthoses are customized to meet individual functional needs and goals.
The document discusses various aspects of traction including definition, history, types (skin vs skeletal), application techniques, risks, and clinical uses. Traction involves applying a pulling force to reduce fractures or dislocations. Skin traction spreads the force over a large area but limited weight. Skeletal traction applies force directly through pins or wires inserted in bones, allowing greater weights. Proper application and counter-traction are important to achieve effective reduction. Clinical applications include treatment of fractures of the femur, hip, spine and extremities. Risks include skin issues, infection and failure to maintain reduction.
This document defines kyphosis as an excessive backward curvature of the spine localized to the thoracic spine, known as a "rounded back" posture. It can be caused by conditions like arthritis, tuberculosis, or postural habits. Kyphosis is classified by severity from first to third degree based on effects like muscle imbalance or vertebral wedging. More severe kyphosis can compress spinal structures and restrict breathing. Rehabilitation focuses on stretching, strengthening, bracing, and manual mobilization to reduce the curvature and its impacts. Studies show manual mobilization and techniques applying passive transverse forces can help attenuate thoracic kyphosis, especially in elderly patients with osteoporosis.
This document provides definitions and information about orthotics. It defines orthotics as externally applied devices that modify the structural and functional characteristics of the neuromuscular and skeletal systems to enable better use of the body part. The document then discusses principles, functions, indications, prescription processes, and nomenclature of various orthotic devices for the spine, upper limbs, lower limbs, knees, and hips. Examples and purposes of different orthotic devices are provided for each body region.
The document discusses crutch walking and the proper use of crutches. It defines crutches as assisting patients to walk while providing support. Crutches increase base of support, maintain center of gravity, redistribute weight bearing, compensate for weak muscles, and decrease pain. Proper crutch use requires muscle strength, correct crutch selection, balance, proper gait patterns, and instructions. There are two main types of crutches: standard axillary crutches and forearm crutches. The document outlines correct stance and four different crutch walking gaits.
Chest physiotherapy involves techniques like percussion, vibration, and postural drainage to mobilize pulmonary secretions in patients who have difficulty coughing them up. It is indicated for conditions involving thick secretions like cystic fibrosis or bronchiectasis. The techniques are contraindicated in situations involving bleeding or instability. Assessment involves a physical exam and reviewing medications and imaging before techniques are applied in specific positions targeting different lung lobes and segments to drain secretions into larger airways.
Orthosis are devices used to support weak joints and correct deformities. They work by applying three point pressure and distributing weight across a wide surface area. Common orthosis include ankle foot orthosis (AFO) which support the ankle and foot, knee ankle foot orthosis (KAFO) which stabilize the knee and lower leg, and hip knee ankle foot orthosis (HKAFO) which provide support from the hip to the foot. Orthosis are made of plastic or metal and their design depends on the joints needing support and the individual's condition.
The document provides information on dressings, bandages, fractures, dislocations, and splinting. It discusses the purpose of dressings in controlling bleeding and absorbing fluids. It describes different types of dressings and bandages, including adhesive dressings for small wounds and various bandage application methods. The document outlines signs and symptoms of fractures and dislocations, and emphasizes immobilizing suspected fractures with splints until medical treatment.
The document provides information about plaster of Paris casts, including their history, composition, application process, types, and care. Some key points:
- Plaster of Paris casts were first used in 1852 and set via an exothermic reaction as calcium sulfate rehydrates.
- Proper application involves padding, applying wet plaster in layers with 50% overlap, holding any reductions, and allowing the cast to fully dry.
- Common cast types include slabs, full casts, spica casts, and braces. Factors like the fracture and joint positions determine the type.
- Signs of compromised circulation like swelling, numbness, or pain require immediate medical attention. Keeping the cast dry
Assist in application & Removal of plaster cast.Abhishek Yadav
This document provides information on assisting with the application and removal of plaster casts. It defines casts and slabs, describes their purposes and types. The key steps of the application process are outlined, including preparing the patient and materials, applying the cast correctly in layers, and ensuring proper positioning afterwards. Potential complications are listed. The purpose and process of cast removal is also defined, including the use of tools like scissors, vibrators and dilators to carefully cut and remove the cast.
it explain about introduction, definition, purpose of applying cast, indcation, type of cast, procedure of application and removal of plaster and management.
This document provides information for an orthopedic symposium on splinting and casting techniques. It includes:
- An agenda for the event with topics on splinting, casting, patient monitoring and discharge instructions.
- Learning objectives around hands-on skills for splinting and casting applications.
- Details and instructions for applying several common splints and casts including volar splints, thumb spica splints, ankle splints and short arm, thumb spica and short leg casts.
- Information is provided on indications, materials needed, techniques, precautions and patient instructions for each application.
Clean the site with an alcohol swab in a circular motion from the center outward. Allow to air dry.
8. Put on sterile gloves
9. Pick up the needle and hold it like a dart. Insert the needle at 10-15 degree angle into the vein.
10. Advance the needle into the vein until blood flashes back into the hub.
11. Advance the catheter over the needle into the vein until resistance is felt.
12. Remove the needle and discard in a sharps container.
13. Attach the IV tubing to the catheter hub.
14. Release the tourniquet.
15. Secure the catheter to the skin using tape or transparent dressing.
This document discusses various surgical techniques used in orthopedic surgery, including the use of tourniquets, patient positioning, radiographs, and draping. It provides details on:
- How tourniquets are used to temporarily occlude blood vessels and control blood flow during limb surgery.
- The history of tourniquet use and different tourniquet types.
