Perawatan Pasien dengan Gips (Cast)

Patient with a C a s t

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Learning Outcomes
1. Membandingkan dan menbedakan plaster & fiberglass
casts (gips)
2. Menjelaskan perawatan yang diperlukan selama proses
pengeringan gips
3. Mencegah komplikasi yang mungkin terjadi
i. Pengkajian keperawatan untuk mendeteksi dini
ii. Tindakan keperawatan untuk mengatasi kompliksasi
4. Pendidikan kesehatan bagi keluarga

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Casting

Goal of semi-rigid immobilization while
avoiding pressure / skin complications

Often a poor choice in the treatment of
acute fractures due to swelling and soft
tissue complications

Good cast technique necessary to
achieve predictable results
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Casting Techniques

Stockinette - may require two different
diameters to avoid overtight or loose
material

Caution not to lift leg by stockinette –
stretching the stockinette too tight around
the heel may case high skin pressure

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Casting Techniques

To avoid wrinkles in
the stockineete, cut
along the concave
surface and overlap
to produce a
smooth contour

Figure from Chapman’s

Orthopaedic Surgery 3rd Ed.
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 Casting Techniques

Cast padding
• Roll distal to proximal
• 50 % overlap
• 2 layers minimum
• Extra padding at fibular
head, malleoli, patella,
Figure from Chapman’s
and olecranon Orthopaedic Surgery 3rd Ed.

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Plaster vs. Fiberglass

Plaster
• Use cold water to maximize molding time

Fiberglass
• More difficult to mold but more durable and
resistant to breakdown
• Generally 2 - 3 times stronger for any given
thickness

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 plaster casts fiberglass casts

inexpensive 
has durability of plaster

heavy but is lighter weight

sets in ~ 3 -1 5 minutes, 
hardens within minutes
then takes 24 - 72 h to dry 
is porous and  there are
(varies with thickness)
fewer skin problems

messy to apply 
does not soften when wet

gives more support for
- hair dryer quickly dries
‘bad breaks’
skin beneath

Costs more

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Care required while the plaster cast dries

once applied heat is given off for ~ 15 minutes & may
be uncomfortable

while the plaster sets, the cast will remain soft &
touching may lead to indentations which may then
create pressure spots

until dry
 handle the cast with palms of hands only - not
fingers
do not rest cast on hard surfaces or sharp edges

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note the use of
1. Stockinette
2. Padding
3. Casting material

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Potential Complications
hidden bleeding
neurovascular compromise
compartment syndrome
skin &/or tissue breakdown
hidden infection from wound &/or ulcer

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Bleeding may occur beneath a cast if

there is trauma to the skin at the time of injury

surgery is required to reduce the fracture
• this will be documented as ORIF
– open reduction & internal fixation

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To detect bleeding

visualize the cast carefully. Give particular
attention to
• areas over known wounds &/or incisions
• dependent areas - remember that liquid flow
follows the line of gravity

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Typical appearance (& terminology to describe)

@ 1000 hours Sanguineous

@ 1200 hours Sero-sanguineous

serous
@ 1400 hours

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If you see bleeding
Mark the outer edges of the bleeding area with time
and date & then initial
Example: JW
Jan 10 - 1000
1200 JW
1400 JW

Then ---- >

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Follow-up

continue to monitor

instruct client to call you if additional bleeding is noted
&/or if s/he notices any other changes

notify MD if
• bleeding continues
• there is a significant change in vital signs
• client condition changes

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Document Narrative Notes
0845 dark red area ~ 3 cm diameter
in narrative notes
noted over outer aspect of
& indicate
malleolus; P 88, R 24,

size BP 108/56; alert but pale;


location 0930 slight extension of bleeding;

client states “feel fine”


vitals 1030 no further bleeding noted; P 80


other signs of BP 120/ 66 ; instructed to call

nurse if further bleeding noted

bleeding
JWladyka RN

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Neurovascular Compromise
Compression of nerves and blood vessels may be
caused by

swelling 2° to injured tissue

impinging bone pieces

swelling 2° to surgery

restrictive pressure 2° the cast

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 by doing C S M
C colour plus 
• capillary refill (normal < 3 sec)
• pulse in affected extremity
– [whether present -- no need to count]
• temperature of skin
S sensation -- do not use a sharp object to assess
M able to move extremity & digits

