Download Chapter One - cvadultcma

CHAPTER 7
PHYSICAL AGENTS TO PROMOTE
TISSUE HEALING
PRETEST
True or False
1. A hot compress is an example of moist heat.
2. Erythema is redness of skin caused by dilation of
superficial blood vessels.
3. The local application of cold may be used to relieve
muscle spasms.
4. Therapeutic ultrasound consists of a shortwave
electrical current.
5. An orthodontist is a physician who specializes in the
diagnosis and treatment of disorders of the
musculoskeletal system.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
2
PRETEST, CONT.
True or False
6.
The most frequent reason for applying a cast is to
aid in the nonsurgical correction of a deformity.
7.
Numbness of the fingers or toes may indicate that a
cast is too tight.
8.
A coat hanger can be used to scratch under a cast if
itching occurs.
9.
Ambulation refers to the inability to walk.
10. A patient using crutches should be instructed to
support his weight against the axilla.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
3
Content Outline
Introduction to Tissue Healing
1. Physical agents: promotes tissue healing
for patients with a disability as a result of:
a. Injury
b. Disease
c. Loss of a body part
2. Physical agents function to:
a. Improve circulation
b. Provide support
c. Promote the return of motion
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
4
Introduction to Tissue Healing, cont.
3. Physical agents used in office include:
a. Heat and cold applied locally
b. Therapeutic ultrasound
c. Casts
d. Ambulatory
aids (e.g.,
crutches,
canes, walkers)
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
5
Local Application of Heat and Cold
1. Used to treat infection and trauma
2. MA applies in office or instructs patient
in how to apply at home
3. MA should know:
a. Effects of heat and cold on the body
b. Adverse reactions of heat and cold
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
6
Local Application of Heat and Cold,
cont.
4. Common applications
a. Dry heat: heating pad, chemical hot
pack
b. Moist heat: hot soak, hot compress
c. Dry cold: ice bag,
chemical cold
pack
d. Moist cold: cold
compress
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
7
Local Application of Heat and Cold,
cont.
5. Applied for short periods to produce
desired results (15 to 30 minutes)
a. Repeat at intervals specified by physician
b. Prolonged application not recommended:
•
Results in adverse secondary effects
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
8
Local Application of Heat and Cold,
cont.
6. Type of heat or cold application depends
on:
a. Purpose of application
b. Location and condition of affected area
c. Age
d. General health of patient
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
9
Local Application of Heat and Cold,
cont.
7. Patient’s heat/cold receptors adjust to
changes in temperature
a. Results in decreased heat/cold sensation
b. Temperature actually remains the same
•
Still provides therapeutic effects
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
10
Local Application of Heat and Cold,
cont.
c. Patient may want to increase the intensity
•
May not perceive same degree of temperature
– Example: turning up a heating pad setting
•
Can result in tissue damage
d. Instruct patient on
dangers of
increasing intensity
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
11
Factors Affecting the Application of
Heat and Cold
1. Age of the patient: young children and
elderly patients more sensitive to heat and cold
2. Location of the application: certain areas
of the body more sensitive
a. Chest, back, and abdomen
b. Broken skin
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
12
Factors Affecting the Application of
Heat and Cold
3. Impaired circulation: these patients are
more sensitive to heat and cold
a. Includes patients with:
•
Peripheral vascular disease
– Diabetes
– Congestive heart failure
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
13
Factors Affecting the Application of
Heat and Cold, cont.
4. Impaired sensation: these patients must be
watched carefully
a. Tissue damage may occur without the
patient's awareness
•
Example: diabetic patient
5. Individual tolerance to change in
temperature: some patients cannot tolerate
temperature change as easily as others
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
14
Application of Heat and Cold
6. Observe application area: before,
during, and after treatment
a. Look for signs indicating that a modification
of temperature needed:
•
Erythema
•
Paleness
•
Pain
•
Swelling
•
Blisters
b. Ask patient how application feels
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
15
Local Effects of Heat
1. Local Effects of Heat (15 to 30 minutes)
a. Dilation of blood vessels at the site of the
application
•
Blood vessel increase in diameter
•
Results in increased blood supply to area:
– Tissue metabolism increases
– Nutrients and oxygen provided to cells at
faster rate
– Waste and toxins carried away faster
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
16
Local Effects of Heat, cont.
