Nursing Techniques. Bandages and Plasters

Authors

Miguez Agustin Burgos. D. U. CITY FREMAP Nursing JARD? N. Seville. D.C.C.U. District Sevilla.

Damián Muñoz Simarro. D. U. Nursing D.C.C.U. District Sevilla.

Susana Tello Perez.

? Index

I. INTRODUCTION .- DEFINITIONS, CONCEPTS AND DISPLAYS II. TYPES OF BANDAGES III. TYPES OF BANDS IV. V. PROCEDURES FOR BANDAGES GENERAL RULES IN THE CONDUCT OF BANDAGES VI. Plaster cast VII. SUMMARY VIII. KEYWORDS IX. Bibliographical references? Charts

I. INTRODUCTION: Definition, concepts and indicators

We can define the dressing as a procedure or technique of wrapping a body part that is damaged for various reasons. Currently most common use is to cover the skin lesions and immobilize musculoskeletal injuries. But it is generally used in the treatment of wounds, bleeding, bruises, sprains, dislocations and fractures.

The indications of the bandages are diverse, including, we note the following:

set dressings or topical medications .- limit the movement of the affected .- fix splints, preventing .- compress properly move a body part .- provide support to any part of the body .- secured in place traction devices .- encourage the return of the venous circulation .- so. ... -

In order to clarify the name of any dressing or immobilization that we hear in the service work, or read in any book, let us put names to all dressings and immobilization of all the body parts that can be sold or immobilized.

a. Dressings:

Skull: Shoulder bandage sun hat .-: v. or Velpeau sling .- Collarbone: 8 numeral (prefabricated or made with band) .- Elbow: brachial bandage .- Forearm, wrist and hand: v. to brachial or scaphoid .- Fingers: compression or soft .- Thighs: Legguards .- Knee: Ankle .- compression: compression suropédico .- Feet: suropédico and forefoot compression .- Achilles Tendon: compressive suropédico with equinus foot. -

b. Detentions:

Humerus gypsum or plaster hanging .- U Elbow: .- brachial splint Forearm Wrist splint to brachial .-: brachial splint before. In some cases should be to avoid the prone brachial-Scaphoid supination .-: .- Hand scaphoid splint: splint to brachial or without extension to the fingers .- 1st finger hand splint or cast scaphoid digital finger .- Other hand splint .- digital syndactyly toes, syndactyly .- Foot: posterior splint or suropédica to "comb" (extended below the toes) and lateral reinforcements .- Achilles Tendon: suropédica with equinus foot .- Ankle posterior splint or suropédica .- Tibia and Fibula: inguinopédica .- Knee: inguinopédica or inguinomaleolar .-

II. TYPES OF BANDAGES

Of the several classifications that exist regarding the types of dressings, we chose the following because they consider it the most functional and understandable for practical purposes.

Soft bandage or happy: used to contain material of a cure or a dressing. §

§ pressure dressing: used to exert a progressive compression of a limb level of the distal to proximal in order to promote venous return. Also used to limit the movement of any joint in the case of bruises and sprains grade I, for example.

Rigid dressing: to completely immobilize the affected part (plaster cast). §

Suspensory bandage, holder of the scrotum or the breast. §

Special mention deserves the taping is a specific technique of dressing that keeps certain functionality of the injured area subject to the same. Applied as a therapeutic technique, selective and mechanically intended to limit the mobility of a joint in the direction of movement that affects the injured structures of peri articular tissues.



III. TYPES OF BANDS

A band is a strip of cloth used for wrapping. They differ in size, composition and quality of the material.





Sell ​​cotton, cotton bandage industrially manufactured in rolls of 7, 10 and 15 cm. in width. §

§ adhesive elastic bandage: it has one side with glue, should not be applied directly to the skin if there are problems with allergies, sensitive skin or varicose veins, putting in these cases another dressing of gauze or cellulose (crepe paper). There are different sizes. Ex - Tensoplast.

Elastic bandage, cotton and weaving is manufactured § elastic fibers, very useful if you need to apply pressure. There are different sizes.

Gauze bandage or mesh edged hydrophilic §: Made of cotton, is indicated mainly for fixing dressings. The quality and characteristics are determined by the quality and quantity of threads per cm. square. They are thin, light, soft and porous and of different sizes.

§ Venda impregnated materials: after humidification solidify and allow for a rigid dressing as the cast.

Tubular Bandages: There are different types according to their use: §

- Of cotton extensible fingers to trunk size. There is also a mesh cotton (ideal for the head). They are generally happy. Compression for support and rehabilitation, consisting of-cotton (83%) and synthetic (latex thread of polyamide 9% and 8%). Allowed to sell from limbs of children through thick trunks.



