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The type of cast applied is determined by the physician. The registered nurse (RN) or licensed practical nurse (LPN) is responsible for daily care and management of the child in a cast.
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Assess neurovascular status every 4 hours for the first 48 hours after the application of a cast.
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Assess skin integrity every 8 to 12 hours.
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Assess for pain every 2 to 4 hours during the acute phase and with vitals thereafter.
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Assess integrity and cleanliness of the cast every shift.
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Employ safe patient handling and movement procedures, including no-lift practices to maintain patient safety and prevent caregiver injury when moving or transferring the child.
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Nonsterile gloves (if indicated)
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Pillows or blankets
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Cold packs
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Pain medication
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Cloth tape or moleskin
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Blow dryer
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Diapers
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Sanitary napkins
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Plastic wrap
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Marking pencil
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Flashlight
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Baking soda
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Toothpaste or dry white cleanser
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Diversionary activities
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Crutches, sling, cast shoes, or wheelchair (if ordered)
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Mechanical lift device and/or friction-reducing device (as needed)
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Review medical record to determine:
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The type of surgical or medical intervention completed on the child
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History of increased temperature or heart rate. Elevations may indicate an infectious process is present
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Pain history and when child was last medicated for pain
-
-
Determine the type of cast, style, and type of material used to make the cast (Figure 26-1).
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Assess child’s vital signs to determine presence of fever or increased respiratory rate or heart rate that may indicate presence of infection.
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Assess child for pain and muscle spasms and provide interventions as indicated (see Chapter 7).
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Administer pain medication when indicated 30 minutes before moving or assessing the patient.
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Use diversional activities and other biobehavioral interventions (e.g., music, stroking of unaffected extremities) to distract the child and assist in pain management during the procedure.
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Explain to the child the purpose of checking the cast and assessing the integrity of the skin and extremities near the cast.
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Encourage family caregivers to be in the room during cast care to assist them in learning to complete care and assessment in preparation for discharge of the child to home.
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