Duodenal distress (with spica cast): spica cast incorporates the trunk and affected limb and can cause respiratory or abdominal distress when edema is present under the cast or cast is too tight to allow for normal body functions

Subjective data: anorexia, nausea, abdominal pain

Objective data: duodenal distress, vomiting, distention, cast too tight

Ineffective breathing related to pressure from cast

Pain related to abdominal distress from pressure

Fear related to cast constriction

6. Promote drying of cast by leaving it uncovered and exposed to air for 48 hr; use no plastic

7. Prevent indenting casts with fingertips or hard surface: place on pillows; use palms of hands when positioning affected limb

8. Avoid excessive padding of Thomas splint in groin area—padding traps moisture, may lead to skin breakdown

1. Place on firm mattress; use bed boards if necessary to reduce muscle spasm

2. Maintain warmth by covering uncasted areas

3. Avoid turning for first 8 hr; when turning: use enough personnel to logroll; do not use bar between legs as turning device; support chest with pillows

4. Monitor for signs of respiratory distress: increased respirations, apprehension

5. Monitor for signs of duodenal distress: vomiting, distention; if these signs occur:

   place in prone position; have cast bivalved; may need NG tube; monitor for fluid imbalance

6. Protect cast with nonabsorbent material during elimination

Complications avoided or detected early enough to prevent serious damage