Nursing Care of the Patient with Traction and Plaster Cast

Subject: Medical and Surgical Nursing I (Theory)

Overview

A patient in traction needs assistance with morning and evening care. The patient should be encouraged to take care of as much of his own needs as he can within the limitations of his immobilization. The ideal way to change the bed linens will depend on the patient and the traction setup. There are a few appropriate ways to make an occupied bed, and based on the traction being used, you should choose the simplest one. Always keep the call bell, wet towelettes, and toilet paper handy. Make sure to check the patient's bowel movements each day. Calcium, protein, iron, and vitamins should all be abundant in a recuperating patient's diet. Roughage-rich foods and plenty of fluids can help prevent bowel and bladder complications. To keep from becoming bored and depressed when in traction, orthopedic patients will need some type of diversionary activity. Despite the fact that a patient wearing an arm or leg cast is significantly more independent than a patient wearing a body or spice cast, it is the duty of the nurse to observe all patients and provide assistance as necessary. By keeping an eye out for breaks, cracks, and soft patches, you can inspect the cast's integrity. To avoid complications, evaluate circulation by performing the blanching test and contrasting the skin temperature and blanching response of the affected limb with that of the unaffected limb. Inform the nursing staff of any danger indications right away. The following warning indications should be taken seriously: pale, numb, or chilly fingers or toes; increased pain; pressure patches; an odor; or the impression that the cast has gone loose.

Nursing care of the patient with traction

Encourage the patient to take on as much responsibility for his morning and evening care as he is able to given his immobility. assist the patient with or complete the chores they are unable to complete.
The ideal way to change the bed linens will depend on the patient and the traction setup. There are a few appropriate ways to make an occupied bed, and based on the traction being used, you should choose the simplest one. A head-to-toe method might be more effective for some patients than a side-to-side one. Make sure the linen is always smooth and dry. Use draw sheets when necessary. Change the pillowcases and reposition any supporting pillows as necessary to keep the patient from being supported by soiled, damp, wrinkled, or flattened pillows.
Give the patient enough time and privacy when helping with the bedpan or urinal. Many people find it difficult to get used to the discomfort of using a bedpan or urinal. Anyone would feel uneasy if they could see their roommates, guests, or hospital staff right beyond the privacy curtain. Always keep the call bell, wet towelettes, and toilet paper handy. Make sure to check the patient's bowel movements each day. The most serious issue of fecal impaction can be avoided by treating constipation. For patients who are immobile, doctors frequently recommend a stool softener to prevent constipation.
Encourage the patient to consume the entire recommended diet. Encourage relatives and friends to send fruit or a favorite "healthy" dish from home, if the doctor permits it. Calcium, protein, iron, and vitamins should all be abundant in a recuperating patient's diet. Drinking plenty of water and eating foods with lots of roughage will help you avoid bowel and bladder issues.
Help the patient breathe deeply several times an hour. The prevention of respiratory complications will be aided by coughing and deep breathing. Encourage the patient to use their unaffected extremities as much as possible.
Eliminate any elements that weaken or change the direction of the traction pull. The ropes should not be hindered and the pulleys should be straight. If the rope's knot touches the pulley or the bed's foot, traction cannot be achieved. The weights must be hanging, not laying on the floor or on the bed. Always align the patient's body with the direction of the traction. Every time you enter the room, check the patient's position and, if necessary, assist the patient in sliding up into bed. Encourage the patient to move around in bed by using the overhead trapeze rather than their elbows.ed.
Look for color (pallor, cyanosis), numbness, edema, signs of infection, and pain in the extremities. On all skin surfaces, look for areas of skin deterioration or pressure sores.
To keep from becoming bored and depressed while in traction, orthopedic patients will need some sort of diversionary activity. Encourage family and friends to visit frequently and to bring games or books for the patient if your treatment facility does not have an occupational therapy department. The use of the radio and television can also pass the time. In order to assess the patient's mental state and to keep the patient from becoming bored, the nursing staff should take the time to stop and chat with the patient.

Nursing care of the patient with plaster cast

Despite the fact that a patient wearing an arm or leg cast is significantly more independent than a patient wearing a body or spice cast, it is the duty of the nurse to observe all patients and provide assistance as necessary. The following steps are used in nursing management to evaluate the efficiency of the cast.
- Examine the cast's edges and every area of skin where pressure from the edges could result. Notify the charge nurse or doctor right once if there are any indications of edema or circulatory impairment.
- In order to check for any plaster fragments or other foreign materials, slide your fingertips under the cast's edges. To increase circulation, gently move the skin back and forth.
- To find scents indicating tissue injury, stoop down and sniff the cast. A musty or moldy smell near the cast's surface could be the first sign that pressure-induced necrosis has begun to form beneath it.
- By keeping an eye out for breaks, cracks, and soft spots, you can inspect the cast's integrity.
To avoid difficulties, the cast body part needs to be regularly inspected and evaluated. Check the following to evaluate the casted component.
- By doing the blanching test and contrasting the skin temperature and blanching response of the diseased leg with that of the unaffected limb, one can evaluate circulation.
- By stroking exposed skin and asking the patient to explain his sensations, you can determine whether the damaged limb is capable of feeling.
- Asking the patient to move his fingers or toes will help you determine how well the affected limb can move.
Complications can be greatly reduced by patient education. Give the patient the following instructions.
- Avoid resting the cast on harsh surfaces or edges that have the potential to damage it and create pressure points.
- Never "scratch" inside the cast with a coat hanger or another foreign item. Skin infection and injury could result from this.
- Inform the nursing staff of any danger indications right away. The following warning indications should be taken seriously: pale, cold fingers or toes; tingling, numbness, increasing pain; pressure patches; an odor; or the impression that the cast is now excessively tight.
- Any cast damage, such as cracks, fractures, or soft places, should be reported.
- Never try to take the cast off or change it.