From Wood LA, Rambo BJ: Nursing skills for allied health services, vol 2, Philadelphia, 1980, Saunders.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
17
Local Effects of Heat, cont.
b. These changes promote healing
c. Skin in area becomes warm and exhibits
erythema
•
Erythema: reddening of the skin caused by
dilation of superficial blood vessels
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
18
Local Effects of Heat, cont.
d. Prolonged application (>1 hour) produces
secondary effects that reverse healing
process
•
Blood vessels constrict
•
Blood supply to the area decreases
e. Apply heat for proper length of time
ordered by physician
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
19
Purpose of Applying Heat
2. Purpose of Applying Heat
a. Relieves:
•
Pain
•
Congestion
•
Muscle spasms
•
Inflammation
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
20
Purpose of Applying Heat, cont.
b. Heat often prescribed for:
•
Low back pain
•
Arthritis
•
Menstrual cramps
•
Localized abscesses
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
21
Heat Works by:
c. Promoting muscle relaxation
•
Relieves pain caused by excessive contraction
of muscle fibers (muscle spasms)
d. Decreasing edema
•
Edema: The retention of fluid in the tissues,
resulting in swelling
-Increased blood supply: increases absorption
of fluid from tissues
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
22
Heat Works by: (cont.)
e. Softening exudates (using moist compress)
•
Exudate: discharge produced by the body's
tissues
– Exudate may form a hard crust and require
removal
f. Increasing suppuration
•
Suppuration: process of pus formation
– Helps in the relief of inflammation by
breaking down infected tissue
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
23
Local Application of Heat
g. Not recommended for:
•
Acute inflammation
•
Trauma
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
24
Heating Pad
a. Heating Pad
•
Converts electrical energy into heat
•
Must not crush wires
- May damage pad resulting in overheating
(1) May burn patient
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
25
Heating Pad, cont.
•
Do not use over areas that contain
moisture
- Example: Wet dressing
•
Often used to:
- Relieve pain
- Relieve muscle spasms
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
26
Hot Soak
b. Hot Soak
•
Direct immersion of a body part in:
- Water
- Medicated solution
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
27
Hot Soak
•
Used to
- Cleanse open wounds
- Increase suppuration
- Increase blood supply to an area
(1) Hastens healing process
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
28
Hot Compress
c. Hot Compress
•
Soft, moist absorbent cloth
- Immersed in a warm solution
- Applied to a body part
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
29
Chemical Hot Pack
d. Chemical Hot Pack
•
Available in a variety of sizes and shapes
•
When activated
- Provides a specific degree of heat for a specific time
•
Used to
- Relieve pain
- Relieve muscle spasms
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
30
Cold
1. Local Effects of Cold (15 to 30 minutes)
a. Constriction of blood vessels
•
Results in decreased blood supply to area
– Tissue metabolism decreases
– Less oxygen used
– Fewer wastes
accumulate
•
Skin in area becomes
cool and pale
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
31
Local Effects of Cold
From Wood LA, Rambo BJ: Nursing skills for allied health services, vol 2, Philadelphia, 1980, Saunders.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
32
Local Effects of Cold, cont.
b. Prolonged application (>1 hour) produces
reverse secondary effects
•
Blood vessels dilate
•
Increase in tissue metabolism
c. Apply cold for proper length of time
ordered by physician
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
33
Purpose of Applying Cold
2. Purpose of Applying Cold
a. Prevents edema if applied immediately after
patient has suffered direct trauma:
•
Bruise
•
Minor burn
•
Joint injury
•
Fracture
•
Sprain: trauma to a joint that causes injury to
the ligaments
•
Strain: an overstretching of a muscle caused by
trauma
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
34
Purpose of Applying Cold, cont.
b. Limits accumulation of fluid in tissues by:
•
Constricting blood vessels
•
Reducing leakage of fluid into tissues
c. Controls bleeding: by constricting
peripheral blood vessels
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
35
Purpose of Applying Cold, cont.
d. Relieves pain: due to numbing effect
•
Reduces stimulation of pain receptors
e. Reduces inflammation: decreases
suppuration in early stages of infection by
inhibiting activity of microorganisms
3. Always place cold application in a
protective covering
•
Applying cold directly to skin
– Could result in a skin burn
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
36
Ice Bag
a. Ice Bag
•
Waterproof bag with a screw-on cap
•
Must be filled with small pieces of ice
•
Placed in a protective covering
•
Used to
-Relieve pain
-Relieve inflammation
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
37
Cold Compress
b. Cold Compress
•
Soft, moist absorbent cloth
•
Immersed in cold solution
•
Applied to a body part
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
38
Cold Compress, cont.