IV. PROCEDURES FOR BANDAGES

There are different ways to make the dressing, that is, various forms of overlapping bands on the affected limb or body part you want to sell, discuss the most common.

§ circular bandage: Each turn completely surrounds the previous one. Used to set the initial and final end of detention, to secure a dressing and to initiate and / or terminate a bandage. is the one used to hold a dressing on his forehead, in the limbs or to control bleeding by compression.

Spiral Bandage: § Usually used in the extremities, in this case each spin of the band cover part (2 / 3) of the previous round and is located slightly oblique to the axis of the limb. Elastic bandage is usually used because it is better suited to the area to sell. You must always start dressing the most distal to proximal (from fingers to heart).

§ spiral bandage or inverted fold: Virtually no use today. It requires practice to acquire the skills necessary for proper placement. It is used in the forearm or leg. It begins with two laps to fix the bandage round, the band went up like a spiral, place your thumb on top of the band, it bends and goes down and back, turns to the member and is repeated previous move, ending the bandage with two circular turns.

Bandage on 8: It is used in § joints (ankle, knee. Wrist and elbow), allowing these to have some mobility. We place the joint in functional position and we make a circular turn in the middle of the joint and alternate ascending and descending turns to form figures of eight.

Spica bandage: The most generally used. § To do this we must hold roll band with the dominant hand and climb up. Always start the distal part. The first round is done with a 45 ° angle towards the root of the limb, the 2 nd on it with an inclination inverted (45 ° in the opposite direction from above), the third as the first but moving a few inches to the root of the member ... so in a sawing motion, the dressing is completed, that the end is an aspect of "spike". The dressing is finished in a remote area of ​​the lesion and secured with tape. As always, the fingers are left free and monitored the appearance in these swelling, cyanosis, and coldness. In this case, loosen or remove the bandage.

§ recurring back Bandage: It is used on the tips of the fingers, head and dies. After setting the circular bandage is carried around the roll towards the end of the finger or stump and turns back: bend is made and returned to the distal part. In the end, secured with a circular turn.

Gauntlet bandage: In a glove covering the hand and fingers separately. §

V. GENERAL RULES IN THE CONDUCT OF BANDAGES

The execution of an appropriate dressing, requires prior training and ongoing. Before explaining some types of dressings, we discuss some general principles in the conduct of bandages:

Wash hands before and after each dressing. §

Prevent skin contact by isolating areas with gauze. §

Protect bony prominences before selling them. §

Use the most appropriate band for the purpose of dressing. §

Start the bandage holding the roll of the band in one hand and the front end to the other. §

§ Do not start or end the bandage directly over a wound or an area in which the patient may be exercised any pressure.

Band distal to the proximal part (finger to the heart). §

§ Bind evenly and firmly, covering 2 / 3 the width of the previous lap. The tension and pressure should be kept the same throughout the process.

In case of placing a dressing, prolonging the dressing cover a CMS. more at each end. §

Leave the distal end of the area selling book to check the vascularity, mobility and sensitivity. §

Secure the bandage with tape. §

Logging in the nursing sheet date, time, type of dressing and sell used and other pertinent observations. §

VI. Plaster cast

A. Techniques for preparation of the plaster cast:

§ grouting: This is a technique already abandoned by almost all health facilities. Orthopedic cast is to mix powder and warm water in equal parts, the resultant slurry completely wet lawn bands and performs orthopedic splint or plaster cast.



§ plaster bandages, made of the service: Like the above procedure is deprecated also for economic reasons, comfort and difficulty in its preparation.

They pose orthopedic bandages lawn by a mass of gypsum powder. The mesh fabric is imprisoned lawn a good chunk of plaster dust and with it the band is constructed.

Bandage plaster of § industrial manufacturing: Almost universal use, offer quality assurance, frag & uumle time accurate, ease of storage and handling. Are often used as splints or casts valves or complete.

Bandages and dipped in warm water and as the plaster is forged acquires the strength to become resistant to immobilization. This makes for a stiff bandage, light, porous and economically within reasonable limits.

Substitutes have appeared recently cast in the form of epoxy resins cas also gain strength and stiffness on contact with water, but its price is high and does not have the plasticity of the cast, so it does not allow a modeling technique requires perfect as the .

B. Types of plaster bandages

In practice three types of bandages used plaster .-

§ cast padding Bandage: It is virtually abandoned, but certain circumstances persist or plaster may require this type. The indications are, or Long-term use of emergency, broken limbs where there is risk of post-traumatic edema in patients to be transferred out of control doctor. And casts placed after orthopedic interventions in patients with neurological damage in the trophism of the soft tissues is severely compromised.

