Question

3:54 X Copy of CS_Ch_41.doc Case Study, Chapter 41, Musculoskeletal Care Modalities 1. June Frankel, a 23-year-old patient, presents to the emergency department with a sports-related fracture injury to her right arm and receives a long-arm fiberglass cast. (Learning Objective 2) a. What nursing assessment should the nurse provide after the cast has been applied? b. What nursing interventions should the nurse provide? 2. Sue Newhart, a 55-year-old patient, is admitted to the medical-surgical unit after a total hip arthroplasty due to osteoarthritis. (Learning Objective 7) a. What considerations should the nurse follow when positioning the patient in bed after hip surgery? b. What nursing interventions should the nurse provide the patient?

Answer 1

1a) The nursing assessment to be done after applying cast is neurovascular assessment to ensure blood flow

1b) Nursing interventions include :-

Keep the cast & extremity elevated

- Allow a wet plaster cast 24-72 hrs to dry (synthetic casts dry in 20 min)

- Handle a wet plaster cast w/ the palms of the hands until dry

- Turn the extremity every 1-2 hrs, unless contraindicated, to allow air circulation & promote drying of the cast

- A hair dryer can be used on a cool setting to dry a plaster cast (heat cannot be used on a plaster cast b/c the cast heats up & burns the skins)

- Petal the cast or apply moleskin to the edges to protect the client's skin maintain smooth edges around the cast to prevent crumbling of the cast material

- Monitor for s/s of infection such as increased temperature, hot spots on the cast, foul odor, or changes in pain

- Instruct the client not to stick objects inside the cast

- Teach the client to keep the cast clean and dry

- Instruct the client in isometric exercise to prevent muscle atrophy.

- Monitor a casted extremity for circulatory impairment such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse -> Notify the HCP immediately if circulatory compromise occur.

2a) Posterior hip precautions

1. Avoid hip flexion at greater than 90 degrees

2.avoid hip internal rotation

3. Avoid hip adduction

#. Tips for posterior hip precautions for avoiding flexion >90degrees

-use adaptive equip to shower/ bathe

-used a raised toilet

-place affected foot forward when standing

#. Tips for avoiding posterior hip internal rotation

-toes should point straight forward

-knees should also point forward

-do not pivot on planted foot, take small steps to turn

#. Tips for avoiding posterior hip adduction

-do not cross legs

-use a pillow in between knees to keep knees separated during rest and sleep times

-use a pillow or prop knees to separate during functional mobility, rolling moving to sitting

#. Anterior hip precautions

1. Avoid hip extension > than 45 degrees

2.Avoid hip external rotation

3. Avoid hip adduction

AVOIDING HIP EXTERNAl ROTATION =toes point forward at all times, knees should also point forward and don't pivot on planted foot, take small steps.

Avoiding Anterior hip extension above 45degrees::: do not leave your affected leg behind while walking, lead with the affected leg and step to it when going down stairs LEAD with the unaffected leg and step to it when going up the stairs

2b) Nursing interventions include :-

- Proper positioning of the patient

- Position 2hourly to avoid pressure sores

- Providing adequate nutrition including proteins ,vitamins for healing

- Assisting the patient to do daily activities

- Teaching the patient regarding medication compliance and it's side effects

- Advising for gular follow ups