•
Used to
-Relieve pain
-Relieve inflammation
-Treat certain conditions:
(1) Headaches
(2) Eye injuries
(3) Tooth extractions
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
39
Chemical Cold Pack
c. Chemical Cold Pack
•
Available in a variety of sizes and shapes
•
When activated provide:
-Specific degree of coldness for a specific period of time
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
40
Chemical Cold Pack, cont.
•
Used to:
-Prevent swelling
-Control bleeding
-Relieve pain
-Relieve inflammation
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
41
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
42
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
43
Therapeutic Ultrasound (US)
1. High-frequency sound
waves
a. Used as a deep-heating
agent
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
44
Therapeutic Ultrasound (US), cont.
2. Beneficial effects of US
a. Reduction of edema
b. Breakup of exudates
c. Increased cellular metabolism
d. Relief of pain
e. Micromassage
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
45
Therapeutic Ultrasound (US), cont.
3. Used to treat musculoskeletal conditions
a. Sprains
b. Joint
contracture
c. Neuritis
d. Arthritis
e. Edema
f. Synovitis
g.
h.
i.
j.
k.
Scar tissue
Bursitis
Fibrositis
Strains
Dislocations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
46
Therapeutic Ultrasound (US), cont.
4. Must not be used over
a. Eyeball
b. Malignant tumors
c. Spinal cord
d. Heart
e. Brain
f. Reproductive organs
g. Areas of impaired sensation or inadequate
circulation
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
47
Parts of the Ultrasound Machine
1. Generator: located in main unit
2. Transducer: crystal inserted between two
electrodes
a. Located in the applicator head
b. Generator produces electric current:
causes crystal in transducer to vibrate and
generate sound waves
•
Sound waves are above frequency heard by
human ear
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
48
Parts of the Ultrasound Machine,
cont.
3. Applicator head: hand-held device
attached to machine by a connector
cord
4. Controls
a. Timing control: determines length of
treatment
•
Measured in minutes
b. Intensity control: governs intensity of sound
waves (measured in watts)
•
Treatment usually ranges between 1 and 4 watts
•
Digital display screen: indicates intensity of
treatment
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
49
Ultrasound Machine
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
50
Coupling Agents
1. Must be used with US
a. Air is a poor conductor of sound
b. Coupling agent: produces air-free contact
between applicator head and skin
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
51
Coupling Agents
2. Available in lotion or gel
3. Must be at room temperature
4. Must be applied liberally
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
52
Coupling Agents, cont.
5. Water also used as coupling agent
a. Good conductor of sound
b. Use of underwater method
•
For sensitive skin that cannot tolerate direct
pressure of applicator head
•
When body surfaces are uneven: cannot obtain good
contact with applicator head (e.g., hands, feet)
c. Skin surface and applicator head: completely
submerged under water
d. Applicator head held ½ to 1 inch from patient's
skin: Slowly and steadily moved in a circular motion
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
53
Administering Ultrasound Therapy
1. Place applicator head firmly on patient's
skin
a. Move slowly and steadily over treated area
b. Sound waves absorbed by tissues and
transformed into heat
•
Produces vigorous deep heating in tissues
c. Micromassage effect: also produced by
mechanical vibration of sound waves
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
54
Administering Ultrasound Therapy,
cont.
2. Move applicator head continuously
a. Type of motion
•
Back-and-forth motion: large body areas (back)
•
Circular motion: smaller areas (ankle)
b. Move at rate of 1 to 2 inches per second
c. Moving head continuously:
•
Prevents hot spots that could burn patient
•
Hot spot: small area in which the temperature
rises rapidly
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
55
Administering Ultrasound Therapy,
cont.
3. Ultrasound dosage
a. Depends on:
•
Area of body receiving
treatment
•
Patient's condition
b. Acute conditions:
•
Require lower intensity
c. Chronic conditions:
•
Require higher intensity
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
56
Administering Ultrasound Therapy,
cont.
4. Series of treatments: 6 to 12 treatments
a. Frequency: once daily to 3 times per week
b. Duration of treatment
•
5 minutes at the
beginning of
treatment series
•
8 to 10 minutes at
end of treatment
series (US treatment
should never exceed
20 minutes)
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
57
Administering Ultrasound Therapy,
cont.
