Spica (body) casts are used to keep the thighbone (femur) and pelvis still. We call this immobilization. This cast holds the joint above the hip (the spine) and the joint below the hip (the knee) still, so that the femur and pelvic bones stay still to heal. It is used after a fractured femur (thighbone), after hip or pelvis surgery, or after tendon surgery around the hip. A spica cast covers the child from the armpits around the chest all the way to the ankle of one or both legs. If the cast only goes to one ankle, the other leg is in the cast to just above the knee. There is an opening in the diaper area. The inside layer is made of Gore-Tex to whisk away moisture, then there is cotton padding, and over all of that is fiberglass. There might be a bar between the legs, this is per surgeon preference. Show
Spica casts are almost always put on with the child sedated or under general anesthesia. The length of time is determined by your doctor and your child's healing process. Typical length of time for a spica cast is 12 weeks. Your doctor may want to perform a spica cast change in the operating room at 6 weeks. Your child will need general anesthesia to be put to sleep for the cast change. We do not typically change the cast more frequently then this because we do not want to expose your child to anesthesia unnecessarily. That being said, it is very important to properly care for your child's spica cast. Here are some tips to make caring for your child easier. Safety
Traveling
Cast care
Skin care
Diet
Going to the bathroom If your child wears diapers Check the diaper often and at least once overnight. For boys, you can also make an "envelope" to catch urine. Use a small disposable diaper. Cut a hole in the front, center of the diaper. The hole should be just wide enough for the penis to fit through. Keep the diaper folded, plastic side out, with the cut side towards your son. Insert penis into the hole of the diaper. Use diaper tapes to secure diaper to cast. Urine will collect in the small diaper. Put a larger diaper over the cast as usual so that both the smaller, cut diaper, and the rest of your child's bottom are covered. If your child is potty trained What if the cast gets wet? Bathing and hair washingYour child will need to have sponge baths. If body odor becomes a problem, you can sprinkle a small amount of deodorant body powder on the cast or spray a small amount of under-arm deodorant on the cast. Do not spray the cast with household cleaners or deodorizers such as Lysol. Washing your child's hair
ClothingClothes should be loose and comfortable. T-shirts should be 1-2 sizes larger than usual to fit over the cast. Boxer shorts or sweat pants in a larger size can also fit over the cast. You may also want to cut shorts or sweatpants and sew in Velcro to allow older children to wear their regular clothing. Breakaway shorts (with snaps on each side) can be used with casts that have a bar connecting the legs of the cast. Your child may be warmer than usual. Light clothing may be all that's needed. Daily activityIf your child complains of pain, give pain medicine as directed by your doctor. Pain medicine may be needed at night for 1-2 weeks. Keep your child where the action is. You may want to bring the child's bed to the living room so they can be where everyone is. This will also save you from running back and forth. Your child will not be able to stand on their injured leg but may be able to stand on the opposite leg. This will allow them to help with getting in and out of bed. A physical therapist can help show you this. Some things for your child to do
Returning to school or day careYour child may need home instruction for the duration of the casting due to the amount of care needed during that time. The Orthopedic Nurse Clinician will help arrange this with your school district. The healthcare provider will tell you when your child can return to school. Generally your child should be off of narcotic medication during the day before returning to school. When to call the doctor
Phone numbers Weekdays: Please call the Orthopedic Nurse Clinicians at (510) 428-3238. Safe transportation for a child in a spica castIf your child's surgery is scheduled in advance, you'll have time to arrange transportation ahead of time. The surgeon is usually able to tell you the approximate size of the cast, that is, how wide it will be, and how much it will bend at the knees. Depending on the width of the abduction of your child's legs, your child may not fit safely into their car seat. The Orthopedic Nurse Clinician can help you figure out what would be best. Sometimes children in spica casts fit in a conventional convertible car seat with lower sides and a wider front especially one that will recline in both rear-facing and forward-facing positions. It will depend on your child's weight, height and age. Here are a few options:
What if my child does not fit in their car seat? Pick-up procedureYou will need to come into the Trauma office and sign the agreement for financial responsibility. You will be given guidance on how you can install the seat correctly and resources to have the car seat checked for proper installation in your vehicle. Return procedureYou will need to return the seat to the Trauma office (or in the Emergency Department if Trauma is closed) at the time of your orthopedic follow-up appointment. Please do not plan to leave the car seat in the Orthopedic Department. Child passenger restraints for children in spica castsEZ-ON vest: Another option for children in spica casts is called the modified EZ-ON vest. This vest is for children aged 2 to 12 and weighing from 20 to 100 pounds. The 101M2 fits children better who are 5-12 years old, 65-100 pounds. The M203-XS fits snugger on children 2-5 years of age, 20-65 pounds. When using the modified EZ-ON vest, your child must travel lying down in the rear seat of the vehicle. See www.ezonpro.com for referral to a distributor in your area. Which procedure with the nurse used to elevate the head of an infant in a spica cast?Using the bedpan
Elevate your child's head and shoulders with pillows when he/she is placed on the bedpan. This will help prevent urine from running backward and inside the cast. A gauze or cloth pad or a small folded towel placed on the back rim of a bedpan will absorb any moisture and help keep the cast dry.
Which protective equipment would the nurse use when caring for an infant admitted with gastroenteritis?Contact precautions includes wearing gloves and a plastic apron or impervious gown when having contact with the patient or the patient's environment, especially when attending to patient toileting and hygiene. Protective eyewear and mask must be worn when there is the potential of vomit or faecal splashing.
Which covering would the nurse use over the exposed area of an infant admitted with exstrophy of the bladder?After delivery, the bladder is covered with a clear plastic dressing to protect it. Children born with bladder exstrophy are treated with reconstructive surgery after birth.
Which is an example of the principles of body mechanics that the nurse uses when caring for immobilized clients?The nurse uses which principles of body mechanics when caring for immobilized clients? Placing the feet apart creates a wider base of support and brings the center of gravity closer to the ground. This improves stability.
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