References

A Textbook of Adult Health Nursing (2nd ed.). Mandal, G. (August 2013). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
archive.org/stream/04852850/4478_djvu.txt
nursingcrib.com/demo-checklist/nursing-management-of-patients-in-traction/
nursing411.org/Courses/MD0916_Nursing_Care_Related_to_the_Musculoskeletal_system/1-39_Nursing_Care_related_to_the_musculoskeletal_system.html

Things to remember

The ideal way to change the bed linens will depend on the patient and the traction setup.
Give the patient enough time and privacy when helping with the bedpan or urinal.
Encourage the patient to consume the entire recommended diet.
The nursing staff should take the time to stop and talk with the patient in order to both relieve boredom and evaluate the patient's mental state.
Examine the cast's edges and every area of skin where pressure from the edges could result.
Asking the patient to move his fingers or toes will help you determine how well the damaged limb can move.
Avoid resting the cast on harsh surfaces or edges that have the potential to damage it and create pressure points.
Never try to delete or alter the cast.
Report any danger signs to the nursing staff immediately.

Questions and Answers

Explain the nursing care for the patient with traction.

Nursing Care of the Patient with Traction

When assisting with a.m. and p.m. care, encourage the patient to do as much for himself as is possible within the constraints of his immobilization. Assist with or perform those tasks that the patient cannot perform.
Assess the patient and the traction set-up to determine the best method for changing the bed linen. There are several acceptable methods for making an occupied bed and, depending upon the type of traction in use, you will want to use the method that is easiest. For some patients, a head-to-toe technique may work better than side-to-side. Always be sure that the linen is smooth and dry. Utilize draw sheets when appropriate. Reposition supporting pillows and change the pillow cases as often as needed to prevent the patient from being supported by soiled, damp, wrinkled, or flattened pillows.
When assisting with the bedpan or urinal, provide adequate time and privacy for the patient. Many patients do not adjust easily to the awkwardness of using a bedpan or urinal. The presence of roommates, visitors, or hospital personnel just outside the privacy curtain is enough to make anyone uncomfortable. Always place toilet tissue, moist towelettes, and call bell within easy reach. Check daily to see whether the patient has had a bowel movement. Treating constipation will prevent the most serious problem of fecal impaction. Physicians will routinely prescribe a stool softener for immobilized patients in order to prevent constipation.
Encourage the patient to eat all of the prescribed diets. If permitted by the physician, suggest that family and friends bring fruit or a "healthy" favorite food from home. A recovering patient's diet should be high in calcium, protein, iron, and vitamins. Plenty of fluids and foods high in roughage will help prevent bowel and bladder complications.
Assist the patient to take several deep breaths each hour. Coughing and deep breathing will help prevent respiratory complications. Encourage the patient to actively exercise the unaffected extremities.
Eliminate any factors that reduce the traction pull or alter its direction. Ropes and pulleys should be in straight alignment and the ropes should be unobstructed. Traction is NOT accomplished if the knot in the rope is touching the pulley or the foot of the bed. The weights must be suspended and not in contact with the bed or resting on the floor. The patient's body should always be in alignment with the force of traction. Check the patient's position each time you enter the room and help the patient slide up in bed if necessary. Encourage the patient to use the overhead trapeze instead of elbows to move in bed.
Check the extremities for color (pallor, cyanosis), numbness, edema, signs of infection, and pain. Look for areas of skin breakdown or pressure sores on all skin surfaces.
Orthopedic patients confined in traction will need some sort of diversional activity to relieve boredom and prevent depression. If your treatment facility has no occupational therapy department, encourage family and friends to visit frequently and bring books or games for the patient. Television and radio may also help to pass the time. The nursing personnel should make opportunities to stop and chat with the patient, both to distract the patient from boredom and to assess the patient's mental status. It is often easy to see a state of depression beginning and it will be easier to dispel in its early stages.

Explain the nursing care of patient with plaster cast.

Nursing Care of the Patient with Plaster Cast

Although a patient with an arm or leg cast is much more self-reliant than a patient in a body or spice cast, it is a nursing responsibility to monitor all patients and assist as needed. Nursing management includes the following actions to assess the effectiveness of the cast.

Check the edges of the cast and all skin areas where the cast edges may cause pressure. If there are signs of edema or circulatory impairment, notify the charge nurse or physician immediately.
Slip your fingers under the cast edges to detect any plaster crumbs or other foreign material. Move the skin back and forth gently to stimulate circulation.
Lean down and smell the cast to detect odors indicating tissue damage. A musty or moldy odor at the surface of the cast may be the first indication that necrosis from pressure has developed underneath.
Check the integrity of the cast by looking for cracks, breaks, and soft spots.

The casted body part must be examined and assessed frequently in order to prevent complications. Assess the casted part by checking the following:

Assess circulation by performing the blanching test and comparing the skin temperature and blanching reaction of the affected limb to that of the unaffected limb.
Assess the presence of sensation in the affected limb by touching exposed areas of skin and instructing the patient to describe what he felt.
Assess the motor ability of the affected limb by having the patient wiggle his fingers or toes.

Patient education will do much to prevent complications. Instruct the patient to do the following:

Avoid resting cast on hard surfaces or sharp edges that may dent the cast and cause pressure areas.
Never use a coat hanger or other foreign object to "scratch" inside the cast. This may cause skin damage and infection.
Report any danger signs to the nursing staff immediately. Danger signs include pale, cold fingers or toes, tingling, numbness, increased pain, pressure spots, odor, or feeling that the cast has become too tight.
Report any damage to the cast such as cracks, breaks, or soft spots.
Never attempt to remove or alter the cast.