- Guidelines for applying tourniquets, exsanguinating limbs, and setting appropriate pressure levels.
- Best practices for positioning patients, preparing surgical sites, and draping to ensure safety and sterile technique.
The BANDAGING for First Aid Provider and Health care PersonelSankappa Gulaganji
BANDAGING
Dr. Sankappa Gulaganji
Associate Professor
BLDEA’s Shri B M Patil Institute of Nursing Sciences, Vijayapur
Definition
A strip of material used mainly to support and immobilize a part of the body. Definition of a bandage. And used
To support - fractured bone
To immobilize – Dislocated shoulder/Jaw
To apply pressure – Stop bleeding & Improve venous blood flow.
To secure a dressing in place.
To retain splints in place.
TYPES OF BANDAGING
Crepe bandages: Crepe bandages, commonly made of cotton, are a woven, elasticated bandage. Crepe bandages are ideal to support the healing of sprains and strains, as they provide good compression to injured areas, as per the PRICE method, but as they’re elastic they don’t prevent joints or muscles from flexing. Washable & Reusable
Conforming bandages: Conforming bandages are very stretchy and, as their name suggests, conform closely to the body’s contours. These bandages are ideal for securing dressings in place, particularly on limbs. These bandages are lightweight, fray-resistant and breathable. These are usually made with synthetic materials.
PRICE Method
Cohesive bandages (adhesive): Cohesive bandages are designed to stick to themselves, but not to skin or hair. This makes cohesive bandages quick and easy to apply and remove, not requiring any tape or pins to hold them in place. These bandages can be used both for holding wound dressings in place and for supporting and providing compression to injured muscles or joints.
Open wove bandages(cotton/Gauze): Unlike other kinds of bandage, these bandages are non-elastic, and can be used to hold dressings in place without constricting or pressuring the wound. This does however make them unsuitable for PRICE therapy. Their loose weave allows good ventilation, helping the skin to breathe and avoiding infection.
Plaster of paris: These bandages are used for creating casts to provide rigid immobilisation of fractured or broken limbs. Impregnated with Plaster of Paris (calcined gypsum), once immersed in water, these bandages can be moulded to the limb. The bandages then set fast into a strong, solid cast. These bandages should only be applied by medical professionals.
Triangular bandage:
Method of Applying Bandages
Circular
Spiral
Reverse Spiral
Figure of Eight
Principles for Applying Bandages
Wash hands
Give victim comfortable position on bed or chair and support the body part to be bandaged.
Always stand in front of the part to be bandaged except when applying bandages to head, eye and ear.
Be sure the bandages is rolled firm.
Make sure the body part to be bandaged is clean and dry.
Assess skin before applying bandage for any break down.
Observe circulation by noting pulse, surface temperature, skin color and sensation of the body part to be wrapped.
Always start bandaging from inner to outer aspect and far to near end.
When bandaging a joint ensures flexibility of the joint.
Always start and end two circular turns.
Cover the area
This document provides information on splinting and casting methods for injuries. It describes the types of materials used for splints and casts including plaster of Paris, fiberglass, stockinette and cotton. It outlines indications and contraindications for splinting. The principles of fracture reduction and casting position are explained for various injuries like Colles' fractures, scaphoid fractures and humerus fractures. Casting positions and applications are described for the wrist, hand and forearm.
This document provides information on types of wounds, dressings, bandages, and bandaging techniques. It discusses abrasions, lacerations, puncture wounds, and other types of wounds. It describes adhesive dressings and gauze dressings that are used to cover wounds. The major types of bandages are roller, tubular, and triangular bandages, which are used to cover wounds, control bleeding, or support injuries. Basic bandaging forms include circular, spiral, figure-of-eight, recurrent, and reverse spiral techniques. The document provides guidance on selecting the appropriate materials and applying bandages to specific body parts.
This document discusses principles of casting and splinting and common pitfalls. It begins by noting how casting skills have declined with newer fixation methods, though casting remains important. It then covers materials like plaster and fiberglass, their properties, advantages, and disadvantages. Key principles discussed include properly padding and molding casts to avoid pressure sores, not overtightening, and positioning joints in positions that maintain mobility. The document cautions against errors like blocking finger motion with upper extremity casts. It provides guidance on casting different areas like the hand, elbow, and lower limb in functional positions. Methods of cast wedging to regain reduction are also reviewed.
The document discusses various topics related to surgical procedures including patient positioning, skin preparation, surgical incisions, suturing techniques, and types of sutures and needles. It provides details on different incision types for procedures like laparotomy and their advantages and disadvantages. It also describes characteristics of round-bodied needles, cutting needles, and factors to consider when choosing sutures and needles for procedures.
The document discusses various topics related to surgical procedures including patient positioning, skin preparation, surgical incisions, suturing techniques, and types of sutures and needles. It provides details on different incision types for procedures like laparotomy and their advantages and disadvantages. It also describes characteristics of various needles like shape, size, and applications as well as suture materials.
This document provides guidelines for applying casts and splints, including:
1) Inspecting the extremity for injuries before application and checking neurovascular status after;
2) Using stockinette, padding, and splint material like plaster or fiberglass layered and molded to the extremity;
3) Ensuring proper padding and positioning of joints during application.
Casting Technique and Modification process of Hip Disarticulation.pptxRishiRajgude
Casting techniques for hip disarticulation prosthetics are crucial for ensuring a comfortable and functional fit for the prosthesis. Some common methods include:
Total Suspension Casting: This method involves suspending the patient to create a mold that accurately captures the shape of the body where the prosthesis will be attached1.