5. During treatment
a. patient should not feel anything
•
If patient feels burning or pain: Stop treatment
quickly and inform physician
b. Pain may indicate:
•
Dosage is too intense
•
Insufficient coupling agent was used
•
Applicator head left in one area too long
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
58
Casts
1. Stiff cylindrical synthetic or plaster
casing
a. Used to immobilize a body part
2. Purpose of applying a cast
a. Immobilize a fracture: most frequent use
•
Keeps fractured bones aligned until proper
healing takes place
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
59
Fracture of Tibia
From McRae R, Esser M: Practical fracture treatment, ed 4, Philadelphia, 2002, Churchill Livingstone.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
60
Casts, cont.
b. Support and stabilize weak or dislocated
joints
c. Promote healing after surgical correction
(knee surgery)
d. Nonsurgical correction of deformities
(congenital dislocation of hip)
3. Casts are applied by an orthopedist (also
known as an orthopedic surgeon)
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
61
Casts, cont.
4. Orthopedist: physician specializing in
diagnosis and treatment of disorders of
musculoskeletal system
•
•
•
•
Bones
Joints
Ligaments
Tendons
• Muscles
• Nerves
• Skin
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
62
Casts, cont.
5. Role of MA in cast application:
a. Assemble equipment and supplies
b. Prepare patient
c. Assist physician
d. Provide or reinforce cast care instructions
e. Clean examining room
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
63
Casts, cont.
6. Pressure area: occurs when cast presses or
rubs against patient's skin
a. Most apt to occur over bony prominence
b. Prevents adequate circulation to area
c. Causes painful rubbing, burning, or stinging
sensation under cast
d. If permitted to continue: pressure ulcer can
develop
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
64
Casts, cont.
7. Pressure ulcer: skin breaks down
a. Begins with a red patch of skin
b. Erodes into subcutaneous tissue
c. Eventually erodes into muscle and bone
d. Deep pressure ulcers often become
infected by microorganisms
•
Develop gangrene
8. Important to detect pressure area early
•
Prompt treatment: to prevent serious
complications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
65
Plaster Casts
1. Consist of powered calcium sulfate
crystals formed into a bandage
a. Not used as often as they once were
b. Must soak bandage roll in tepid water to
activate crystals
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
66
Plaster Casts, cont.
c. When wet: plaster molds easily to body part
d. Available in rolls of widths from 2 to 6
inches
•
Smaller width: arms
•
Larger width: legs and trunk
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
67
Plaster Casts, cont.
e. Plaster cast may initially be applied after a
fracture
•
Can easily be molded to allow for swelling
•
After swelling has gone down: may take several
days to a week
– Synthetic cast applied
1) Weighs less
2) More durable
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68
Synthetic Casts
1. Consist of knitted fabric tape made of:
a. Fiberglass (used most)
b. Polyester
c. Cotton
d. Plastic
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
69
Synthetic Casts, cont.
2. Tape impregnated with polyurethane resin
a. Activates when soaked in
water
b. Comes in different colors
c. Packaged in individual
rolls in airtight pouch
d. Available in widths from 2
to 8 inches
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
70
Synthetic Casts, cont.
3. Advantages of Synthetic Casts
a. Dry and set more quickly
•
Are weight-bearing soon after application
b. Less likely to become indented because of
fast drying time
•
Indentation: can result in pressure area
c. Weigh less than plaster casts
•
Less restrictive to patient
•
Patient has greater mobility
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
71
Synthetic Casts, cont.
3. Advantages of Synthetic Casts, cont.
d. Less bulky than plaster casts
•
Can usually wear regular clothing over them
e. Moisture resistant
•
Does not break down when wet
– Plaster casts often break down when wet
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
72
Synthetic Casts, cont.
4. Disadvantages of Synthetic Casts
a. Cannot be molded to body part as easily as
plaster
•
Less effective for immobilizing severely
displaced bones and unstable fractures
b. More expensive than plaster cast
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
73
Synthetic Casts, cont.
c. Surface is rougher than plaster casts
•
Increases chance of:
– Snagging clothes
– Scratching furniture
– Causing abrasions on
other body parts
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
74
Cast Application
1. Applied so cast fits snugly but allows
adequate circulation
2. Complete healing of fracture: 4 to 6
weeks
3. Casts classified according to body part
they cover
a. Type used depends on:
•
Nature of injury or condition
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
75
Short Arm Cast
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
76
Long Arm Cast
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
77
Short Leg Cast
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
78
Long Leg Cast
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
79
Cast Application, cont.
4. Steps for Cast Application
a. Inspect the skin
•
Must be clean and dry
•
Observe for redness, bruises, open areas
– Record in patient's chart: helps to evaluate
complaints after cast applied
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
80
Cast Application, cont.
b. Apply the stockinette
•
Soft tubular knitted cotton material
– Stretches to accommodate the diameter of
the body part
•
Put on like a stocking
•
Purpose
– Provides
comfort
– Covers rough
edges of ends
of cast
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
81
Cast Application, cont.
