A child with scoliosis has a spica cast applied. Which action specific to the spica cast should be taken?
A. Check the bowel sounds
B. Assess the blood pressure
C. Offer pain medication
D. Check for swelling
Correct Answer: A. Check the bowel sounds
A body cast or spica cast extends from the upper abdomen to the knees or below. Bowel sounds should be checked to ensure that the client is not experiencing a paralytic ileus. Auscultate the abdomen for bowel sounds, if bowel sounds are present, or the patient reports they are passing flatus, clear fluids can commence and aperiments can be administered. Patients must not commence oral fluids if bowel sounds are not present as this finding indicates an ileus.
Option B: Checking the blood pressure is a treatment for any client. Routine post anaesthetic observations are a requirement for patient assessment and the recognition of clinical deterioration in post-operative patients; acknowledging that children are at a high risk of complications post anesthetics, surgeries and procedures.
Option C: Offering pain medication is inappropriate. Patients who have had a closed reduction usually only require oral analgesia. Patients who have sustained a fracture or who have had open reduction or osteotomy will usually require an opioid infusion and/or epidural. Pain scores, interventions, and evaluation of interventions performed, should be documented in the observation flowsheet.
Option D: Checking for swelling isn’t specific to the stem. Evaluate patients’ skin integrity regularly. Observe for any redness, irritation, or burning sensation. In the acute postoperative period, swelling can occur and a tight cast can potentially cause neurovascular compromise. Children who have had an open reduction or osteotomy may have significant swelling in the groin area. Monitor swelling and plaster to ensure the cast is not too tight.