Forming Blocks: This technique uses blocks to form the shape of the prosthesis around the patient’s body, marking key anatomical points like the iliac crests and pubis2.
Anatomical Compression Contour Method: Developed by Bobby Latham, CP, and Alex Hedquist, CPO, this method focuses on creating a contour that fits the anatomy of the patient3.
Each of these techniques has its own advantages and is chosen based on the individual needs of the patient, the type of prosthesis being fitted, and the expertise of the prosthetist. For more detailed information, you can refer to this Presentation.
This document provides information on various types of bandaging including the principles, procedures, and techniques for bandaging different parts of the body like the eye, ear, finger, elbow, and stump. It discusses selecting the appropriate bandage material, preparing the patient, and correctly applying bandages while following steps like starting from the inner aspect and overlapping turns. Specific bandaging methods are explained for different body parts.
Bandages and binders are used to support injuries, hold dressings in place, and immobilize body parts. The three major types are roller, tubular, and triangular bandages. Roller bandages can be elastic or non-elastic and are used for wounds, sprains, and holding dressings. Tubular bandages are for fingers and toes. Triangular bandages make slings and cold compresses. Proper application includes circular, spiral, figure-eight, recurrent, and reverse spiral wrapping techniques.
BANDAGING: TRIANGULAR BANDAGING AND CRAVAT, TYPES OF KNOTSManisha Thakur
BANDAGING: TRIANGULAR BANDAGING AND CRAVAT, TYPES OF KNOTS: CRAVAT, ELBOW BANDAGE, ARM SLING, PALM BANDAGE, HAND BANDAGE, HEAD BANDAGE, ELBOW BANDAGE, EAR INJURY BANDAGE, FOREARM BANDAGE, LEG AND THIGH BANDAGE, FOOT BANDAGE. TYPES OF KNOTS: PRINCIPLES OF TYING KNOTS, TYPES: REEF KNOT, BOWLINE , SHEET BENT
This document discusses bowel elimination and enemas. It begins by defining defecation and factors that can affect bowel function. It then describes types of altered bowel function and normal patterns. The document focuses on enemas, defining them as the introduction of fluid into the rectum and colon. It describes various types of enemas including cleansing, retention, and rectal washouts. It provides details on administering enemas, including equipment, procedures, solutions used, and contraindications. The overall purpose is to review bowel elimination and the use of enemas to promote or treat bowel function.
1. The document discusses human development from fertilization through birth. It describes the processes of gametogenesis, fertilization, gastrulation, and organogenesis.
2. During gastrulation, the zygote undergoes cell migration and differentiation to form the three germ layers - ectoderm, mesoderm, and endoderm - which go on to generate the major tissues and organ systems.
3. The period from 3-8 weeks is known as the organogenesis stage, where rapid development and differentiation of organs occurs. Exposure to environmental factors during this critical stage can result in birth defects.
The document provides an overview of the digestive system. It discusses that the digestive system breaks down food into smaller particles for absorption by cells in the body. The two main functions are digestion and absorption. The digestive system is divided into the gastrointestinal tract and accessory organs. The gastrointestinal tract extends from the mouth to the anus. Accessory organs include things like the liver and pancreas which release substances into the GI tract.
Bacteria are classified based on taxonomy, nomenclature, and observational techniques. Morphology, staining properties, motility, growth characteristics, biochemical activities, and genetics are used to classify and identify bacteria. Bacterial cells have a cell envelope consisting of a capsule, cell wall, and cell membrane. The cell envelope encloses cellular elements like ribosomes, nucleoid, and mesosomes. Some bacteria also have extracellular appendages like flagella and pili.
This document outlines different classes of adrenergic drugs including agonists and antagonists. Adrenergic agonists can be direct-acting, mimicking norepinephrine, or indirect-acting, promoting norepinephrine release. Examples include epinephrine, norepinephrine, dopamine, and isoproterenol. Adrenergic antagonists block receptors and include alpha blockers like prazosin and beta blockers like propranolol. Indirect antiadrenergic agents decrease norepinephrine release through mechanisms like depletion from neurons (reserpine) or inhibition of release (guanadrel).
Pain serves as a protective mechanism and is part of the normal healing process. Analgesics are drugs that selectively relieve pain by acting in the central nervous system or peripheral mechanisms without significantly altering consciousness. They are largely classified as opioids like morphine and codeine or NSAIDs like aspirin and ibuprofen. Opioids act by binding to opioid receptors in the CNS to produce analgesic effects, while NSAIDs block prostaglandin production by inhibiting the cyclooxygenase pathway to reduce inflammation and pain. Both drug classes can cause adverse effects like gastrointestinal issues, bleeding risks, and dependence/withdrawal symptoms that require careful consideration of risks and benefits when used clinically.
The document discusses surgical conscience and ethics. It defines surgical conscience as doing unto patients as you would want done to yourself. This involves respecting patients, their privacy, beliefs and needs. Reporting incidents and being honest are also important ethical responsibilities. Situations like peer apathy, stress or personal problems can undermine surgical conscience. The document also outlines legal aspects of surgery, criminal responsibilities, areas of negligence and hazards in the operating room environment.
This document provides an overview of different types of anesthesia including local, regional, and general anesthesia. It discusses key terms, types of local anesthesia including infiltration and nerve blocks, common local anesthetic agents and their uses. Regional anesthesia techniques like epidural and spinal anesthesia are also covered. The stages of general anesthesia induction, excitement, relaxation, and danger are defined. Methods of administering general anesthesia via inhalation are described.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
1. Cast
• Objectives
– At the end of this lesson the students will be
able to
• Define the term cast
• Describe the indications and
contraindications for cast application.