•
Available in widths of 2 to12 inches
– 3-inch width: for arm casts
– 4-inch width: leg casts
– 10- to 12-inch width: body casts
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
82
Cast Application, cont.
c. Apply the cast padding
•
Soft cotton material
•
Available in widths of 2 to 4 inches
•
Purpose
– Prevents
pressure
areas
– Shields
patient’s skin
when cast is
removed
Courtesy 3M Health Care, St. Paul, Minn
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
83
Cast Application, cont.
•
2 to 3 layers applied over stockinette using
spiral turn
– Each turn: overlaps by one-half width of roll
•
Extra layers applied over bony prominences
– To prevent
pressure
areas
Courtesy 3M Health Care, St. Paul, Minn
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
84
Cast Application, cont.
d. Apply the cast bandage or tape
•
Applied over cast padding
•
Number of rolls depends on desired strength of
cast
– Synthetic cast: usually 3 to 5 layers
– Plaster cast: usually 4 to 6 layers
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
85
Cast Application, cont.
•
Physician wears rubber gloves
– Protects hands from
casting material
•
Allow cast to dry
– Plaster casts require a
longer drying time
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
86
Cast Application, cont.
•
Cast must be completely dry
– Becomes hard and inflexible
– Is then able to bear weight
•
Supportive device usually prescribed (e.g.,
sling, crutches)
– Prevents strain
– Minimizes swelling
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
87
Cast Application, cont.
5. Plaster Cast
a. Completely immerse roll in tepid water: until
bubbles no longer rise from roll
•
Activates the plaster
b. Gently squeeze edges toward center of roll:
to remove excess water
•
Do not wring roll
•
Roll should be saturated but not dripping
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
88
Cast Application, cont.
c. Physician wraps body part using spiral turn
•
Until desired number of layers applied
d. Stockinette folded over edges of cast
•
Provides smooth, comfortable edge
e. Physician molds plaster to conform to
contours of body part
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
89
Cast Application, cont.
f. Physician trims ends with cast knife
•
To remove rough edges
•
To provide movement of fingers or toes
g. Instruct patient that warmth may be felt
during application
•
Usually has a soothing effect
h. Instruct patient not to put weight on cast
until dry (24 hours)
•
Wet cast may break down
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
90
Cast Application, cont.
6. Synthetic Cast
a. Keep pouch sealed until ready to use
•
Otherwise air causes tape to harden: becomes
rigid and cannot be used
b. Completely immerse roll of tape in cool RT
water
•
For period of time recommended by
manufacturer
– Example: fiberglass tape immersed for 10 to
15 seconds
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
91
Cast Application, cont.
c. Tape is wrapped over body part using spiral
turn
•
Until desired number of layers applied (between
3 and 5)
d. Cast is allowed to dry (time specified by
manufacturer)
•
Example: fiberglass cast dries in 30 minutes
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
92
Cast Application
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
93
Cast Application Precautions
1. Plaster Cast:
a. Water temperature to activate plaster
bandage: must not exceed 95° F
•
If thick cast being applied: can burn patient if
temperature exceeds 95° F
b. Do not cover wet cast with a towel, plastic,
or other material
•
Heat cannot escape: can burn patient
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
94
Cast Application Precautions, cont.
c. Take precautions to prevent indentions:
can cause pressure areas
•
Indentations may be caused by:
– Cast coming in contact with hard surfaces
while drying
– Handling wet cast with palm of hands
(rather than fingertips)
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
95
Cast Application Precautions, cont.
2. Plaster Cast and Synthetic Cast:
a. Remove excess casting particles
•
If not removed: can get under cast: causes
irritation and infection
– Plaster cast: remove plaster crumbs from
skin with damp, warm cloth
– Synthetic cast: remove synthetic material
with alcohol swab or acetone
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
96
Cast Application Precautions, cont.
b. Physician makes sure cast is not too tight
by checking:
•
Circulation
•
Sensation
•
Movement of extremity
c. Physician makes sure joints excluded from
cast are free to move
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
97
Guidelines for Cast Care
1. MA responsible for explaining cast care
to patient
2. Often presented on an instruction sheet
a. Signed by patient
b. Copy filed in patient's chart
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
98
Cast Care Guidelines
1. Wait before putting pressure or weight
on a cast
a. Plaster cast: wait 24 hours
•
•
Allows plaster to dry completely
Prevents cast from breaking down
b. Synthetic cast: can bear weight 30 minutes
to 1 hour after application
2. Elevate cast above heart level for 24 to
48 hours:
a. Prop up on pillows
b. Decreases swelling and pain
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
99
Cast Care Guidelines, cont.
