NAME :_______________________________ SKILLS NO : _________

BSN :_______ DATE :______________

Caring for a Cast

A cast is a rigid external immobilizing device that encases a body part. Casts are used to
immobilize a body part in a specific position and to apply uniform pressure on the
encased soft tissue. They may be used to treat injuries, correct a deformity, stabilize
weakened joints, or promote healing after surgery. Casts generally allow the patient
mobility while restricting movement of the affected body part. Casts may be made of
plaster or synthetic materials, such as fiberglass. Each material has advantages and
disadvantages. Non-plaster casts set in 15 minutes and can sustain weight bearing or
pressure in 15 to 30 minutes. Plaster casts can take 24 to 72 hours to dry, with no weight
bearing or pressure application during this period. Nursing responsibilities after the cast
is in place include maintaining the cast, preventing complications, and providing patient
teaching related to cast care.

Equipment
 Washcloth
 Towel
 Skin cleanser
 Basin of warm water
 Waterproof pads
 Tape
 Pillows
 Clean gloves, if indicated

Assessment
Review the patient’s medical record and nursing plan of care to determine the need for
cast care and care of the affected area. Perform a pain assessment and administer the
prescribed medication in sufficient time to allow for the full effect of the analgesic prior
to starting care. Assess the neurovascular status of the affected extremity, including distal
pulses, color, temperature, presence of edema, capillary refill to fingers or toes, and
sensation and motion. Assess the skin distal to the cast. Note any indications of infection,
including any foul odor from the cast, pain, fever, edema, and extreme warmth over an
area of the cast. Assess for complications of immobility, including alterations in skin
integrity, reduced joint movement, decreased peristalsis, constipation, alterations in
respiratory function, and signs of thrombophlebitis. Inspect the condition of the cast. Be
alert for cracks, dents, or the presence of drainage from the cast. Assess the patient’s
knowledge of cast care.

Nursing Diagnosis
Determine the related factors for the nursing diagnoses based on the patient’s current
status. An appropriate nursing diagnosis is Risk for Peripheral Neurovascular
Dysfunction. Other nursing diagnoses that may be appropriate include:

 Anxiety
 Disturbed Body Image
 Risk for Disuse Syndrome
 Risk for Falls
 Risk for Infection
 Risk for Injury
 Deficient Knowledge
 Impaired Physical Mobility
 Acute Pain
 Self-Care Deficit (bathing/hygiene, feeding, dressing or grooming, or toileting)
 Risk for Impaired Skin Integrity
 Delayed Surgical Recovery
 Impaired Tissue Perfusion
 Impaired Home Maintenance

Outcome Identification and Planning

The expected outcome to achieve when caring for a patient with a cast is that the cast
remains intact and the patient does not experience neurovascular compromise. Other
outcomes include that the patient is free from infection, the patient experiences only mild
pain and slight edema or soreness, the patient experiences only slight limitations of range
of joint motion, the skin around the cast edges remains intact, the patient participates in
activities of daily living, and the patient demonstrates appropriate cast-care techniques.
 Implementation 0 1 Remarks

Action 1. Review the medical record and the nursing plan of care to
determine the need for cast care and care for the affected body part.
Action 2. Identify the patient. Explain the procedure to the patient.
Action 3. Perform hand hygiene and put on gloves, if necessary.
Action 4. Close the room door or curtains. Place the bed at an
appropriate and comfortable working height, if necessary.
Action 5. If a plaster cast was applied, handle the casted extremity
or body area with the palms of your hands for the first 24 to 36
hours, until the cast is fully dry.
Action 6. If the cast is on an extremity, elevate the affected area on
pillows covered with waterproof pads. Maintain the normal
curvatures and angles of the cast.
Action 7. Keep cast (plaster) uncovered until fully dry.
Action 8. Wash excess antiseptic or antimicrobial agents, such as
povidone---iodine (Betadine), or residual casting material from the
exposed skin. Dry thoroughly.
Action 9. Assess the condition of the cast. Be alert for cracks, dents,
or the presence of drainage from the cast. Perform skin and
neurovascular assessment according to facility policy, as often as
every 1 to 2 hours. Check for pain, edema, inability to move body
parts distal to the cast, pallor, pulses, and abnormal sensations. If
the cast is on an extremity, compare it to the uncasted extremity.
Action 10. If breakthrough bleeding or drainage is noted on the
cast, mark the area on the cast. Indicate the date and time next to
the area. Follow physician orders or facility policy regarding the
amount of drainage that needs to be reported to the physician.
Action 11. Assess for signs of infection. Monitor the patient’s
temperature. Assess for a foul odor from the cast, increased pain, or
extreme warmth over an area of the cast.
Action 12. Reposition the patient every 2 hours. Provide back and
skin care frequently. Encourage range of motion for unaffected
joints. Encourage the patient to cough and deep breathe.
Action 13. Instruct the patient to report pain, odor, drainage,
changes in sensation, abnormal sensation, or the inability to move
fingers or toes of the affected extremity.
Action 14. Remove gloves and dispose of them appropriately; place
the bed in the lowest position, if necessary.
Action 15. Perform hand hygiene. Document all assessments and
care provided. Document the patient’s response to the cast,
repositioning, and any teaching.

Evaluation
The expected outcome is achieved when the patient exhibits a cast that is intact without
evidence of neurovascular compromise to the affected body part. Other expected
outcomes include: the patient remains free from infection, the patient verbalizes only
mild pain and slight edema or soreness, the patient maintains range of joint motion, the
patient demonstrates intact skin at cast edges, the patient is able to perform activities of
daily living, and the patient demonstrates appropriate cast-care techniques.

Special Considerations
 Explain that itching under the cast is normal, but the patient should not stick
objects down or in the cast to scratch.
 Begin patient teaching immediately after the cast is applied and continue until the
patient or a significant other can provide care.
 If a cast is applied after surgery or trauma, monitor vital signs (the most accurate
way to assess for bleeding).

Older Adult Considerations

 Older adults may experience changes in circulation related to their age. They may
have slow or poor capillary refill related to peripheral vascular disease. Obtain
baseline information for comparison after the cast is applied. Use more than one
neurovascular assessment to assess circulation. Compare extremities or sides of
the body for symmetry.

Comments/Suggestions:___________________________________________________
______________________________________________________________________
______________________________________________________________________
_________________
Student’s Signature:___________

Clinical Instructor’Name and Signature_____________________

Date:___________