AADO Trauma Management with Cast Application Kwok Wai Yu APN, O&T, PWH 3 rd November, 2013

Transcription

1 AADO Trauma Management with Cast Application 2013 Kwok Wai Yu APN, O&T, PWH 3 rd November, 2013

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3 *? Fracture, when, how, what type? *? Post operation case,?sg,?flap,?tendon or nerve repair *? General Condition: stable or ill? * mobilization, young / elderly: what ADLs need? *? Treatment plan, pre / post operation preparation? *? Patient background, relationship with staff, any trouble behavior or trouble family members? *Anything I can help the case? Nursing care, education, social support?

4 Keynotes of Nursing Care *We provide Total Patient Care, not Total Cast Care. *Total Patient Care including 4 aspects: Physical, Psychological, Social & Spiritual *Prevention is better than Cure: Promote health education.

5 As a fixed mould to immobilize a part of body: *Stabilize and control movement: fragments or damaged tissues, joints and limbs *Rest injured or infected tissues *Support fracture bones *Maintain alignment *Correct deformity *Promote post- operative tissue healing

6 Complications of Cast As a fixed mould to immobilize a part of body: Skin allergy: dermatitis, Skin laceration, Pressure sore Inflammatory process: swelling tissue constriction or compression: muscle, artery, vein, nerve, compartment syndrome Pain

7 Complications of Cast As a fixed mould to immobilize a part of body: Systemic: DVT PE Trunk plaster too fit: Nausea, abdominal muscle clamps, retention of urine, abdominal distension, constipation, nutrition problems, etc. Osteoporosis Localize: Joint stiffness, muscle wasting, skin maceration Inadequate Immobilization: Loose reduction, delayed, mal or non-union

8 Nursing Care of Cast Prevention: Ensure good applying practice Patient or career education to gain cooperation Early detection: Monitor any S / S of complications Promptly management: If in doubt, bivalve and reapply

9 F/ 6 yrs, good PHx. Fell from height, Fracture Bilateral Hip with operation done, applied Hip spica cast post operation. Plan home with cast for 6 months, reviews 6 weeks intervals.

10 Nursing Care Pre and post operation nursing care Cast care ~ Monitor the skin condition for early detect of allergy ~ If skin irritated, remove the cast, clean the skin and reapply other material

11 Nursing Care ~ Assess the tightness of cast, avoid too tight or too loose ~ Check X-ray for confirm the acceptability of reduction and alignment

12 Nursing Care Avoid leave child alone and invite parents or career to accompany To enhance body image, allow chose preferable color Discuss with child the expectation of activities and cast appearance

13 Nursing Care To praise and admire good practice Provide lovely toys for accompany

14 Education: Dos Fluid, protein and fiber intake

15 Education: Dos Limbs exercise and mobilization above and below the injury part

16 Education: Don ts Avoid pressing cast before cool down, may lead to muscle impingement

17 Education: Don ts Avoid change position immediately after cast applied, may loss alignment

18 Education: Don ts Avoid putting things inside cast, if cannot remove dropping items, seek medical help

19 Education: ADLs Invite and educate family to care of ADLs: ~ Technique in change diapers (use 2 diaper to keep cast dry), use a slightly damp cloth to clean urine or stool get on the cast ~ Assist baby is sit up position for easy bowel open, encourage fluid and fiber intake ~ Not to bath but use sponge and cloth to clean skin, avoid lotion or powder inside the cast ~Re-position child frequently

20 Education: Monitoring Educate family to seek medical advise if: ~ The cast softens, cracks, breaks, gets very dirty, or starts to smell. ~ Child has red, swollen or tender skin near or underneath the cast ~ Your child s toes are cool or cold, look blue, or start to swell ~ Your child develops an unexplained fever ~ Complaint of a painful area under or around the cast

21 Promote Child safety Refer and provide community resources

22 M/ 38 yrs, good PHx. Fell from bicycle, Fracture Right Tibia and Fibular. Operation done, applied long leg cast post operation. Plan Home with Cast for 6 weeks.

23 Nursing Care Pre and post operation nursing care Risk of Compartment syndrome Signs and Symptoms: 5 Ps: Pain Paraesthesia Pallor Paralysis Pulseless

24 Nursing Care Prevent Compartment syndrome ~ Close monitoring of neurovascular status ~ Extremities exercise ~ High elevation

25 Nursing Care Care of Compartment syndrome ~ Loosen crepe bandage ~ Bivalve the cast

26 Nursing Care ~ If there is abrasion wound over the ankle need daily dressing, the cast may need to open a window Windowed plaster are not encouraged Danger of edematous tissue herniating through the window and skin injury

27 Nursing Care Provide adequate analgesic Invite patient and family involve in treatment plan and discharge plan Encourage voice out stress and concern Refer MSW if needed

28 Education: Dos Fluid, protein and fiber intake

29 Education: Dos NWB ~6 weeks Toes and hip exercise and mobilization Refer PT for crutches walking exercise

30 Education: Don ts Wet plaster or cast Self stop medications, seek medical advise if cannot tolerate drug's side effect Advance weigh bearing time, walk on the cast Stick anything down into the cast to scratch or itch.

31 Education: Monitoring Educate patient to seek medical advise if: ~ Excessive pain ~ Excessive swelling ~ Bluish or white discoloration of toes ~ Notice any crack in cast

32 Promote Exercise

33 Enhance Sport safety Refer and provide community resources

34 M/ 71 yrs, PHx: DM, IHD, AF, Gout Fell from stairs due to sudden dizziness, Left ulnar fracture. Conservative management, applied short arm cast. Plan Home with Cast for 6 weeks.

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36 Assist in ADLs Assist in contact family

37 Assess and prevent fall

38 Sore prevention due to fragile skin If sore developed, provide wound care

39 If apply slab or cast with K-wire, parallel wire to wall of cast Adequate cushion to protect skin Cover second layer of gauze to prevent knocking against cast Early follow up appointment

40 Exercise the joints not under the cast Avoid limbs prolong hand down to prevent swelling Avoid wet the cast

41 Contact doctor immediately if: ~ Fingers become blue or swollen ~ Unable to move limb ~ Pain could not tolerated ~ Feel pins and needle or numbness ~ Blister like pain ~ Discharge or wetness under the cast ~ Drop any object under the cast ~ Cast crack, loosen, or soft

42 Promote exercise: start from now, not till injury Introduce slow exercise to elderly

43 www. nofall.hk

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46 Bring Home Message *We provide Total Patient Care, not only Cast Care. *Prevention is better than Cure: Promote health education.

47 Mr Au Wai Kin, APN, O&T, PWH Ms Tsang Wing Yan, APN, O&T, PWH

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