A nurse determines that a fracture bedpan should be used for the patient who:
Bivalve: Splitting the plaster cast in two complete pieces to relieve swelling, pressure or neurovascular compromise, or to allow for frequent assessment Show
Closed reduction: The hip is gently manipulated into the acetabulum by flexion, traction and abduction under a general anaesthetic and then immobilised in a hip spica cast. An adductor tenotomy, which involves percutaneous lengthening of tendons, may also be performed. Developmental Dysplasia of the Hip (DDH): An abnormality in the development of the hip joint. The size, shape, orientation, or organisation of the femoral head, acetabulum or both can be affected. The abnormality may be congenital or may develop during infancy or childhood. Femoral/Pelvic osteotomies: Usually performed on children with DDH greater than 18 months. The cutting and repositioning of bone required to reconstruct and safely maintain the hip in the reduced position. Hip Spica: A plaster of Paris covering the torso and continuing down to the ankle on the affected side and to the knee on the unaffected side or covering bilateral legs to the ankle. There is an opening around the perineal area for toileting. Used to immobilise and maintain optimal position for abduction and flexion of the hips, pelvis, and/or femur. Open Reduction: Usually performed after failed closed reduction in children greater than 2 years. Involves lengthening tendons, removing obstacles to reduction and tightening the hip capsule. AssessmentPhysical assessmentPatient assessmentNeurovascular assessment
Pain assessment
Skin and plaster assessment
ManagementAcute managementHydration and NutritionPositioning
Transferring patient
Toileting
Cast care
Sleeking or Petaling
Figure 1. Applying waterproof tape to edges of the perineal area Scotching
Figure 2. Applying waterproof tape to edges of perineal area and scotching the plaster. Dressings
Hygiene and skin care
Diet/Constipation
Ongoing ManagementAllied Health ReferralsPhysiotherapy
Occupational Therapy
Potential ComplicationsPressure areas
Pruritus
Neurovascular compromise
Plaster issues
Mesenteric Artery Syndrome / Cast Syndrome Mesenteric artery syndrome/cast syndrome can occur isas a rare complication secondary to pressure of the cast around the abdomen. It is associated with proximal duodenal obstruction resulting in the external compression of the third portion of the duodenum by the superior mesenteric artery. Signs and symptoms are general and unpredictable in nature and can include emesis which is frequently bilious, and may contain partially digested food, nausea, early satiety, and abdominal pain. Diagnosis occurs by performing upper gastrointestinal imagingseries withusing contrast. Parents and carers need to be aware of this complication before the child is discharged from hospital. If, after the child is at home, the cast is found to be too tight around the abdomen, the child needs to attend their closest hospital emergency department as soon as possible. A small round hole can be cut into the cast to relieve the pressure on the child’s stomach. Discharge Planning and assessmentCar seating and transportation
Figure 3: padding used for infant in car seat. Fitting car seats and restraint modificationsIt is neither legal nor safe for parents to use the following information to make changes to their child's restraint without the advice of a trained health care professional. In Victoria, it is compulsory for children travelling in a vehicle to be restrained appropriately for their age and height, with a child restraint that complies with the Australian/NZ Standard 1754.
If the patient is unable to be fitted into an appropriate restraint they must be transferred home via non-emergency patient transport and follow up transfer for outpatient appointments to be organised by the patient’s GP.
Completing Letters in EMRIf using EMR, there are two letters available in the Communication Management Activity. Both letters need to be completed and provided to the parent/carer before the patient is discharged. The RCH Medical Car Seat Letter is to be accessed, printed and signed by the medical team. The OT car seat letter is to be completed by the OT or nurse fitting the car seat as well as the parent/carer.
Once completed, print by clicking preview and print. Further information can be located on the TOCAN website /tocan/ Fitting prams/strollers/ wheelchairsThe child in a hip spica needs to be assessed to determine if they fit into their pram. Please refer to physiotherapy for fitting of all prams/strollers and wheelchairs. If the child does not fit into their own pram, an alternative pram can be fitted by physiotherapy and then hired from EDC. Older children may require a reclining wheelchair which can also be hired from EDC. Refer to TOCAN Case Studies for examples of troubleshooting car-seating and restraints for individual medical conditions /tocan/case_studies/Case_Studies/ Education
Follow-up / Review
Family centered care
Special considerations
Companion documentsLinksEvidence tablePlease click here to view the evidence table. Please remember to read the disclaimer. The revision of this nursing guideline was coordinated by Kiralee Ciampa, RN, Platypus Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated February 2018. Why use a fracture bedpan?Description. Why use a fracture bedpan and not a regular bedpan? A fracture bedpan is smaller and goes under the patient from the front and alleviates the need of turning the patient. This helps to reduce discomfort and possible re-injuring of the fracture.
Who may use a fracture bed pan?Fracture pans
These bedpan products are specifically created for patients and individuals who are recovering from a hip fracture or hip replacement. This kind of bedpan can also be used by patients who are not able to roll over or raise their hips high enough for a traditional bedpan.
What is bedpan used for?A bedpan is a container used to collect urine or feces, and it is shaped to fit under a person lying or sitting in bed. Bedpans can be made of plastic or metal, and some can be used with liners to prevent splashing and to make cleaning easier. If you are helping someone with a bedpan, try to be relaxed.
What are important steps in placing a client with a hip fracture on the bedpan?Make sure the buttocks are firm against the bedpan, pushed in a downward motion into the stretcher or mattress pad. Hold the bedpan with one hand and the hip with the other and roll the patient onto the bedpan. Avoid patient injury by never forcibly placing the pan under the buttocks.
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