Member is wrapped with a bandage of cotton pressed thin with a thickness of 1-2 cm. It is reinforced by greater thickness bony prominences are padded ends with elastic bandage final paper. This layer is placed on the plaster cast.

Not padded plaster cast: § It is the most widely used method in practice. The technique is as follows in the case of complete casts:

1. It covers the entire segment will be plastered with a tubular mesh cotton fabric that extends beyond the limit to be understanding the plaster itself. This segment must include fracture, contusion etc.. and proximal and distal joints.

2. On this mesh tubular cottony bandaged spiral taking special care to protect bony prominences.

3. Placing the plaster bandage: With the patient in correct position to be cast (in the most functional as possible, close to the anatomical approach, unless there is a different medical indication), it will spiral wrapping the segment with the plaster bandage without imparting any pressure to a thickness of about 0.5 cm. Gently massage is practiced on the cast for the impregnation of the slurry is uniform and understand all the turns of the bandage.

4. Setting and modeling: For the 5-8 minutes the plaster begins to gradually gain strength and hardness. Just finished the plastering and still soft and malleable modeling begins. This should be achieved reproduce the shape, contours and depressions which are peculiar to the body casting. Ex - Relief of the patella, Achilles, etc. He carefully monitors the position of joints included in the cast.











Modeling and correction of joint positions are simultaneous actions to be performed quickly and safely, while within the 5 to 10 minutes it takes to finish his plaster frag & uumle process. After this time, the plaster loses its malleability and does not tolerate position changes, claiming it already set, comes at the cost of breaking it into its structure.

The plaster splint is often used as definitive treatment in stable lesions and / or complicated or as a prelude to the full cast as otherwise provided significant swelling or injury can be moved or somehow complicated or surgical in nature.

To make and apply a splint we will consider, in summary, the following points:

a bandage or plaster is used for industrial production that folds on itself.

o The length is calculated by direct measurement on the surface to freeze.

or thickness to be approximately 0.5 cm. (6 to 8 layers). Rate making it thicker in some cases (restless children, patients loaded, etc ....).

or splint is usually placed in the dorsal aspect of MS and in the back of MI, to allow easier movement of the fingers, provided there is no express indication of the doctor (eg a splint to the palmar brachial the forearm).

Prior to the application or a splint, the skin must be protected, just as in the case of complete casts.

o cast or shell should conform exactly to the contour of the member while it may hurt rough breakdown.

o Finally we will set the splint with a bandage, if we wet the gauze to prevent shrinkage prior to contact with wet plaster. Generally we tend to use hypoallergenic elastic bandage.







C. Most common varieties plaster casts

§ Boot inguinopédico long or full cast: Includes the entire lower limb, which covers over from the inguinal fold, trochanteric region and back at the gluteal fold. Terminates at its distal end including the entire foot, its lower limit, on the dorsal side of the foot reaches the root of the fingers and the plantar surface up to 1-2 cm. beyond the fingertips. The knee should be slightly flexed, well modeled on the femoral condyles, around the ball, under the beds of the tibial plateau, anterior tibial tuberosity, malleoli and tibial perineums marking the PRE grooves, retro and inframaleolares. The same care should be taken in the molding of the plantar arch.

Gypsum short boot: base ranges from § of massifs of the tibial plateau, anterior tibial tuberosity and back about 5-7 cm. under the fold of knee flexion. Below includes the entire foot, leaving the fingers free for the dorsal and plantar extended by up to 1-2 under the fingers - cm. beyond the tip. The model should be careful at the level of tibial plateau, grooves PRE, retro and inframaleolares and arch of the foot. Pay special attention to the padding around the base of the tibial plateau, ankle and heel.

§ brachial Plaster: casts of more frequent with short boot and plaster before help arrives. Includes, top, bottom level of armpit and below ends just above the level of the metacarpophalangeal joint and palmar flexion crease. The wrist is immobilized in slight dorsiflexion and in neutral rotation. The elbow flexion of about 100 °. Prone neutral supination. The padding must be with special attention olecranon and medial epicondyle epicondyle apophysis idees style radius and ulna. The lower limit for dorsal, comes immediately behind the heads of the metacarpals with the fist, for palmar flexion crease to the metacarpophalangeal joints. Thus, the fingers can deflect at its maximum amplitude level of the metacarpophalangeal joints.

§ Plaster with brachial: Includes over 2-3 cm. below the anterior fold of elbow flexion and distal ends above the metacarpophalangeal joints and flexion at the palmar crease. Must be protected bony prominences of the apophysis of the ulna and radius estiloidal and shaping should be careful in these prominences and in the hollow palm. The bands that pass through the space between the thumb and index must be well shaped, leaving ample room for mobility. The hand remains unobtrusive extension.





