CONTINUING CARE FOR CLIENTS WITH CASTS

Special Considerations
●
●
●
●
●
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

Procedure Rationale
1. Wash crumbs of plaster from the skin with a damp cloth
and feel along the cast edges or areas that press into
the client’s 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)
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
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.
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 cut out. 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 physician’s permission, be immersed
in water if polypropylene stockinet and padding were
applied.
a. Wash the soiled area with warm water and a mild soap
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.
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 physician’s approval, teach isometric (muscle
setting) exercises.
18. Teach isometric exercises on the client’s 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.