• Identify the materials used in cast
application and cast removal.
• List and explain the steps to applying a
plaster cast and removing cast.
• List the complications of cast
• Discuss nursing cares for patient with cast
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2. A cast is a rigid external immobilizing device that is
molded to the contours of the body.
• A cast is used specifically:
to immobilize a reduced fracture,
to correct a deformity,
to apply uniform pressure to underlying soft tissue, or
to support and stabilize weakened joints.
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3. Types of Cast
• Short arm cast
Extends from below the elbow to the palmar crease,
secured around the base of the thumb.
If the thumb is included, it is known as a thumb spica or
gauntlet cast.
The short arm cast may be used for:
Distal forearm fractures
Wrist sprains and carpal injuries
Some metacarpal fractures
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5. …..Types of Cast
• Thumb spica cast
– The thumb spica cast may be used for:
• Scaphoid fractures
• Some thumb fractures
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6. …….Types of Cast
• Long arm cast
Extends from the upper level of the auxiliary fold to the proximal
palmar crease.
The elbow usually is immobilized at a right angle.
The long arm cast may be used for:
Mid to proximal forearm fractures
Elbow fractures and dislocations
Distal humeral fractures
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8. …….Types of Cast
• Short leg cast:
– Extends from below the knee to the base of the
toes.
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9. ……Types of Cast
• Long leg cast
–Extends from the junction of the upper and middle
third of the thigh to the base of the toes.
–The long leg cast may be used for:
• Tibial fractures
• Femoral fracture
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21. Cast Application
• Equipments
–Stockinette
• Stockinette is usually the first layer applied
over the area to be cast.
• Its ends can be folded over the cast edges to
soften them.
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23. Cast Application
• Equipments
–Cotton
• Cotton comes in a range of widths from 5-15
cm; the smallest ones are easiest to work with.
• 5-10 cm cotton should be used for the upper
extremity and 10-15 cm for the lower
extremity.
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25. Cast Application
• Equipments
–Plaster of Paris
• Plaster is the most commonly used casting
material.
• Immersion in water initiates an exothermic
reaction in the plaster causing it to harden.
• Once applied, it will feel hard within 4 minutes,
however, it takes 2-3 days to dry completely.
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27. Cast Application
• Equipments
–Bucket
• The bucket should be filled with water at or below
room temperature.
• Cooler water decreases the risk of burning the
patient’s skin as the plaster sets and
• also allows for more working time with the casting
material.
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31. Cast Application
• Step 1: Evaluation
the nurse should prepare the patient for the sensation of
increasing warmth so that the patient does not become
alarmed.
Before cast application, certain examinations must be
performed:
Complete neurovascular exam of the affected region
Note the quality of the skin in the region to be cast
Radiographs as necessary
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32. Cast Application
• Step 2: Prepare equipment
Choose appropriate width stockinette:
5 cm for arm
7.5 cm for leg
Prepare rolls of the appropriate width of plaster of
paris
7.5 cm for arm
10-15 cm for lower leg
20 cm for thigh
Fill plaster bucket with room temperature water.
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33. Cast Application
• Step 3: Prepare patient
The patient should be positioned such that both they,
and the person applying the cast, will be comfortable
for the procedure.
For upper extremity casting, this
may sometimes involve propping the patients arm up
on a table or similar support.
For lower leg casts, the patient may sit with their leg
over the side of the bed or raised up from the bed on a
prop.
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34. • Step 4: Stockinette
Measure the length of stockinette needed.
It should extend 3-4 cm beyond the area to be cast at
each end.
Using your own palm length as a guide, determine
where the thumb hole is to be cut.
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35. Cont……d
• Step 4: Stockinette
At this location, cut a slit in the stockinette large
enough to give the base of the thumb lots of space.
Roll the stockinette over the area to be casted and
smooth it out.
Never apply plaster to skin or stockinette alone!
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36. Cont……d
• Step 5: Cotton
Begin wrapping the cotton about 2 cm above where the
cast edges will be.
Beginning proximally, wrap the cotton distally,
overlapping the layers by 50%.
When you reach the hand, the cotton may need to be
torn to better contour the base of the thumb.
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37. Cont……d
• Step 5: Cotton …
Once the hand is wrapped, continue back up the
forearm
Extra pieces of cotton folded to half their width
can be applied at either end of the cast for
smoother cast edges.
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38. Cont……d
Joints should be placed in their proper position of function
before, during, and after padding is applied to avoid areas of
excess wrinkling and subsequent pressure.
In general, the wrist is placed in slight extension and ulnar
deviation, and the ankle is placed at 90 degrees of flexion.
Elbow at right angle.
mulualem .B.(BSc,MSc) 38
39. Cont…..d
• Step 6: Prepare plaster
Hold the plaster roll in one hand and the free end of the
plaster in the other
Holding the roll obliquely, immerse the entire roll of
plaster in water.
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40. Cont…….d
• Step 6: Prepare plaster
When the bubbles stop, remove the roll
and gently squeeze to remove some of the excess water.
Do not squeeze too much water out or you will have less
working time and much of the plaster will be squeezed
back into the bucket.
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41. Cast Application
• Step 7: Apply plaster
As the plaster is being applied, it can be smoothed out with the
flat palmar surface of the hand. Not on your finger,
The entire cast should use about 3 rolls of plaster.
Start proximally and wrap towards the hand
When applying plaster to the palm and between thumb and
index finger, pinch the plaster to decrease its width.
