CEBU TECHNOLOGICAL UNIVERSITY

In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Ave. cor Panganiban St., 6000 Cebu City, Cebu, Philippines
Tel. Nos. (032)316-5128/(032) 4186105
Email address: ctuccmc_cn@ymail.com

CAST CARE AND COMFORT

Name: BONTILAO, JIMNAH RHODRICK M. Level: 3-B

Instructor in Charge: MRS. AISSA CARLIT Date materials checked:

Date performed:

I. Learning Objectives:
a. Define the terminologies related to this procedure.
b. Identify the indications that necessitate the need for a cast.
c. Enumerate the necessary client teachings essential for the procedure.
d. Develop plan of care to restore, maintain and promote health for client
following this procedure.

II. Definition of Terms

a. CAST - are solid dressings applied to a limb or other body part.

b. TYPES OF CASTS:

Waterproof Casts
Special waterproof cast liners may be used under a fiberglass cast so the cast can get wet without
falling apart. These waterproof liners can only be used after the injured area has stopped swelling,
usually a week or two after the initial injury.
Split (Bivalve) Casts
For some injuries, the first cast may be split in order to allow room for swelling. The sides of the bivalve
cast will be taped with cloth medical tape. The cast is secured from the inside at the top and bottom, so
if the tape starts to peel, the cast should not fall apart.
Casts for upper extremities (arms, wrists, fingers)
Short arm casts
- used for forearm and wrist fractures
- applied below the elbow to the hand
- also used to hold the forearm or wrist muscles and tendons in place after surgery
Long arm casts
- used for upper arm, elbow, or forearm fractures
- applied from the upper arm to the hand
- also used to hold the arm or elbow muscles and tendons in place after surgery
Shoulder spica cast
- used for shoulder dislocations, or after surgery on the shoulder area
- applied around the trunk of the body, the shoulder, arm, and hand
Casts for the lower extremities (hips, legs, knees, ankles)
Short leg casts
- used for lower leg fractures, ankle fractures, and severe ankle sprains and strains
- also used to hold the leg or foot muscles and tendons in place after surgery to allow for
healing
 - applied to the area below the knee down to the foot
- may be walked on once the fracture is stable enough to bear weight without becoming
re-injured
- not appropriate for most children under the age of 3, who may kick off the short leg cast
Long leg casts/ Leg Cylinder Cast
- used for knee or lower leg fractures, knee dislocations, or after surgery on the leg or
knee
- applied from the upper thigh to the ankle or foot
- usually applied with the knee bent to prevent walking on the cast
Spica casts – extend from the midtrunk to cover one or both extremities.
Body casts – encase the trunk of the body.
Abduction A-frame cast
- used to hold the hip muscles and tendons in place after surgery to allow time for healing
- applied from upper thighs to the feet, with a bar placed between both legs to keep the
legs and hips immobile
Clubfoot cast
- used to treat clubfoot
- applied from upper thigh to toes
- usually changed every 5-7 days

III. Purposes
Casts are applied to:
 Immobilize a body part in a specific position
 Exert uniform compression to soft tissue
 Provide for early mobilization of unaffected body parts
 Correct or prevent deformities
 Stabilize and support unstable joints.

IV. Materials and supplies needed:

Plaster casts – mold very smoothly to the body’s contours. The cast initially emits heat and
takes about 15 minutes to cool and 24 to 72 hours to dry. It must be handled carefully until dry.
Fiberglass casts – are dry in 10 to 15 minutes and can bear weight 30 minutes after
application.
Polyester-cotton knit casts – take about 7 to 10 minutes to dry and can withstand weight
bearing almost immediately
 PROCEDURE RATIONALE

1. WASH HANDS To prevent transmission of microorganisms.

2. CHECK CIRCULATION, MOVEMENT &
SENSATIONS (CMS):
a. Note color and temperature of skin.
b. Pinch finger or toe and watch for
capillary refill within 2 – 4 seconds.
c. Ask client to wiggle fingers or toes if
possible
d. Ask the client to tell you if he/ she feels
you touching the extremity. Be aware of
possible hypersensitivity or neuropathic
sensation of the extremities which changes
the normal baseline.
3. ASSESS SKIN
a. Tell client not to put object in to the cast.
If the part turns white/blue, and if it is cold, it
indicates poor blood circulation.
Delayed capillary refill indicates poor blood
circulation.
Encouraging patient to move allows better blood
circulation.
This is done to test if the patient’s nerves are still
functioning. Tight casts can damage the nerves
that may cause decreased sensation or
hypersensitivity.
Putting object inside the cast may cause skin
injury or irritation, that may lead to infection.

b. Use the powders or creams only outside Lotion can make the skin too soft. Powder can
collect under the cast. These can cause pressure
the cast. sores and other skin problems.

