Role of Nursing Personnel
Registered Nurse (RN)
- Perform neurovascular assessment on the affected extremity.
- Assess for manifestations of compartment syndrome.
- Monitor cast during drying for denting or flattening.
- Teach patient and caregiver about cast care and complications of casting.
- Determine correct body alignment to enhance traction.
- Instruct patient and caregiver about traction and correct body positioning.
- Teach patient and caregiver ROM exercises.
- Assess for complications associated with immobility or fracture (e.g., wound infection, constipation, VTE, renal calculi, atelectasis).
- Develop plan to minimize complications associated with immobility or fracture.
Licensed Practical/Vocational Nurse (LPN/LVN)
- Check color, temperature, capillary refill, and pulses distal to the cast.
- Mark circumference of any drainage on the cast.
- Monitor skin integrity around cast and at traction pin sites.
- Pad cast edges and traction connections to prevent skin irritation.
- Monitor pain intensity and administer prescribed analgesics.
- Notify RN of changes in pain or if pain persists after prescribed analgesics are administered.
Unlicensed Assistive Personnel (UAP)
- Position casted extremity above heart level as directed by RN.
- Apply ice to cast as directed by RN.
- Maintain body position and integrity of traction (after being trained and evaluated in this procedure).
- Assist patient with passive and active ROM exercises.
- Notify RN about patient complaints of pain, tingling, or decreased sensation in the affected extremity.
Role of Other Team Members
- Assess patient’s current mobility and need for assistance.
- Teach safe ambulation with assistive device based on patient’s weight-bearing restrictions.
- Establish exercise regimen and teach patient to perform exercises safely.
- Coordinate physical therapy with RN so that patient can receive timely analgesia.
- Discuss home environment with patient and identify possible modifications to facilitate recovery (e.g., stair training if allowed by patient’s weight-bearing restrictions, bed placement on first level to avoid stairs).
- Assess impact of patient’s condition on ability to perform ADLs.
- Instruct patient in use of assistive devices (e.g., long-handled reacher, shoe donner) to facilitate self-care while maintaining activity restrictions.
- Discuss home environment with patient and identify possible modifications to facilitate recovery (e.g., bed placement on first level for access to bathroom).