II practiced Nea” dcare with sterile without taking help ig all sterile items glove i jal saline or sterile or or gauze pieces Jutions (alcohol, ution in weak th : clean area to dirty ition to size, type dor, any bleeding, isue, condition of ure length, width, forceps. ently by wound d healing. Tough | dark-brown black on-viable. vound surface, as apply secondary :or with soft gauze e dressing change tainers. Take care ire and all related omparing with \d’s and parent's wound care and n the procedure, rance of wound ‘€, and condition type of dressing dure, use of pain fthe child and/or PROCEDURE-S: ASSESSMENT ayy oe CHILDREN WITH CAST CARE op Clinical Guidelines + Castis a solid mold ofa part, usually , | immobiliz © of fractures, ale ing, surgical interventions and in any other” " It is usually made of POP, sodium Pi Se Injunt dextrin that is rubbed into crinoline then” ch carefully applied to the immobilized 4. “tin dd part a to harden Part ang + Plaster cast is rigid dressing made of with Plaster of Paris (POP), used injured part especially in bone fra retro ne nora yurethane, : asingly as prefers alternatives to plaster, especially for non-weight beatin: parts of the body 2 * POP castis easy to prepare, get desired shape when dried, do not shrink or cracked and act as very hard splint. is a low cost material * The purpose of POP cast is to maintain support and Allon, Gauze impregnate {0 immobilize, CLUTES oF sup to improve bone alignment. It also helps to promot fracture healing and to correct deformity * Management of the child in plaster cast and daily care is important for prevention of complications related 0 fracture and cast. Equipment Required | db * Hand hygiene supplies for hand washing ae * Waterproof apron to protect dress of doctor an‘ * Clean unsterile gloves, asrequired on ofc * Examination/treatment table for applica jt’ * Cotton and bandage to protect the skin 0! area * POP or gypsum, bowl of water * Synthetic casting materials jntos! and long mma i (such as ibers"* : “awl available abs and col a x forceps, C ee \ * Sponge holding forceps, cotton ~ isi ‘ : iy skin preparation agns ane? ment of vital sib * Articles for ass examination * Extra pillows or blanket * Plastic wrap to protect the cast required pe ci ate tH roll to elevate! arounJesfor administration of medications, as prescribed Artic eae articles, any wound is present : Wout jew box and X ay plates, as needed _ | child care articles including clothing and age jate diaper a are Peienor pencil to mark date ofthe cat * Waste disposal contains as per BMW rules A procedure record shect and child’s case sheet. assessment and Preparation + Assess the chi infections and Review the ind 's health status, vital signs, signs of + n before and after application of cast. ations of use of cast and the need for Leg cylinder cast Shor leg cast A > y «One and onehat Blatrl ong leg ip spa cast hip spica cast ( is as Weel Lane yO Shor arm Longarm Arm oylnder east cast east 4.2: Different types of cas {ype of cast (Refer Fig. 4.2). Assess child and parents for anxiety and level of understanding for the importance of cast application to plan for necessary support, explanation and teaching Self-preparation should be done with the practices of standard precautions Environment should be clean, calm, well lighted and free from overcrowding All required articles and equipment should be well arranged in the treatment room Preparation of parents: Explain the importance of the procedure of application of cast and plan of further management Unitatera hip spica cast Minerva cast ‘Shoulder spica cast children. s z ng 10) sinpa201g BUISINN WBIEaH PHNursing Procedures for Surgical Conditions E = z 5 Preparation of child: Make the child clean, comfortable and explain as per level of understanding about pplication of east and care of cast. Allow the parent during appli {and thereafter, as feasible. Administer pain medication, if preseribed. Use diver ies and nonpharmacologieal measure to distract the child with cast ion of ional act Performing the Steps of Procedure with Rationale/ Point of Emphasis propriate. Wear Perform hand hygiene. Don gloves protective plastic apron. Assess the child forpain, usingage-appropriate technique and use pharmacological and nonpharmacological measures for pain management. Assess for pain every 2-4 hours during acute phase and then along with vital signs assessment. Assist the doctor during application of cast. Follow necessary precautions to prevent complications and promote healing. . Assess the child for the followings: ~ Vital signs to identify compromised circulation and tissue oxygenation - Pulse above and below the injured area for early detection and intervention of compromised circulation and compartment syndrome ~ CRT by pressing on fingers and toes (normal CRT 1-2 seconds), to find insufficient circulation to the distal extremity - Sensation of extremities by