4. ASSESS PAIN OR SORENESS. This allows blood circulation and prevent pressure
sores.
a. Reposition the extremity every 2 hours

b. Elevate the extremity and apply ice. Elevation of extremities with cast above the heart
level must be done. This is also done during the
first 24 -72 hours after cast is applied.This is done
to reduce swelling. To do this in legs, pillow must
be placed under the legs. To do this in arms, place
pillow in patient’s chest and let patient’s arms cross
over it.

Loosely wrap an ice pack covered in a thin towel

around your child's cast at the level of the injury.
Wrapping the ice is important to keep the cast dry.
Ice that's packed in a rigid container and touches
the cast at only one point won't be as effective.
5. ASSESS CAST FOR INTACT COTTON Padding protects the skin from injury.
PADDING. Pad or add additional padding to

areas of redness or irritation.

6. ASSESS FOR INTACT EDGES.

a. If edges are crumbling or peeling, or if Tapes are used to support the cast and prevent it
the cast have bee bivalve or windowed, use from falling.
tape to petal the edges.

b. Do not allow the cast to get wet. Teach Moisture may cause softening of skin and skin
the client how to cover the cast when irritation, that may also lead to infection. The
bathing or showering. patient must opt for bathing than showering. When
bathing, the cast must be covered with plastic.

7. ASSESS SAFETY.
If the cast is on the lower extremity, and the
client is to ambulate, provide a cast boot Cast boot is used for protection and safety.
for protection & safety

8. INSTRUCT CLIENT AND CAREGIVER

ABOUT SIGNS AND SYMPTOMS AND
REPORT TO THE HEALTH CARE
PROVIDER NAMELY:
a. An increase in swelling Increased swelling may indicate infection or poor
circulation.

Tingling or burning sensation may be caused by

b. A tingling or burning sensation damage to the nerves and vessels due to tight cast
or injury.

c. Inability to move muscles around the Drainage may indicate infection. Drainage must be
cast. traced on the cast and date must be noted.

d. Any drainage, which may show through Cracks or breaks may cause instability, preventing
the cast the injury to heal. This may also welcome dirt, that
may cause infection.
e. Any cracks or breaks in the cast.

9. SUPPORT THE CAST:

a. Use pillows for arms and legs

b. Use bed board under the mattress for To promote stability and comfort.
spica cast

10. ASSESS FOR INFECTION Foul odor may indicate infection. The nurse must
use his/her sense of smell in assessing.
a. Check for foul odor under the casts

b. Check for drainage on cast Drainage may indicate infection.

c. Mark drainage and date on cast This is done to monitor the flow of the drainage, if
it spreads over time.

11. SYNTHETIC CAST SHOULD BE KEPT Synthetic casts are usually made out of a
material called fiberglass, a type of moldable
DRY. plastic.
Fiberglass casts are much more waterproof than
plaster casts, but not completely. While the outer
layer is waterproof, the soft padding underneath is
not. In some cases, your doctor may be able to put
a waterproof liner under the cast, which makes the
entire cast waterproof.
12. IF THE HEALTH CARE PROVIDER
DOES PERMIT BATHING OR SWIMMING,
THE WET CAST SHOULD BE DRIED
QUICKLY AND THOROUGHLT. Dry the cast
with a towel. Allowing to dry until the Maintaining the cast dry protects the patient from
padding underneath does not feel cold or skin irritation and infection.
damage of the skin.

13. DO AFTER CARE To maintain environmental cleanliness and

sanitation. To prepare the environment for the next
patient.
14. WASH HANDS To prevent cross contamination or transmission of
microorganisms.

15. DOCUMENT RELEVANT DATA To establish patient record.