3. Gently move toes or fingers frequently
a. Prevents swelling and joint stiffness
4. Ice can be applied to casted extremity:
reduces swelling
a. Ice chips in ice bag: loosely wrapped
around cast at injury site
5. Prevent foreign particles from being
trapped under cast (dirt, sand, powder)
a. Can irritate skin and lead to infection
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
100
Cast Care Guidelines, cont.
6. Do not use any object to scratch skin
under cast (e.g., coat hanger, pencil)
a. May cause break in skin
•
Could become infected
– Object could be lost in cast
7. Do not engage in activities that could
cause injury due to physical disability
(e.g., driving a car)
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
101
Cast Care Guidelines, cont.
8. Keep cast dry
a. Bath or shower: cover with plastic bag and secure with
tape
b. Hang limb over side of tub or outside shower
c. Wet plaster cast: loses shape and may break down
d. Synthetic cast
•
Outside of cast is moisture resistant, but cast padding is
not
•
If becomes wet: dry ASAP to prevent maceration
–
Maceration: softening and breaking down of the
skin, which can lead to infection
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
102
Cast Care Guidelines, cont.
9. To dry a wet cast:
a. Blot outside with towel
b. Blow dry on low setting (high setting can
burn skin)
c. Use a sweeping motion until completely dry
10.Inspect skin around cast at regular
intervals for:
a. Redness
b. Sores
c. Swelling
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
103
Cast Care Guidelines, cont.
11.Do not trim cast or break off rough
edges: may weaken or break cast
a. If rough edge occurs: file with emery board
b. Notify physician if cast becomes:
•
Loose
•
Broken
•
Cracked
12.Synthetic casts: can be signed with
permanent markers
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
104
Symptoms to Report
1. Report immediately
2. May indicate cast is too tight or infection
is developing
a. Increased swelling or pain that does not go
away with meds, elevation, or rest
b. Tingling or numbness of fingers or toes
c. Coldness, paleness, or blueness of fingers
or toes
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
105
Symptoms to Report, cont.
d. Painful rubbing, burning, or stinging under
cast
e. Foul odor or drainage coming from cast
f. Sore areas around edge of cast
g. Chills, fever, nausea, or vomiting
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
106
Cast Removal
1. Bivalve cast: cut cast
in half
2. Entire length of cast
cut on two opposite
sides: down to level
of cast padding
3. Cast cutter: electric
hand-held saw with a
circular blade that
oscillates (saw
vibrates but does not
rotate)
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
107
Cast Removal, cont.
4. Reassure patient:
saw is noisy but only
a tickling sensation
and some heat will
be felt
5. Cast pried apart with
cast spreader
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
108
Cast Removal, cont.
6. Bandage scissors:
used to cut through
cast padding and
stockinette
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
109
Cast Removal, cont.
7. Cast is removed
a. Skin: typically appears yellow and scaly
b. Extremity: thinner with flabby muscles
•
Explain to patient: is normal and results from
lack of use
8. Physician may recommend exercises
and physical therapy
a. To regain strength and function
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
110
Splints and Braces
1. Splint
a. Rigid removable device used to:
•
Support and immobilize displaced or fractured
part of the body
•
Protect areas that are sprained or strained
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
111
Splint
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
112
Splints and Braces, cont.
b. Molded to fit specific part of the body
c. Well padded: provides comfort and
prevents pressure areas
d. Can be made by orthopedist or
commercially available
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
113
Splints and Braces, cont.
e. May be applied initially to fracture
•
Can be adjusted to accommodate swelling
•
After swelling subsides: cast is usually applied
f. When fracture is almost healed
•
Cast may be removed
•
Another splint applied
-Allows for bathing of extremity
-Easy removal for therapy
g. After fracture heals completely: splint no
longer needed
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
114
Splints and Braces, cont.
