Csjune Frankel, A 23-Year-Old Patient, Presents To The Emerg

Csjune Frankel A 23 Year Old Patient Presents To The Emergency Depar

Csjune 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. What nursing assessment should the nurse provide after the cast has been applied? What nursing interventions should the nurse provide?

Following the application of a cast, especially in cases involving long-arm fiberglass casting for fractures, comprehensive nursing assessment is vital to ensure proper healing, prevent complications, and promote patient comfort. The primary assessments include neurovascular checks, skin integrity, and patient comfort. These assessments are essential to identify early signs of complications such as neurovascular impairment or skin breakdown. Furthermore, nursing interventions are geared toward maintaining circulation, promoting comfort, preventing pressure ulcers, and educating the patient about self-care and warning signs of complications.

Post-Application Nursing Assessment

The initial and ongoing nursing assessment post-cast application should focus on neurovascular status, skin condition, and patient comfort. This includes inspecting the extremity for color, temperature, capillary refill, edema, and skin integrity. Palpation of distal pulses—such as dorsalis pedis and radial arteries—complements visual assessments to confirm adequate circulation. Assessing sensory function involves checking for numbness or tingling, which may indicate nerve compression or injury. Motor function assessment involves gauging the patient’s ability to move fingers or toes, depending on the limb involved.

Additionally, the nurse should monitor for signs of compartment syndrome, a severe complication characterized by increased pressure within a confined space that can compromise blood flow and nerve function. Signs include increasing pain disproportionate to the injury, pain on passive movement, pallor, coldness, paresthesia, and pulselessness—often summarized as the 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, pressure). Continuous monitoring is essential in the initial hours after cast application, especially if trauma is significant.

Post-Application Nursing Interventions

Nursing interventions aim to prevent complications and promote effective healing. Elevation of the affected limb is critical to reduce edema; this should be maintained above the level of the heart when possible. Applying ice packs intermittently can help manage swelling and pain, being careful to protect the skin from direct contact with ice. The nurse should educate the patient on keeping the limb elevated and avoiding inserting objects into the cast to scratch or scratch inside.

Patient education involves informing the patient about the importance of reporting symptoms such as increased pain, numbness, tingling, coldness, or color changes in the fingers or toes. The nurse should also instruct the patient to keep the cast dry and clean, avoiding getting it wet, which could compromise its integrity. The application of a cast saw should be avoided unless specifically instructed; patients should be advised to avoid inserting objects inside the cast to scratch or relieve itching, instead using a hairdryer on a cool setting if itching occurs.

Routine monitoring of neurovascular status should be documented at regular intervals—initially every 15 minutes for the first hour, then every hour for the next 24 hours, or as prescribed. If any signs of neurovascular compromise or compartment syndrome are observed, immediate action is required, which may include removing or loosening the cast and seeking urgent medical intervention.

In addition, the nurse should promote comfort through appropriate pain management strategies, including administering prescribed analgesics and ensuring proper positioning. Encouraging mobility of unaffected joints and muscles to prevent stiffness and maintaining skin integrity through regular observation are fundamental nursing practices.

True/False Statement

Compartment syndrome—the most serious complication of casting and splinting—occurs when increased pressure within a confined space compromises blood flow. True.

References

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