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42. Cont…..d
• Step 7: Apply plaster…
Fold the plaster back on itself to create a thicker pad of
plaster to reinforce the palm, where much cast wear
occurs.
Fold the stockinette and cotton over the first layer of
plaster to create a smooth cast edge.
Continue to apply the final layer of plaster and smooth
outer surface.
mulualem .B.(BSc,MSc) 42
43. • Step 8: Mould plaster
The cast should be molded, depending on the type of
cast, to maximize its fit on the limb.
Rub the cast to help the plaster layers adhere to each other
and give it a smooth surface
To mould, apply pressure with the flat palmar surface of
your hands.
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44. Cast Application
• Step 9: “Finish” cast:
Smooth edges.
Trim and reshape with cast knife or cutter.
Remove particles of casting materials from skin.
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45. Cast Application
• Step 10: Support cast during hardening.
Handle hardening casts with palms of hands.
Support cast on firm smooth surface.
Avoid pressure on cast.
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46. Cast Application
• Step 11: Promote drying of cast.
Leave cast uncovered and exposed to air.
Turn patient every 2 hours supporting major joints.
Fans may be used to increase air flow and speed
drying.
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47. Cast Application
• Step 12: Patient instructions
Keep the cast dry!
Plaster casts take 2-3 days to dry completely
To reduce and minimize swelling, the limb should be
elevated at a level of the heart for at least 2 days.
Fingers and toes should be wiggled often
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48. Cast Application
• Step 12: Patient instructions…
– DO NOT:
• Put anything down the cast
• Trim or cut the cast
• Remove any padding from the cast
• Drive while in a cast.
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49. How To Know if Something Is Wrong With Your Cast
Pain that is not adequately controlled with medication
prescribed by your doctor.
Increasing swelling
Numbness or tingling in the extremity (hand or foot).
Inability to move your fingers or toes beyond the cast.
Circulation problems in your hand or foot.
Loosening, splitting or breaking of the cast.
Unusual odors, sensations, or wounds beneath the cast.
If you develop a fever or generalized illness
mulualem .B.(BSc,MSc) 49
50. Cast removal
It is important to remember that removing a cast can be a
frightening experience for patients.
A clear explanation of how the cast saw works will help
improve the patient’s comfort.
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56. Cast removal
• Step 1: Cast saw
Inform and explain the patient about the procedure.
Cut two straight lines down either side of the cast moving
the saw in and out with brisk movements
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57. Cast removal
• Step 1: Cast saw…
When making a cut, apply pressure until you feel the
release of the saw cutting through to the other side.
If the patient complains of pain, stop the saw and assess
the area.
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59. • In hand plaster Only one cut is required, because the plaster is
thin enough to be opened out without difficulty when it has
been cut through. In the leg plaster two cuts should be made.
The first cut should be made along the lateral surface and
should pass behind the lateral malleolus, in the hollow
between the malleolus and the heel.
• Hence it should extend along the lateral border of the sole of
the foot. The second cut should be made along a
corresponding line at the medial side of the plaster, passing
behind the medial malleolus.
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61. Cast removal
• Step 2: Cast spreader
–Use the cast spreaders to widen the opening
made by the cast saw.
• Step 3: Cut through padding
–Use the blunt ended bandage scissors to cut the
cotton and stockinette.
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62. Cast removal
• Step 4: Skin treatment
–Assess the skin that was under the cast for any
damage, and to ensure any incisions have healed.
–The skin can be washed with a mild soap.
–Apply emollient lotion.
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63. Cast removal
• Step 4: Patient teaching
–Teach patient to avoid rubbing and scratching skin
–Teach patient to control swelling by elevating the
extremity or using elastic bandage if prescribed.
• The extremity is elevated (but no higher than heart
level, to minimize the effect of gravity on perfusion
of the tissues).
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64. Cast
• Complications
– Compartment syndrome
– Pressure points/skin breakdown: This happens most
commonly with the peroneal and radial nerves.numbnes
– Skin irritation
– Loss of reduction(healing): As swelling subsides, the cast
will become looser, and fracture reduction may be lost.
– This can be avoided by following up with the patient 7-10
days after cast application, to ensure the cast still fits
properly.
– Disuse syndrome
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65. Cast Care
• The following information provides general
guidelines
–Keep cast dry. Moisture weakens plaster and
damp padding next to the skin can cause
irritation.
–Walking casts. Do not walk on a "walking
cast" until it is completely dry and hard. It
takes about two to three days for plaster to
become hard enough to walk on.
–Avoid dirt. Keep dirt, sand, and powder away
from the inside of the cast.
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66. Cast Care
• The following information provides general guidelines…
– Padding. Do not pull out the padding from the cast.
– Itching. Do not stick objects such as coat hangers inside
the cast to scratch itching skin. Do not apply powders or
deodorants to itching skin.
– Trimming. Do not break off rough edges of the cast or
trim the cast before asking your health professionals
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67. Cast Care
• Swelling due to the injury may cause pressure in the
cast for the first 48 to 72 hours.
• This may cause the injured arm or leg to feel snug or
tight in the cast.
• It is very important to keep the swelling down.
• This will lessen pain and help the injury heal.
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68. • Pain associated with the underlying condition (eg,
fracture) is frequently controlled by immobilization.
Pain due to edema that is associated with trauma,
surgery, or bleeding into the tissues can frequently
be controlled by elevation and, if prescribed,
intermittent application of cold packs.
