{
  "name": "Traction & Casting Care",
  "slug": "traction-cast-care",
  "url": "https://nursingplex.com/care-plans/traction-cast-care",
  "category": "Musculoskeletal",
  "summary": "Alignment maintenance, pin-site care and neurovascular assessment.",
  "nursing_diagnoses": [
    "Risk for peripheral neurovascular dysfunction",
    "Acute pain",
    "Risk for infection"
  ],
  "overview": [
    "Traction applies a pulling force to reduce and align fractures, relieve muscle spasm and prevent deformity. Skin traction such as Buck's applies light weight through boots or tape, while skeletal traction uses pins or wires placed directly into bone for heavier, sustained pull.",
    "Casts immobilize a reduced fracture with plaster or fiberglass. Plaster takes 24–72 hours to dry fully and must be handled with palms, not fingertips; fiberglass dries in about 30 minutes and is lighter but less moldable.",
    "The dominant nursing risks are the same for both: neurovascular compromise, compartment syndrome, skin breakdown and — for skeletal traction — pin site infection. Frequent neurovascular checks are the single most important task, and unrelieved pain out of proportion to injury is the earliest warning of compartment syndrome."
  ],
  "key_facts": [
    {
      "label": "Neurovascular checks",
      "text": "The six Ps: pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia — check distal to the device."
    },
    {
      "label": "Compartment syndrome",
      "text": "Deep, unrelenting pain worsened by passive stretch and unrelieved by opioids; bivalve the cast and notify surgery immediately — do not elevate above heart level."
    },
    {
      "label": "Traction weights",
      "text": "Hang freely, never touch the floor or bed, and are never removed without a specific order."
    },
    {
      "label": "Plaster drying",
      "text": "Leave uncovered, handle with palms, support on pillows and expect warmth as it cures."
    },
    {
      "label": "Pin site care",
      "text": "Clean per protocol with chlorhexidine; report purulent drainage, increasing redness, pain or loose pins."
    },
    {
      "label": "Cast rule",
      "text": "Never insert objects to scratch under a cast; use cool air instead."
    }
  ],
  "nursing_priorities": [
    "Maintain neurovascular integrity distal to the device.",
    "Maintain effective traction alignment and countertraction.",
    "Prevent pin-site and skin infection.",
    "Control pain and muscle spasm.",
    "Prevent immobility complications."
  ],
  "assessment": {
    "subjective": [
      "Pain quality, severity and whether it is relieved by analgesia",
      "Numbness, tingling, burning or itching under the cast",
      "Muscle spasm and comfort with current positioning",
      "Understanding of restrictions and home care"
    ],
    "objective": [
      "Color, temperature, capillary refill, pulses, sensation and movement distal to the cast or traction",
      "Cast condition: cracks, softening, indentations, drainage staining and odor",
      "Traction setup: weights hanging free, ropes in pulleys, correct alignment, body position",
      "Pin sites for drainage, redness, crusting and pin loosening",
      "Skin at cast edges and under straps; edema of the extremity",
      "Temperature and inflammatory markers if infection is suspected"
    ],
    "related_factors": [
      "Fracture, surgical fixation and soft tissue swelling",
      "External compression by cast or bandage",
      "Percutaneous pins creating a portal for infection",
      "Prolonged immobility in traction"
    ]
  },
  "goals": [
    "The client will maintain intact neurovascular status distal to the device every shift.",
    "The client will maintain prescribed alignment with traction functioning correctly.",
    "Pin sites will remain free of infection.",
    "The client will report pain 3/10 or lower.",
    "The client will remain free of pressure injury, VTE and respiratory complications."
  ],
  "interventions": [
    {
      "title": "Neurovascular monitoring",
      "points": [
        "Assess the six Ps every hour for the first 24 hours, then every 4 hours, and compare with the opposite limb.",
        "Report deep unrelenting pain, pain with passive stretch, paresthesia or a tense, swollen compartment immediately.",
        "Elevate a newly casted limb to heart level to control edema — but not above heart level if compartment syndrome is suspected.",
        "Apply ice over the fracture site for the first 24–48 hours as ordered."
      ]
    },
    {
      "title": "Traction maintenance",
      "points": [
        "Keep weights hanging freely off the floor and never lift or remove them without an order.",
        "Ensure ropes run in the pulley grooves without fraying and that knots are secure.",
        "Maintain body alignment and countertraction; keep the patient from sliding to the foot of the bed.",
        "Never release skeletal traction; for skin traction, follow orders for removal during care."
      ]
    },
    {
      "title": "Skin, pin and cast care",
      "points": [
        "Perform pin care per protocol and document drainage character; report purulence or new pain.",
        "Petal cast edges with tape to prevent skin irritation and keep the cast clean and dry.",
        "Inspect skin at cast edges and under traction straps every shift and pad bony prominences.",
        "Use a hair dryer on cool setting for itching; never insert objects into the cast."
      ]
    },
    {
      "title": "Immobility and comfort",
      "points": [
        "Encourage isometric and range-of-motion exercises of uninvolved joints and muscles.",
        "Use a trapeze bar for repositioning and provide pressure-relieving surfaces.",
        "Give scheduled analgesia and muscle relaxants for spasm; use repositioning and heat where allowed.",
        "Maintain VTE prophylaxis, incentive spirometry, hydration and bowel regimen."
      ]
    }
  ],
  "patient_teaching": [
    "Report numbness, tingling, coldness, blue color, or pain that keeps getting worse despite medication.",
    "Keep the cast dry — cover for showers and never place a wet cast against skin.",
    "Do not scratch inside the cast or use lotion or powder under it.",
    "Elevate the limb and exercise the fingers or toes frequently to reduce swelling.",
    "Report a foul smell, drainage stains, or a soft or cracked cast.",
    "Keep follow-up appointments for cast checks and x-rays."
  ]
}