D. Recommendations for patients with plaster bandages (plaster splint or complete)

All patients with a cast member should be given a series of tips for the care of the entire cast or splint and how to warn of a series of symptoms that appear when needed health care. It is advisable to give patients written these tips through a brochure produced in the service itself.

1. Cast or splint care

§ To reduce inflammation plaster elevate the limb above the heart, the arm attached with a sling on the chest and leg on a pillow on a chair. Rest and elevation reduce pain and speed healing by reducing inflammation.

Carefully move the joints that are free (especially fingers feet), activates circulation. §

§ Keep the cast dry, moisture weakens the plaster and can cause skin irritation. When the shower cover the cast with a sealed plastic bag.

Avoid introducing dirt, sand or powder inside the splint or cast. §

Do not remove the padding (cotton) inside the cast. §

Do not insert objects such as wires or thin knitting needles to scratch the skin when it bites. §

§ Do not cut the plaster, lined with cotton is better than cutting edge. Poorly cut edges, can cause real wounds.

Never remove a cast or brace yourself, you can damage the skin and prevent the injury heals. §

No nail polish, rings or bracelets or use the limb immobilized in a cast or splint. §

§ If the cast was one of the legs, not to support the foot without medical clearance, wandering on crutches after being charged. If you are given permission to support, not do so until the plaster is completely dry and hard (at least two days).

2. Symptoms that require medical attention after the application of a plaster

Continued increase in pain (which may be caused by inflammation) and / or the cast or splint feels tight. §

Numbness and tingling in the limb that does not yield to the elevation of the limb immobilized. §

§ Excessive swelling immobilized limb, bluish or whitish, loss of mobility and / or cold temperature free joint (usually fingers and toes).

Spotting or discharge from inside the cast. §

E. Most common complications

The following are the most frequent complications in patients with casts members and / or immobilized .-

§ Bleeding .- in case of open fractures is external bleeding may compromise the patient's hemodynamic status.

§ .- Vascular lesions due to anatomical location, bony lesions, vascular lesions may occur associated.

Neurological injuries .- § anatomic considerations are the same as for the vascular lesion. Neurological damage may be partial or complete, and the peripheral nervous system can recover all or part their deficits under the intrinsic properties of Schwann cells.

Compartment syndrome in § .- limbs are various spaces surrounded by inextensible fascias of the muscles. Within these compartments are muscular structures, vascular and nervous. When an assault as ischemia, bleeding, reperfusion or trauma that increases interstitial pressure within this space in expandable structures are involved in it. This syndrome is manifested initially by pain at rest that is exacerbated by passive movement, if not treated early signs of nervous tissue damage and even vascular compromise with ischemia, hypoxia and anoxia that generates irreversible damage to muscle tissue.

Other complications directly caused by the immobility caused by trauma and immobilization. §

or deep vein thrombosis.

or pulmonary embolism.

or atelectasis / pneumonia.

Muscle wasting and deconditioning or physical.

or Injury own methods of immobilization.

or pressure ulcers.

VII. Summary

Knowledge of basic facts in the management of bandages inescapable part of the therapeutic procedures than any D. U. Nursing must master. There are countless circumstances in which the use of a method of restraint is imperative and mandatory.

It should be clear consciousness that a bandage on an emergency circumstance, not only constitutes the best treatment of pain of a fracture, dislocation, bruise etc. But also can prevent displacement of bone fragments exposure focus, and vascular compromise or nerve by the action of moving pieces, among others.

The different types of dressing are used to treat wounds, bleeding, bruises, sprains, dislocations, fractures, etc..

The combination of bandages to others and the practice acquired by D. U. Nursing is what makes performing a type of bandage suitable to each injury that we face.

VIII. Keywords

Bandages §

§ Fixed Assets

§ Bands

Plaster §

§ Injury

U. Nursing § IX. Bibliography

1. Murillo Jiménez, L. y Montero Perez, F.J. "Emergency Medicine: Therapeutic Guide." Harcourt Publishing. Madrid. 2006. 2. Ronald McRae "Practical Treatment of fractures," McGraw-Hill-American in Spain, SAU Madrid. 2003 3. "The art of making a cast." Smith-Nephew Editorial. 2002. Barcelona 4. Roces Way, J.R. And Fernández Martín, C. "Manual of taping in consultation Primary Care Nursing." Editorial BDF. Gijón. 2002 5. J. Burgos "Fractures. Orthopedic Surgery." Pan American Ed. Madrid. 1999. 6. Beare, P.G., Myers, J.L. "Medical-surgical nursing." 3rd edition. Ed Harcourt, Inc. Madrid, 2000.

Source: Medical Portals.

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