Ice bags (one-third to one-half full) or cold application
devices are placed on each side of the cast, if
prescribed, making sure not to indent or wet the cast.
mulualem .B.(BSc,MSc) 68
69. Cont……d
• Pain may be indicative of complications. Pain
associated with compartment syndrome is relentless
and is not controlled by modalities such as elevation,
application of cold if prescribed, and usual dosages
of analgesic agents.
• Severe burning pain over bony prominences,
especially the heels, anterior ankles, and elbows,
warns of an impending pressure ulcer
mulualem .B.(BSc,MSc) 69
70. Cast Care
• To help reduce swelling:-
–Elevate.
• It is very important to elevate your injured
arm or leg for the first 24 to 72 hours.
• Elevation allows clear fluid and blood to
drain "downhill" to your heart.
–Exercise.
• Move uninjured, but swollen fingers or
toes gently and often.
• Moving them often will prevent stiffness
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71. • Isometric contractions of the muscle maintain
muscle mass and strength and prevent atrophy.
• Quadriceps-Setting Exercise
• Position patient supine with leg extended.
• Instruct patient to push knee back onto the mattress
by contracting the anterior thigh muscles.
• Encourage patient to hold the position for 5 to 10
seconds. Let patient relax.Have patient repeat the
exercise 10 times each hour when awake.
mulualem .B.(BSc,MSc) 71
72. • Gluteal-Setting Exercise
• Position patient supine with legs extended, if
possible. Instruct patient to contract the muscles of
the buttocks. Encourage patient to hold the
contraction for 5 to 10 seconds. Let the patient relax.
Have patient repeat the exercise 10 times each hour
when awake.
• For hand …instruct the patient ‘make fist’.
mulualem .B.(BSc,MSc) 72
73. Cast Care
• To help reduce swelling…
–Ice.
• Apply ice to the cast.
–Place the ice in a dry plastic bag or ice
pack and loosely wrap it around the
cast at the level of the injury.
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74. Cast Care
• Warning Signs
–Increased pain and the feeling that the cast is
to tight.
–Numbness and tingling in the hand or foot.
–Burning and stinging.
–Excessive swelling below the cast.
–Loss of active movement of toes or fingers.
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75. Cast…..Nursing care
• Check color, temp, capillary refill, movement &
sensation of exposed part every 2 hrs for 24 hrs then
every 4 hrs.
• Change patient's position every 2 hrs.
while awake.
• Use proper positioning to keep pressure off
prominences in cast (i.e. heels).
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76. Cast…Nursing care
• Check skin around cast edge every 4 hrs
• Monitor if there is any broken skin, foul odor or
drainage noted under cast edges.
• Provide daily nursing care.
• Teach family care of cast while in hospital.
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77. Cast
• Key points
–Definition of cast
–Types of cast
–Cast application
• Equipment
• Procedure
–Cast removal
• Equipment
• Procedure
–Nursing care for pts with cast
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78. Fixation
• Objectives
–At the end of this lesson the student will be
able to:-
Define what fracture fixation mean
Describe the difference between internal and
external fixation of fracture
Identify internal and external fixation materials
Discuss how to assist during fixation application
Discuss nursing care for patient with fracture
fixation
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79. Fixation
• Fixation is the process of holding or fastening in a fixed
position
• Fracture Fixation is the immobilization of the parts of a
fractured bone especially by the use of various metal
attachments.
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80. Fixation
• The basic goal of fracture fixation
To stabilize the fractured bone.
To enable fast healing of the injured bone.
To return early mobility and full function of the injured
extremity.
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81. Types of fixation for fracture
1. External fixation
2. Internal Fixation
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82. External fixation
A device placed outside the skin that stabilizes bone fragments
with pins or wires connected to bars.
• Is a surgical treatment used to stabilize bone and soft
tissues at a distance from the operative or injury focus.
Indication
Fractures with soft tissue damage
Polytrauma – damage control surgery
Skeletal infection.
mulualem .B.(BSc,MSc) 82
83. • External fixation materials
–The most common external fixation
materials
Cast
Splint
Bandages
Traction
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84. External Fixation
• Splint
– A splint is a device used for support or
immobilization of limbs or of the spins.
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85. External Fixation
• Bandage
– A bandage is a strip of material such as gauze used to protect,
immobilize, compress, or support a wound or injured body part.
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86. External Fixation
External Fixation Advantages
– Minimal damage to blood supply
– Minimal damage to soft tissues
– Fixation is away from site of injury
– Good option when significant infection risk
External Fixation Disadvantages
– Restricted joint motion
– Pin tract infection
– Inadequate stability for certain fractures.
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87. Fixation
• Risks and complications of fixation materials
Infection
Stiffness
Loss of range of motion
Non-union and mal-union
Damage to the muscles and nerve
Arthritis and tendonitis
Chronic pain associated with plates, screws, and pins
Compartment syndrome and Deformity
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88. External Fixation
• Nursing Interventions
It is important to prepare the patient psychologically for
application of the external fixator.
After the external fixator is applied, the extremity is elevated to
reduce swelling.
If there are sharp points on the fixator or pins, they are covered
to prevent device-induced injuries.
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89. • Nursing Interventions
The nurse monitors the neurovascular status of the extremity
every 2 to 4 hours and assesses each pin site for redness,
drainage, tenderness, pain, and loosening of the pin.
The nurse must be alert for potential problems caused by
pressure from the device on the skin, nerves, or blood vessels
and for the development of compartment syndrome
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90. Internal Fixation for Fractures
Internal fixation is an operation in orthopedics that involves
the surgical implementation of implants for purpose of
repairing a bone.
