Nursing Care Related to the Musculoskeletal System


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a. 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.


(1) 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.


(2) 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.


(3) 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.


(4) Check the integrity of the cast by looking for cracks, breaks, and soft spots.


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


(1) 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.


(2) Assess the presence of sensation in the affected limb by touching exposed areas of skin and instructing the patient to describe what he felt.



(3) Assess the motor ability of the affected limb by having the patient wiggle his fingers or toes.


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


(1) Avoid resting cast on hard surfaces or sharp edges that may dent the cast and cause pressure areas.


(2) Never use a coat hanger or other foreign object to "scratch" inside the cast. This may cause skin damage and infection.


(3) 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.


(4) Report any damage to the cast such as cracks, breaks, or soft spots.


(5) Never attempt to remove or alter the cast.


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