gently touching the fingers and toes for numbness, quality of response to stimuli, neurobehavioral response (such as rest, sleep, mood, level of consciousness, etc.). Assess neurovascular status every 4 hours for the first 48 hours after application of cast - Motor functions (presence of flexion, extension, abduction and adduction) of fingers and toes to identify the normal range of motion or impaired or absent motor functions ~ Skin integrity and presence of any skin disruptions. Assess skin around cast edges every 6-8 hours for irritation, rash or skin breakdown and skin over bony. prominences for redness and tingling sensation. Check that the cast is not too tight anywhere - Compare the color and temperature of both limbs, above and below the injury site to diagnose compartment syndrome Swelling of fingers or toes distal to fracture or surgical site to detect inadequate venous return, Swelling peaks within 24-48 hours. Delay in attending to swelling, even for as litt compartment syndrome a paralysis. Perform interventions to promot indicated. (a) Protect edges of cotton to decrease skin irritatio skin integrity, as ts with cloth tape or ithe edges are rough; (b) Relieve the itching by blowing, rubbingthe ing over the ‘Bes ort down the c img tho daily bath (tub bath or sponge bath wn) Fo, ccossible skin arcas cle nas easy itching. Wash fingers and toes neg tig Jamp washcloth; (d) Provideperinealanane x ildren with casts extending close y gent contamination with urine ang ot skin from to pi diaper and plastic wrap to protect the cast 6. Assess integrity ofthe cast because not intact, healing. Expose the wet cast to room an elevate the cast on pillows up to 4 inche : of heart. Handle the cast gently only with hands. Plaster casts take 24-48 hours to ds, casts dry within 30-60 minutes : Inspect the cast for cracks, softening 2 flaking or flattening. Flattened and fai can cause skin irritation and undue pressu prominences. Soft cracked cast will not provide to maintain alignment of the fracture sie. 8, Inspect the cast for signs of drainage or bad oderin~ the wound underneath the cast. Mark the circ ofthe drainage on the castas baseline parameter=n detect whether there is more drainage or not. 9. Clean the surface of the cast, as needed. Plaser can be cleaned with toothpaste. Fiberglass c cleaned with damp cloth. 10, Explain to the child in age-appropriate lang parents about the need for limited activity andr care with the cast. 11, Instruct the child and parents not to putanyitem the castand not to scratch under the cast with ary to prevent skin irritation and infections. 12, Assist the child to perform passive and active « motion exercises of all extremities to preves and stiffness. This should be done 3-4 times 2 maintain functional ability ofthe extremit 13. Assist the child to ambulate by the wse of "2" crutches, cast shoes, or walking boot, or wheels" indicated. For upper limbs sling can be used. in cast should be encouraged to be up and ov once the cast has dried and pain is well mans’ 14, Collaborate with technician or physiotte! provide teaching regarding the use of 8" equipment such as crutch, walker 15, Provide diversional activities for the child tivity to adjust with the condition. 16, Provide comfort with suitable position of using extra pillows or shect. que 17, Prevent complications of immobility jt! : pres neal ret ssand anxiety, depression ss by ongoing nursing incervent© utryr : Maint Involve P Take care ‘ pet BMW rules. : a pocument and inform the procedure and al, . observational findings related to cast care. ain cleanliness and hygienic care of the a arents, as feasible of reusable articles and dispose the waste a: 19. ste é evaluation and Documentation Evaluate child’s vital signs, neurovascular status, skin conditions at regular interval and compare with baseline data. Inform doctor about any abnormal findings. Evaluate child and parents for their anxiety and understanding to provide support, as needed. Evaluate parent's ability to perform the need based care to their child with the cast * Document details of application of cast (date, time, type, indications, material used), all observational findings, medications administered, interventions done to prevent complications and to treat the problems, expected date of removal of cast and instruction given to the parents about care of child with cast. . Communication and Teaching for Homecare and child, as appropriate are of the child with pital, at home and * Communicate with parents regarding application of cast and c cast, plan of management at hos removal of cast neta * Teach the parents about cast care, medications, tye practices, skin care, toileting, positioning, neurovascu an checks, mobility, precautions during ase comfort measures, appropriate one ee eaaion intake, diversional activities, schooling and co need for : ications, medical help, plan for removal of cast and 10