Chapter 41

- general health -presenting signs and symptoms -emotional status - understanding of the need for the device - condition of the body part to be immobilized

Before the cast, splint, or brace is applied, the nurse completes an assessment of the patient's

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 (a break in the continuity of the bone), to correct or prevent a deformity (e.g., clubfoot, hip displacement), to apply uniform pressure to underlying soft tissue, or to support and stabilize weakened joints.

Cast

A hallmark sign is pain that occurs or intensifies with passive range of motion

Compartment Syndrome

Compartment syndrome—the most serious complication of casting and splinting—occurs when increased pressure within a confined space (e.g., cast, muscle compartment) compromises blood flow and low tissue perfusion occurs, most often in an extremity

Compartment Syndrome

The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately.

Compartment Syndrome

Immobilization in a cast, splint, or brace can cause muscle atrophy and loss of strength, and can place patients at risk for disuse syndrome, which is the deterioration of body systems as a result of prescribed or unavoidable musculoskeletal inactivity

Disuse Syndrome

Extends from the axillary fold to the proximal palmar crease. The elbow usually is immobilized at a right angle.

Long-arm cast

Extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

Long-leg 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

Short-arm cast

A body jacket that encloses the trunk, shoulder, and elbow

Shoulder spica cast

A short- or long-leg cast reinforced for strength

Walking cast

Encircles the trunk

body cast

To prevent this, the nurse instructs the patient to tense or contract muscles (e.g., isometric muscle contraction) without moving the underlying bone

Disuse Syndrome

Encloses the trunk and a lower extremity. A double hip spica cast includes both legs.

Hip spica cast

Extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position.

Short-leg cast

On occasion, the plaster cast may have rough edges, which can crumble and cause skin irritation. Petaling the cast resolves this problem if the underlying stockinette does not cover the edges of the cast. To prevent skin breakdown, moleskin can be used over any rough area of the cast that may rub against the patient's skin

petaling:smoothing the rough edges of a cast with smooth material (e.g., moleskin) so the underlying skin does not become abraded

The time that it takes for a plaster cast to dry completely depends on its size, thickness, and location, as well as environmental drying conditions. A freshly applied cast should be exposed to circulating air to dry and supported on a firm and smooth surface

plaster casts

. The cast may feel warmer in the affected area, suggesting underlying tissue erythema.

pressure ulcers

bandage used to support an arm

sling

They are also noncircumferential and thus do not compromise circulation when the natural swelling during the inflammatory phase of injury occurs

splints and braces

They offer many advantages over casts in that they are faster and easier to apply.

splints and braces