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Frequency of C S M

assess q2h X 8, then q4h X 48, then q 8 h

at first sign
• elevate limb > heart
• give analgesia
• if symptoms persist notify MD stat as
compartment syndrome may be occurring 

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If swelling persists

the physician will order the
cast to be bivalved
Note - Bivalving may be
done by
• a physician
• an orthopedic technician
• a specially trained nurse

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Compartment
Syndrome - a special form of neurovascular compromise

muscles, nerves & blood vessels are enclosed
in though inelastic fascia (or compartments)


if the muscle within a compartment becomes
swollen it cannot stretch & thus the nerves and
blood vessels are compressed

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Signs & Symptoms

deep, throbbing, unrelenting pain
• not controlled by analgesics
• often seems out of proportion to the injury

swollen and hard muscle

diminished capillary refill, cyanotic nailbeds,
obscured pulse

parasthesia, paralysis
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To reverse compartment syndrome

A fasciotomy is performed

Burrell et al; 1590

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Skin &/or tissue breakdown
Is most likely if the

cast is resting too close to the tissue --
particularly over boney prominences

cast edges are sharp and irritating the
skin

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Monitor Pressure Areas

The cast over the area may
become warm d/t
inflammation beneath

if there is skin breakdown
there might be drainage

if the area becomes Diagram to be added
infected there may be an
odour
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Windowing a cast
Using cast cutting equipment

an orthopedic tech

MD, or

specially trained nurse
cuts out a piece of the plaster
over the area of concern
if required a dressing is applied Picture to be added

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Finishing a cast

If the edges are not
covered with
stockinette, then
you may need to
cut small pieces of
Burrell et al; 1591
tape to smooth over
the edges -- this is
referred to petalling
the cast
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Prosedur Pemasangan Gips
Persiapan alat –alat: 
Pemotong gips

Bahan gips dengan ukuran 
Kasa dalam tempatnya
sesuai ekstremitas tubuh 
Alat cukur
yang akan di gips 
Sabun dalam tempatnya

Baskom berisi air hangat 
Handuk

Gunting perban 
Krim kulit

Bengkok 
Spons rubs ( terbuat dari

Perlak dan alasnya bahan yang menyerap

Waslap/duk keringat)

Padding (pembalut terbuat
dari bahan kapas sintetis)

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 Prosedur Tindakan
1. Siapkan klien dan jelaskan prosedur
2. Siapkan alat-alat
3. Daerah yang akan di pasang gips dicukur, dibersihkan,dan di cuci
dengan sabun, kemudian dikeringkan dengan handuk
4. Sokong ekstremitas atau bagian tubuh yang akan di gips.
5. Posisikan dan pertahankan bagian yang akan di gips dalam posisi
yang di tentukan
6. Pasang duk pada klien.
7. Pasang spongs rubs (
8. Balutkan gulungan bantalan tanpa rajutan dengan rata dan halus
sepanjang bagian yang di gips. Tambahkan bantalan didaerah
tonjolan tulang dan pada jalur saraf (mis: caput fibula)
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 Prosedur Tindakan
9. Siapkan klien dan jelaskan prosedur
10. Balutkan gulungan bantalan tanpa rajutan dengan rata dan halus
sepanjang bagian yang di gips. Tambahkan bantalan didaerah
tonjolan tulang dan pada jalur saraf (mis: caput fibula)
11. Pasang gips secara merata pada bagian tubuh.
12. Setelah pemasangan, haluskan tepinya, potong serta bentuk
dengan pemotong gips.
13. Bersihkan Partikel bahan gips dari kulit yang terpasang gips.
14. Sokong gips selama pergeseran dan pengeringan dengan
telapak tangan.
15. Mendokumentasikan prosedur dan respons klien pada catatan
klien
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Open surgical approach

Direct Reduction Technique

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 Open reduction & internal fixation
(ORIF)


Plating through
modified incisions
• Indirect reduction
techniques
• Limited incision for:
– Passing and
positioning the plate
– Individual screw
placement
• Soft tissue “friendly”
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 External Fixation

Temporary stabilization of long bone
injuries in unstable patient
• Minimally invasive
• Decreases bleeding
• Pain control
• Nursing care
• “Damage control”

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Traction

Method of choice for acetabular and proximal
femur fractures

If there is a knee ligament injury usually use
distal femur instead of proximal tibial traction

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Traction

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