Uri P.

Monte de Ramos
ASSISTING WITH A CAST APPLICATION

BSN-III

Group G 2013

Purpose: To support and protect injured bones and soft tissue, reducing pain, swelling, and muscle spasm, maintains alignment and prevents movement of the bones while it heals.

Special Considerations: Before and after cast application: 1. Assess for signs of restricted circulation 2. Take the clients pulse rate, respiratory rate, and blood pressure Administer ordered analgesics before cast application Before cast is applied, remove clothing from the body area and rings from fingers of the affected limb Ensure safe storage of the clients valuables Wash the skin area to receive the cast and dry it thoroughly if ordered Stabilize and support the limb appropriately during cast application. Remove excess cast material from clients skin after application. Document assessment and interventions.

Equipment: Rolls of cast materials Plastic lined bucket of water at the prescribed temperature: 1. Tepid water for Plaster of Paris and water activated 2. Cool water at 26 C (80 F) for polyester and cotton cast or A thermostatically controlled hydro collator or a boiler or cooking pot with a temperature- regulating thermometer for a thermoplastic cast.

Uri P. Monte de Ramos

Stockinet Cotton sheet wadding or padding Felt padding (optional) Plaster Splints (optional) Moisture- resistant drapes Rubber gloves Plastic aprons Water- soluble lubricant Plaster knife Large bandage scissors Pillows Damp cloth

BSN-III

Group G 2013

PROCEDURE 1. Explain the procedure to the client, including the length of time the cast material requires for drying. Explain that the cast may feel warm during and after the application 2. Provide an analgesic as ordered 3. Assist the client into a comfortable sitting or lying position 4. Remove clothing from the body area and rings from fingers of the affected limb and give them to a family member or store safely in a locked safe.

RATIONALE

Uri P. Monte de Ramos

5. Support the part to receive the cast 6. Wash the skin area, and dry it thoroughly, if ordered. If there is no open wound, powder may be applied. 7. Provide stockinet of the correct size if used, and cut it several inches longer than the length of the extremity so that it will extend beyond the plaster edges. Then roll the stockinet to facilitate application. 8. Provide sheet wadding and felt pads as needed. Usually 2- 3 layers are applied. 9. Provide gloves for the physician prior to application of the cast material. 10. Hand the physician the casting material or place the material within the physicians reach. Preparation of cast material varies depending on the type of casting material used. 11. Squeeze a generous amount of water-soluble lubricant on the physicians gloves as requested 12. Support the limb while the physician applies the stockinet, padding, and cast material. With one hand, grasp the clients toes for a leg cast or fingers for an arm cast, and with the other hand support beneath the limb areas on which the physician is not working. 13. After the cast is applied, pull the stockinet out over the proximal and distal cast opening edges, while the

BSN-III

Group G 2013

Uri P. Monte de Ramos

physician secures it in place with one or two layers of cast material. 14. Remove any excess cast material deposited accidentally on the clients skin. 15. Assess the client with special reference to the cast. 16. Provide firm support for the cast. 17. Gather and dispose the used materials appropriately 18. Document.

BSN-III

Group G 2013

Uri P. Monte de Ramos

BSN-III

Group G 2013

CLIENT CARE IMMEDIATELY AFTER A CAST APPLICATION

Equipment: Soft, pliable pillows PROCEDURE 1. Assess the toes and fingers for nerve or circulatory impairments every 30 mins for several hours following application and then every 3 hours for the first 24-48 hours or until all signs and symptoms of impairment are negative RATIONALE 1 2 3 4 5

2. Immediately after the cast is applied, place it on pillows. Avoid using plastic or rubber pillows. 3. Support the cast in the palms of your hands rather than your fingertips 4. Control swelling by elevating arms or legs on pillows or, for leg fracture, by elevating the foot of the bed 5. Report excessive swelling and indications of neurovascular impairments to the physician or nurse in charge. 6. Apply ice packs to a hip spica cast 7. Expose the cast to the circulating air

Uri P. Monte de Ramos

8. Check agency policy about the recommended turning frequency for clients with different kinds of cast 9. Avoid the use of artificial means to facilitate drying. This means including fans, hairdryers, infrared lamps, and electric heaters 10. Monitor drainage for 24-72 hours after surgery. Outline the stained area every 8 hours.

BSN-III

Group G 2013

11. Never ignore any complaints of pain, burning or pressure. If patient is unable to communicate, be alert to changes in temperament, restlessness, or fussiness.

12. Give pain medications selectively 13. Do not disregard the cessation of persistent pain or discomfort complaints 14. Document

Uri P. Monte de Ramos

BSN-III

Group G 2013

CONTINUING CARE FOR CLIENTS WITH CASTS

Special Considerations: Remove crumbs of plaster from the skin, petal rough cast edges. For bed- confined patients, provide skin care over all bony prominences and turn the clients at least every 4 hours Keep the cast clean and dry Encourage clients to move toes or fingers of the casted extremity frequently Provide necessary instructions about cast care, ways to move safely, activity allowed, exercises, elevating the involved extremity, signs of neurovascular problems, ways to handle itching

Equipment: Rubbing alcohol Mineral, olive, or baby oil to apply to the skin after cast removal Adhesive tape Scissors Damp washcloth for Plaster of Paris Warm water and a mild soap for synthetic casts Pillows Fracture pan