Indications for Internal Fixation
Displaced intra-articular fracture
Axial, angular, or rotational instability that cannot be controlled by closed
methods
Open fracture
Polytrauma
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91. • Benefits of Internal Fixation
Earlier functional recovery
More predictable fracture alignment
Potentially faster time to healing
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92. • Internal Fixation materials for Fractures
– The most common types of internal fixation
materials are :-
• Wires
• Plates
• Pins
• Nails or Rods
• Screws
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93. • Internal Fixation materials
–Wires
Wires are often used as sutures or threads to "sew" the
bones back together.
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94. • Internal Fixation materials…
–Pins
Pins hold pieces of bone together.
They are usually used in pieces of bone that are too small to
be fixed with screws.
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95. • Internal Fixation materials
– Plates
• Plates are like internal splints that hold the fractured ends of
bone together.
• Extend along the bone and are screwed in place.
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96. • Internal Fixation materials
–Nails or Rods
• inserting a rod or nail through the hollow center of the bone
that normally contains some marrow.
• Held in place by screws until the fracture has healed.
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97. • Internal Fixation materials
– Screws
• Bone screws are used for internal fixation more often than
any other type of implant.
• Can be used alone to hold a fracture, as well as with plates,
rods, or nails.
• May be left in place, or removed after the bone heals.
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99. • Nursing Interventions…
– This typically includes cleaning each pin site separately three
times a day with cotton-tipped applicators soaked in sterile
saline solution.
– Crusts should not form at the pin site.
– Sterile conditions and advances in surgical techniques reduce,
but do not remove, the risk of infection when internal fixation is
used.
– The severity of the fracture, its location, and the medical status
of the patient must all be considered.
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100. Key points
• Definition of fixation
• Types of fixation
– Internal
– External
• Fixation materials
• Nursing intervention for patient with fixation
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101. Traction
• Traction is the application of a pulling force to a part of the
body.
• Purposes:
– To minimize muscle spasms
– To reduce, align, and immobilize fractures
– To reduce deformity
– To increase space b/n opposing surfaces
• As muscle and soft tissues relax, the amount of weight used
may be changed to obtain the desired effect.
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102. Types of Traction
• The 3 basic types of traction are
– Manual
– Skin
– Skeletal
• The categories reflect the manner in which
traction is applied.
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104. Principles of effective traction
Whenever traction is applied, counter traction must be used to
achieve effective traction.
Counter traction is the force acting in the opposite direction.
Usually, the patient’s body weight and bed position
adjustments supply the needed counter traction.
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106. Skin traction
Used to control muscle spasms and to immobilize an area
before surgery.
Uses a weight to pull on traction tape or on a foam boot
attached to the skin.
The amount of weight applied must not exceed the tolerance of
the skin.
No more than 2 to 3.5 kg of traction can be used on an
extremity
Pelvic traction is usually 4.5 to 9 kg, depending on the weight
of the patient.
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109. Skeletal traction
Skeletal traction is applied directly to the bone
This method of traction is used occasionally to treat fractures of
the femur, the tibia, and the cervical spine
The traction is applied directly to the bone by use of a metal pin
or wire inserted through the bone distal to the fracture
Avoid nerves, blood vessels, muscles, tendons, and joints
during application.
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110. 110
Cont’d…
• Skeletal traction frequently uses 7 to 12 kg to achieve the
therapeutic effect.
• The weights applied initially must overcome the shortening
spasms of the affected muscles.
• As the muscles relax, the traction weight is reduced to prevent
fracture, dislocation and to promote healing.
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112. • CONTRAINDICATIONS:
Patients with structural diseases secondary to tumor or
infection, rheumatoid arthritis and severe vascular
compromise.
Acute strains, sprains and inflammation condition
Malignancy
Aneurysm.
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113. Traction Care
The nurse must assess and monitor the patient’s psychological
responses to traction.
It is important to evaluate the body part to be placed in traction
and its neurovascular status and compare it to the unaffected
extremity.
As long as the client is in traction, skin integrity must be assessed
and documented, examining especially for redness, bruises, and
lacerations.
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114. Traction care
Traction must be continuous to be effective in reducing and
immobilizing fractures.
Skeletal traction is never interrupted.
Weights are not removed unless intermittent traction is
prescribed.
Any factor that might reduce the effective pull or alter its
resultant line of pull must be eliminated:
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115. Traction Care
The patient must be in good alignment in the center of the bed when
traction is applied.
Ropes must be unobstructed.
Weights must hang free and not rest on the bed or floor .
Knots in the rope must not touch the pulley or the foot of the bed.
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116. Nursing Management:
Alteration in Peripheral Tissue Perfusion:
Tissue perfusion is enhanced by client exercises within the
limitations of the traction.
Exercises, regular deep breathing and coughing, adequate
fluids, and elastic stocking work together to prevent deep
venous thrombosis.
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117. Nursing Interventions:
Peripheral sensation management :
Evaluating the client’s pain, sensation, active and passive ROM,
color, temperature, capillary refill time, and pulses.
Providing pin site care:
The wound at the pin insertion site requires attention .
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118. Nursing Interventions:
Attaining maximum mobility with traction:
During traction therapy:
Encourage the patient to exercise muscles and joints that are
not in traction.
During the patient exercises :
Ensures that traction forces are maintained and that the
patient is properly positioned to prevent complications
resulting from poor alignment.
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119. Nursing Interventions:
• Monitoring and managing potential
complications:
– Pressure Ulcers
– Venous Stasis and Deep Vein Thrombosis
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120. quiz
1. writ the two types of fixation(2.5)?
2. Write the common nurses roles for post op
patients from cast replacement(2.5)?