2. Brace:
a. Supports a part of the body and holds in
correct position
•
Allow for functioning of body part while healing
takes place
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
115
Splints and Braces, cont.
b. Short leg walker: rigid frame with
removable padded liner
•
Type of brace
•
Used (instead of a cast) to heal a stable fracture
of lower leg
– Example: stress fracture
•
Extends from just below knee to toes
•
Permits walking and standing, which encourage
healing
•
Can be removed to permit bathing of leg
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
116
Short Leg Walker
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
117
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
118
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
119
Ambulatory Aids
1. Used by individuals who require aid in
ambulation
a. Ambulation: walking or moving from one place to
another
b. Ambulatory: Able to walk as opposed to being
confined to a wheelchair or a bed
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
120
Ambulatory Aids
2. Includes:
a. Crutches
b. Canes
c. Walkers
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
121
Ambulatory Aids
3. Device used depends on:
a. Type and severity of
disability
b. Amount of support
required
c. Patient's age and degree
of
muscular coordination
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
122
Ambulatory Aids, cont.
4. May be prescribed for:
a. Temporary condition:
•
Fracture
•
Sprain to lower extremity
•
Disability following orthopedic surgery
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
123
Ambulatory Aids, cont.
b. Long-term condition
•
Paralysis
•
Deformity
•
Permanent weakness of lower extremities
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
124
Crutches
1. Artificial support made of wood or
aluminum
2. Provide assistance in walking for
patients with problems of lower
extremities:
a. Disease
b. Injury
c. Birth defects
3. Remove weight from legs and transfer it
to arms
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
125
Crutches, cont.
4. Axillary crutch: used most frequently
a. Consists of shoulder rest and handgrips
b. Extends from ground almost to patient's
axilla
c. Rubber tips prevent crutches from slipping
on the floor
d. Made of wood or tubular aluminum
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
126
Axillary Crutch
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
127
Crutches, cont.
5. Forearm crutch (Lofstrand)
a. Tube of aluminum that extends to forearm
b. Metal cuff attached to crutch: fits around
forearm
c. Handgrip extends from crutch for weight
bearing
d. Advantage: individual can release handgrip
•
Enables use of hand; metal cuff holds crutch in
place
e. Used by patients who are paraplegic or
have cerebral palsy
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
128
Forearm Crutch
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
129
Axillary Crutch Measurement
1. Purpose
a. To ensure correct crutch length
b. Proper placement of handgrip
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
130
Axillary Crutch Measurement
2. Incorrectly fitted crutches can cause:
a. Back pain
b. Nerve damage
c. Injuries to the axilla and palms of hands
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
131
Axillary Crutch Measurement, cont.
3. Crutches that are too long
a. Shoulder rest exerts pressure on axilla
•
Can injure radial nerve leading to crutch palsy:
– Crutch palsy: muscular weakness in the
forearm, wrist, and hand
b. Forces patient's shoulders forward
•
Prevents patient from pushing body off ground
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
132
Axillary Crutch Measurement, cont.
4. Crutches that are too short
a. Patient is bent over and uncomfortable
b. Crutches are awkward to use
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
133
Axillary Crutch Measurement, cont.
5. Handgrips that are too low
a. Pressure exerted on axilla
6. Handgrips that are too high
a. Crutches are awkward to use
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
134
Axillary Crutch Measurement, cont.
7. Wooden crutches: bolts and wing nuts
used to adjust
a. Adjusted with bolts and wing nuts
8. Aluminum crutches: spring-loaded push
buttons used to adjust
a. Adjusted with spring-loaded push buttons
on an inner tube
•
Pop into holes on an outer tube
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
135
Crutch Guidelines
1. MA is responsible for instructing patient
of the following:
a. Wear well-fitting shoes with nonskid soles
•
Provide good traction
•
Provides stability
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
136
Crutch Guidelines
b. Use correct posture to:
•
Prevent strain on muscles and joints
•
Maintain balance
c. Support weight with hands on the
handgrips
•
Axillary pads should press against side of rib
cage
•
Do not support weight on axilla: may cause
crutch palsy
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
137
Crutch Guidelines, cont.
d. Look ahead when walking rather than down
at feet
e. Be aware of the surface walking on
•
Should be clean, flat, and dry
•
Remove throw rugs and obstacles to prevents
falls
f. Keep crutches 4 to 6 inches out from the
side of feet
•
Prevents obstruction of pathway for feet
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
138
Crutch Guidelines, cont.
g. Take steps by:
•
Moving crutches forward a safe and comfortable
distance (6 inches)
•
Take small steps when first learning
•
Do not move forward more than 12 to 15 inches
with each step
– Greater distance: crutches could slide
1) Patient could lose balance
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
139
Crutch Guidelines
h. Report tingling or numbness in the upper
body
•
May be using crutches incorrectly
•
Crutches may be wrong size
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
140
Crutch Guidelines, cont.
i. Extra padding can be added to the shoulder
rests for more comfort
•
Make sure padding does not press against axilla
•
Handgrips can also be padded
j. Keep crutch tips dry
•
Prevents slipping
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
141
Crutch Guidelines, cont.
k. Inspect crutch tips regularly
•
Should be securely attached
•
Replace if worn
l. Check wing nuts of wooden crutches
periodically to make sure tight
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
142
Crutch Gaits
1. Type of gait used depends on:
a. Amount of weight patient able to support
b. Patient's physical condition
c. Patient's muscular coordination
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
143
Crutch Guidelines, cont.