Uri P. Monte de Ramos

PROCEDURE 1. Wash crumbs of plaster from the skin with a damp cloth and feel along the cast edges or areas that press into the clients skin. It may be necessary to use a duck billed cast bender to bend cast edges that may irritate the skin 2. Cover rough edges of the cast when it is dry. If the stockinet has not been used to line the cast, petal the edge with small strips of adhesive tape. 3. Check the cast daily for foul odors 4. Discourage the patient from using long sharp objects to scratch under the cast 5. When cast is removed, dry, flaky and encrusted skin is observed, remove this debris gently and gradually by: a. Apply oil (mineral, olive, or baby) RATIONALE

BSN-III

Group G 2013
1 2 3 4 5

b. Soak the skin with warm water and dry it

c. Caution the client not to rub the area too vigorously

d. repeat steps a and b for several days

Keeping the Cast Clean and Dry 6. Tub baths and showers are contraindicated. POP cast is

Uri P. Monte de Ramos

kept clean by wiping it with a damp cloth. Place a bib or towel over a body cast to catch spills. If a spill does wet the cast, allow the area to air dry.

BSN-III

Group G 2013

7. Use a fracture bedpan for people with long leg, hip spica, or body casts. 8. Before placing the client on the bed pan, tuck plastic or other waterproof material around the top of a long leg cast or in around the perineal cutout. Remove plastic when elimination is completed 9. For people with long leg casts, keep the cast supported on pillows while the client is on bed pan. 10. For clients with hip spica casts, support both extremities and the back on pillows so that they are as high as the buttocks 11. When removing the bedpan, hold it securely while the client is turning or lifting the buttocks. After removing the bedpan, thoroughly clean and dry the perineal area

12. Synthetic casts: Synthetic casts can be cleaned readily and may, with the physicians permission, be immersed in water if polypropylene stockinet and padding were applied. a. Wash the soiled area with warm water and a mild

Uri P. Monte de Ramos

soap

BSN-III

Group G 2013

b. Thoroughly rinse the soap from the cast

c. Dry thoroughly to prevent skin maceration and ulceration under the cast.

d. If the cast is immersed in water, the cast and underlying padding and stockinet must be dried thoroughly. First blot excess water from the cast with a towel. Then use a handheld blow-dryer on the cool or warm setting, directing the air stream in a sweeping motion over the exterior of the cast for about 1 hour or until the client no longer feels a cold clammy sensation like that produced by a wet bathing suit.

Turning and Positioning Clients 13. Place pillows in such a way that: a. Body parts press against the cast edges as little as possible.

b. Toes, heels, elbows, etc., are protected from pressure against bed surface.

Uri P. Monte de Ramos

BSN-III

Group G 2013

c. Body alignment is maintained

14. Plan and implement a turning schedule incorporating all possible positions.

Exercise 15. Unless contraindicated, encourage active ROM exercises for all joints on the affected extremities, as well as on the joints proximal and distal to the cast

16. Encourage the client to move the toes and/or fingers of the casted extremity as frequently as possible.

17. With the physicians approval, teach isometric (muscle setting) exercises.

18. Teach isometric exercises on the clients unaffected limb before the person applies it to the affected limb. Demonstrate muscle palpation while the client is carrying out the exercise. 19. Document assessments and nursing implementations on the appropriate records.

Uri P. Monte de Ramos

TRACTION CARE

BSN-III

Group G 2013

Purpose: To apply a continuous pulling force to an extremity or body part, maintain its alignment, and prevent infection.

Guidelines: All traction should have a counter traction to prevent the client from being pulled by the force of traction against the pulleys or the bed, thus negating the traction To apply and maintain the correct amount of traction, all traction weights should be hanging freely and the ropes should not touch any part of the bed. The traction force should follow an established line of pull. The line of pull determines the position and alignment of the body as prescribed by the physician Traction should always be applied while the client is in proper body alignment in a supine positio

Equipment: Protective skin devices, e.g. heel protectors Trapeze Rubbing alcohol Antiseptic agent Sterile gauze dressing Picking forceps PROCEDURE 1. Inspect the traction apparatus regularly, whenever you are at the bedside or at prescribed intervals, such as every 2 hours 2. Provide protective devices and measures to safeguard RATIONALE 1 2 3 4 5

Uri P. Monte de Ramos

the skin. E.g. heel protectors, pillows, etc) massage the skin. 3. Maintain the client in supine position unless there are other orders 4. Provide a trapeze to assist the client to move and lift the body for back care if the person is unable to turn, e.g., if the client has balanced suspension traction 5. Do not remove skeletal and adhesive skin traction. 6. Non adhesive skin traction is intermittent and can be removed; check agency policy about any orders required. Remove weights first; then unwrap the bandage and provide skin care. Rewrap the limb and slowly reattach the weights 7. Provide pin site care and this varies with different hospital protocols. Carefully inspect the site Use sterile technique Remove crusts with a rolling technique Cover sites with a sterile barrier Determine the frequency of care by the amount of drainage 8. Teach client deep breathing and coughing. 9. Teach the client appropriate exercises 10. Document

BSN-III

Group G 2013

Uri P. Monte de Ramos

BSN-III

Group G 2013