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121. Traction
• Reference
– Redemann S, Modalities for immobilization. In Maher A,
Salmond S, Pellino T, (Ed.), Orthopaedic Nursing,
Chapter 12, 311-318, 2002. Philadelphia: W B Saunders.
– Taylor I, Ward Manual of Traction, Chapter 2, 3, 5, 6.
1987, Churchill Livingstone.
– Traction Working Party, Traction update. Journal of
Orthopaedic Nursing, 6(4): 230-235, November 2002.
– 5National Association of Orthopaedic Nurses. (NAON).
Core Curriculum for Orthopaedic Nursing. 6th Edition.
Chapter 10. 2007.
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122. Nursing Management:
Alteration in Peripheral Tissue Perfusion:
Tissue perfusion is enhanced by client exercises within the
limitations of the traction.
Exercises, regular deep breathing and coughing, adequate
fluids, and elastic stocking work together to prevent deep
venous thrombosis.
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123. Nursing Interventions:
Peripheral sensation management :
Evaluating the client’s pain, sensation, active and passive ROM,
color, temperature, capillary refill time, and pulses.
Providing pin site care:
The wound at the pin insertion site requires attention .
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124. Nursing Interventions:
Attaining maximum mobility with traction:
During traction therapy:
Encourage the patient to exercise muscles and joints that are
not in traction.
During the patient exercises :
Ensures that traction forces are maintained and that the
patient is properly positioned to prevent complications
resulting from poor alignment.
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125. Nursing Interventions:
• Monitoring and managing potential
complications:
– Pressure Ulcers
– Venous Stasis and Deep Vein Thrombosis
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126. Traction
• Reference
– Redemann S, Modalities for immobilization. In Maher A,
Salmond S, Pellino T, (Ed.), Orthopaedic Nursing,
Chapter 12, 311-318, 2002. Philadelphia: W B Saunders.
– Taylor I, Ward Manual of Traction, Chapter 2, 3, 5, 6.
1987, Churchill Livingstone.
– Traction Working Party, Traction update. Journal of
Orthopaedic Nursing, 6(4): 230-235, November 2002.
– 5National Association of Orthopaedic Nurses. (NAON).
Core Curriculum for Orthopaedic Nursing. 6th Edition.
Chapter 10. 2007.
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Editor's Notes
Casts permit mobilization of the patient while restricting movement of a body part.
The purposes of a cast are to immobilize a body part in a specific position and to apply uniform pressure on encased soft tissue.
The metacarpophalangeal joints (MCP) are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the first phalanges, with the exception of that of the thumb, which is a saddle joint.
The scaphoid bone is one of the carpal bones of the wrist. It is situated between the hand and forearm on the thumb side of the wrist (also called the lateral or radial side). It forms the radial border of the carpal tunnel.
Compartment syndrome is a limb- and life-threatening condition which occurs after an injury, when there is insufficient blood supply to muscles and nerves due to increased pressure within the compartment such as the arm, leg or any enclosed space within the body.
Insensate limbs-lacking sensation
For upper extremity casting, this may sometimes involve propping the patients arm up on a table or similar support.
For lower leg casts, the patient may sit with their leg over the side of the bed or raised up from the bed on a prop.
prop [prop]
noun (plural props)
1. rigid support: a rigid object, e.g. a beam, stake, or pole, that supports something or holds it in place
Wiggled:shake ,move
brisk [brisk]
(comparative brisk·er, superlative brisk·est) adjective
1. quick: done quickly and energetically a brisk
Compartment syndrome
Red flags for compartment syndrome are pain out of proportion with the injury, and pain on passive stretch of the digits.
Later signs include pallor, paresthesia and pulselessness; appearance of these signs should not be waited for!
If compartment syndrome is suspected, the cast and any dressings should be removed.
Pressure points/skin breakdown
A localized burning point under the cast under the cast suggests that excessive pressure is being exerted by the cast.
If the patient complains of numbness or motor dysfunction, the cast may be putting pressure on an underlying nerve.
This happens most commonly with the peroneal and radial nerves.
Skin irritation
Skin irritation may occur at the cast edges if not properly padded, especially with fiberglass casts.
Loss of reduction
As swelling subsides, the cast will become looser, and fracture reduction may be lost.
This can be avoided by following up with the patient 7-10 days after cast application, to ensure the cast still fits properly.
Keep cast dry. Moisture weakens plaster and damp padding next to the skin can cause irritation.
Walking casts. Do not walk on a "walking cast" until it is completely dry and hard. It takes about two to three days for plaster to become hard enough to walk on.
Avoid dirt. Keep dirt, sand, and powder away from the inside of the cast.
Padding. Do not pull out the padding from the cast.
Itching. Do not stick objects such as coat hangers inside the cast to scratch itching skin. Do not apply powders or deodorants to itching skin.
Trimming. Do not break off rough edges of the cast or trim the cast before asking your health professionals
Sew…. stitch
stitch, seam, baste, hem, embroider, darn antonym: unpick
Pressure Ulcers-Examines the patient’s skin frequently for evidence of pressure or friction.
Venous Stasis and Deep Vein Thrombosis-Teaches the patient to perform ankle and foot exercises within the limits of the traction therapy every 1 to 2 hours when awake to prevent DVT, which may result from venous stasis.
Pressure Ulcers-Examines the patient’s skin frequently for evidence of pressure or friction.
Venous Stasis and Deep Vein Thrombosis-Teaches the patient to perform ankle and foot exercises within the limits of the traction therapy every 1 to 2 hours when awake to prevent DVT, which may result from venous stasis.