Care of Clients with Casts: Techniques and Considerations

Cast

CAST is a hard covering that is used to support fractured arms, legs or other body parts.

Purpose of Cast

Correct deformity, Hold a broken bone in place as it heals, Immobilize a bone especially after surgery, Prevent or decrease muscle contractions, Support, maintain and realign a bone, Serve as a mold of a limb in making an artificial limb.

Caring a cast while it dries

Keep the cast uncovered to dry, Check for cracks or breaks in the cast, Keep the cast always clean, Turn patient every 2 hours while the cast dries, Prevent any indentation in the cast due to pressure, Avoid resting the cast on hard surfaces or sharp edges, Avoid using the abduction bar in lifting or carrying the patient, Place a plastic lining at the edge of the cast if the cast is near the groin to avoid soiling and wetting the cast.

Plaster of Paris

White in color, made up of gypsum sulphate, dries in 1-3 DAYS.

Synthetic (fiberglass) material

Moldable plastic with variety of colors, patterns, and designs, dries in 20-30 minutes, lighter, cooler & waterproof.

Casting Materials

Plaster of Paris, Drying takes 1-3 days, If dry, it is SHINY, WHITE, hard and resistant

Fiberglass, Lightweight and dries in 20-30 minutes, Water resistant.

Characteristics of a Good Cast

White, Shiny, Odorless, Light in weight, Not too tight, Not too loose, Resonant on percussion.

Cast care instructions/HEALTH TEACHINGS

Keep the cast always clean and dry, Report presence of cracks or breaks in the cast, Rough edges should be padded to protect the skin from irritations, Avoid using any objects in scratching the skin under the cast, May use a hairdryer in a cool setting to relieve itchiness, Never blow warm or hot air into the cast, Avoid putting powders or lotion inside the cast, Cover the cast while eating to prevent food spills and crumbs from entering the cast, Elevate the cast on a cloth-covered pillow above the level of the heart to decrease swelling, Encourage the client to move his/her fingers or toes to promote circulation, Avoid using the abduction bar in turning, lifting or carrying the client, Report alarming signs.

Cast Application

Apply the stockinet first, Apply the wadding/padding sheet.

Alarming Signs

Signs indicating potential issues with a casted extremity, including fever, pain, swelling, drainage, discolorations, numbness or tingling sensation, and cold fingers or toes.

Assessing a Casted Extremity

The process of evaluating the condition of a casted limb, focusing on pain, blood supply, temperature, neurologic function, and infection.

Principles in Application of Cast

Guidelines for applying a cast, including applying stockinet and padding first, including joints above and below the affected area, applying in a circular motion, and supporting with the palm.

Management of Pain

Includes elevating the involved part, applying cold packs, and administering analgesic agents as prescribed.

Blood Supply/ Circulatory Function / Capillary Refill

Assessment of blood flow to the extremity, including checking for discoloration and capillary refill by applying pressure to toenails or fingernails.

Temperature of the Skin

Assessment of skin temperature by touching fingers or toes to determine coolness or warmth.

Neurologic Function

Evaluation of nerve function by asking the patient to move fingers or toes and assessing for numbness or tingling sensation.

Infection

Signs of infection in a casted extremity, including swelling, foul odor, fever, and drainage.

Unilateral hip spica cast

A cast applied from the chest to the foot on one leg, used for thigh fractures and to hold hip or thigh muscles and tendons in place after surgery.

One and one-half hip spica cast

A cast technique used for similar purposes as the unilateral hip spica cast.

Bivalving

A cast technique that involves cutting the cast into two halves to relieve tightness of the casted extremity.

Windowing

The process of creating an opening in a cast at the site of an open wound for visualization, inspection, dressing, and medication application.

Reinforcing

Reapplication of plaster to regain strength in a cast that has become unstable.

Petalling The Cast

A technique used to provide additional support and protection to the edges of a cast.

Stryker cast cutter

A tool used in bivalving, windowing, and removal of a cast.

Cast spreader

A device used to widen a bivalve cast.

Bandage scissor

A tool used to cut wadding sheet and stockinet.

Pail of water at room temperature

Used to wet the cast during application or adjustment.

Discoloration

A sign of potential circulatory issues, assessed by capillary refill.

Numbness or tingling sensation

Symptoms indicating potential nerve issues in the casted extremity.

Foul odor

A potential sign of infection in the casted extremity.

Swelling

An indication of possible complications in the casted extremity.

Fiberglass

A lightweight casting material that hardens quickly.

Stockinet

A protective covering for the skin under a cast.

Wadding sheet/gauze bandage

Used as padding in a cast.

Trimming knife

A tool used to smoothen the edges of the cast.

Bilateral long leg hip spica cast

Applied from the chest to the feet, immobilizing hips and legs.

Pantalon Cast

Used for affection of the pelvis.

Delvit Cast

Used for affection of the 3rd of the tibia-fibula with callus formation.

Cast Brace

Used for fracture of the distal 3rd of femur and proximal 3rd of tibia with callus formation.

Short leg hip spica cast

Applied from the chest to the thighs or knees to hold hip muscles and tendons in place after surgery.

Walking Cast

Used for affection of tarsals and metatarsals with callus formation.

Basket Cast

Used for massive bone injury of the patella to facilitate wound dressing.

Patellar Tendon Bearing Cast

Used for affection of tibia-fibula with callus formation.

Quadrilateral/Ischial Weight Bearing Cast

Used for affection of the shaft of femur with callus formation.

Body Cast

Encircles the trunk, stabilizing the spine, used for affection of the lower dorso-lumbar spine.

Minerva Cast

Applied around the neck and trunk of the body, used for affection of the cervical and upper dorsal spine.

Rizzer's Jacket

Used for affection of thoraco-lumbar spine and to correct scoliosis.

Shoulder Spica Cast

Applied around the trunk to the shoulder, arm, and hand, used for affection of the upper portion of the humerus and shoulder joint.

Complications of Casts

Include necrosis, pressure sores, nerve pulses, and compartment syndrome.

Compartment Syndrome

A condition that may lead to vascular insufficiency and nerve and muscle compression due to unrelieved swelling.

Signs/Symptoms of Compartment Syndrome

Include pain, swelling, discoloration, coolness, tingling sensation, and absent or diminished sensation.

Nursing Interventions for Casts

Include assessing alarming signs and complications of casted body and extremities and assessing neurovascular status hourly during the first 24 hours.