2. Patient should learn a fast and a slow
gait
a. Fast gait: for speed in open areas
b. Slow gait: for crowded areas
•
More than one gait reduces patient's fatigue
(different combination of muscles used for each)
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
144
Crutch Gaits, cont.
3. Four-Point Gait
a. Very basic and slow gait
b. Patient must be able to bear considerable
weight on both legs
c. Most stable and safest gait
d. Used by patients with:
•
Leg muscle weakness or spasticity
•
Poor muscular coordination or balance
•
Degenerative leg joint disease
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
145
Crutch Gaits, cont.
4. Two-Point Gait
a. Similar to, but faster than four-point gait
b. Only two points support body at one time
c. Patient must have partial weight bearing on
each foot
d. Patient must have good muscular
coordination
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
146
Crutch Guidelines, cont.
5. Three-Point Gait
a. Patients who cannot bear weight on one leg
b. Patient must be able to support full weight
on unaffected leg
c. Patient must have good muscular
coordination and arm strength
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
147
Crutch Guidelines, cont.
d. Used by patients:
•
Who are amputees without a prosthesis
•
With musculoskeletal or soft tissue trauma to a
lower extremity
– Fracture
– Sprain
•
With acute leg inflammation
•
With recent leg surgery
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
148
Crutch Gaits, cont.
6. Swing Gaits
a. Includes:
•
Swing-to
•
Swing-through
b. Used by patients:
•
With severe lower extremity disabilities
– Example: paralysis
•
Who wear leg braces
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
149
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
150
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
151
Canes
1. Lightweight, easily moveable device
2. Made of wood or aluminum with a rubber
tip(s)
3. Provides balance
and support
Courtesy 3M Health Care, St. Paul, Minn.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
152
Canes, cont.
4. Used by patients who have weakness on
one side of body
a. Hemiparesis
b. Joint disabilities
c. Defects of neuromuscular system
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
153
Canes, cont.
5. Types of canes
a. Standard cane: provide least amount of
support
•
Used by patients who require only slight
assistance
b. Tripod and quad canes: three or four legs
•
Easier to hold and provide greater stability
•
Cane can stand alone; frees patient's arms when
getting up
•
Disadvantage: bulkier and more difficult to move
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
154
Quad and Standard Canes
Courtesy of 3M Health Care, St. Paul, MN.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
155
Canes, cont.
6. Hold cane on side of body opposite to
the side that needs support
7. Properly adjust cane length
a. Cane handle should be level with greater
trochanter
b. Elbow flexed at 25- to 30-degree angle
8. Instruct patient to stand erect and not
lean on cane
a. Ensures good balance
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
156
Walkers
1. Aluminum frame with
handgrips and four
widely placed legs;
open on one side
2. Lightweight and easily
movable
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
157
Walkers, cont.
3. Should extend from the ground to the
level of patient's hip joint
4. Used by patients who need more help
with balance and walking than can be
provided by crutches or cane:
a. Geriatric patients with weakness or
balance problems
b. During healing process for knee or hip joint
replacement surgery
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
158
Walkers, cont.
5. Provides the greatest amount of stability
6. Disadvantages
a. Slow pace
b. Difficulty maneuvering
in small room
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
159
POSTTEST
True or False
1.
The recommended time for the application of heat is
15 to 30 minutes.
2.
The local application of heat results in constriction of
blood vessels in the area to which it is applied.
3.
The most frequent cause of low back pain is poor
posture.
4.
Therapeutic ultrasound produces a superficial
heating of the skin.
5.
During an ultrasound treatment, the applicator head
must be moved continuously to prevent hot spots.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
160
POSTTEST, CONT.
True or False
6.
A wet cast can cause a pressure area to occur.
7.
Synthetic casts dry more quickly and weigh less than
plaster casts.
8.
It usually takes 10 to 12 weeks for a fracture to heal.
9.
Incorrectly fitted crutches may cause crutch palsy.
10. A cane should be held on the strong side of the body.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
161