Care of Client with Cast

J.A.K.E NCMB 316 RLE

CARE OF CLIENT WITH CAST Caring a cast while it dries:

Cast 1) Keep the cast uncover to dry.
- CAST is a hard covering that is used to support fractured 2) Check for cracks or breaks in the cast.
arms, legs or other body parts. 3) Keep the cast always clean
- Purpose of Cast: 4) Turn patient every 2 hours while the cast dries
• C - Correct deformity 5) Prevent any indentation in the cast due to pressure.
• H - Hold a broken bone in place as it heals 6) Avoid resting the cast on hard surfaces or sharp edges
• I - Immobilize a bone especially after surgery. 7) Avoid using the abduction bar in lifting or carrying the
• P - Prevent or decrease muscle contractions patient
• S - Support, maintain and realign a bone 8) Place a plastic lining at he edge of the cast if the cast is
• S - Serve as a mold of a limb in making near the groin to avoid soiling and wetting the cast
• an artificial limb.
What are casts made of? Cast Technique
- The outside, or hard part of the cast, is made from two - Reinforcing
different kinds of casting materials. • Reapplication of Plaster for the purpose of regaining its
- Plaster of Paris strength in case of instability.
- Synthetic (fiberglass) material • Wet
1) Plaster of Paris • Break
- white in color, • Crack
- made up of gypsum sulphate
- dries 1-3 DAYS Cast care instructions/ HEALTH TEACHINGS:
2) Synthetic (fiberglass) material 1) Keep the cast always clean and dry.
- moldable plastic with variety of colors, patterns, 2) Report presence of cracks or breaks in the cast.
and designs. 3) Rough edges should be padded to protect the skin from
- dries 20-30 minute irritations.
- Lighter, Cooler & Waterproof 4) Avoid using any objects in scratching the skin under the
Casting Materials cast.
• Plaster of Paris 5) May use a hairdryer in a cool setting to relieve itchiness.
• Drying takes 1-3 days Never blow warm or hot air into the cast.
• If dry, it is SHINY, WHITE, hard and resistant 6) Avoid putting powders or lotion inside the cast.
• Fiberglass 7) Cover the cast while eating to prevent food spills and
crumbs from entering the cast.
• Lightweight and dries in 20-30 minutes
8) Elevate the cast on a cloth-covered pillow above the level
• Water resistant
of the heart to decrease swelling.
Characteristics of a Good Cast (plaster of paris) when
9) Encourage the client to move his/her fingers or toes to
applied
promote circulation.
• White
10) Avoid using the abduction bar in turning, lifting or carrying
• Shiny
the client.
• Odorless 11) Report alarming signs
• Light in weight Alarming Signs
• Not too tight 1) Fever
• Not too loose 2) Pain
• Resonant on percussion 3) Swelling
4) Drainage
Cast Application 5) Discolorations
1) Apply the stockinet first. 6) Numbness or tingling sensation
2) Apply the wadding/padding sheet. 7) Cold fingers or toes
3) Fiber glass or the plaster cast
Principles in Application of Cast Assessing a Casted Extremity
1) Apply stockinet and padding first before applying a cast 1) Pain
2) Apply cast by including the joint above and the joint below - Asked the patient if he feels any pain in the casted
the affected part extremity and if the pain is increasing.
3) Apply cast in circular motion and smoothen with the palm - Asked presence of pain on passive extension.
4) Support with the palm not the fingertips - Asked the patient to identify the exact location,
describe the character and intensity of any pain.
- Management:
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J.A.K.E Care of Client with Cast NCMB 316 RLE

• Elevating the involved part 6. Newspaper To protect the floor/area

• applying cold packs
• administering analgesic agents as prescribed 7. Disposable To protect the hands of the operator
2) Blood Supply/ Circulatory Function / Capillary Refill gloves
- Discoloration – Assess capillary refill by applying
8. Pail of water at To wet the cast
pressure to one of the toenails or fingernails and check
room temperature
for discoloration.
3) Temperature of the skin 5. Stryker cast Used in bivalving & windowing &
- Coolness – Assess temperature by touching fingers or cutter removal of cast
toes if warm to touch.
4) Neurologic Function 6. Cast spreader To widen a bivalve cast
- Numbness or tingling sensation/paresthesia 3. Bandage scissor To cut wadding sheet and stockinet
- Absence or diminished sensation
• Asked patient if he/she can move fingers or toes of
the casted extremity.
• Asked patient for the presence of numbness or
tingling sensation
• Asked the patient if he feels when you touch his
fingers or toes to assess nerve paralysis
5) Infection
- Swelling, foul odor, fever
• Assess presence of swelling below or above the
casted extremity
• Assess presence of foul odor in the casted extremity
• Check for the presence of drainage and note the
color and amount.
• Mark the circumference of the stain on the cast as a
gauge for any increase in the amount of drainage
Cast Techniques
• Bivalving – Cutting the cast into two halves from the upper Type of Cast Location Uses
portion to the bottom part for the purpose of relieving
tightness of the casted extremity Unilateral hip Applied from the Thigh fractures.
• Windowing – Putting a window on a cast at the site of an spica cast: chest to the foot on Also used to hold
open wound of the casted extremity for the purpose of one leg. the hip or thigh
visualization, inspection, dressing as well as application of muscles and
medication tendons in place
• Reinforcing – Reapplication of Plaster for the purpose of after surgery to
regaining its strength in case of instability. allow healing.
• Wet One and one- Applied from the Thigh fracture.
• Break half hip spica chest to the foot on Also used to hold
• Crack cast: one leg to the knee the hip or thigh
of the other leg. A muscles and
Petalling The Cast bar is placed tendons in place
Materials & Uses between both legs after surgery to
instruments to keep the hips allow healing.
and legs
1. Plaster of Paris/ Casting materials immobilized.
Fiberglass
Bilateral long Applied from the Pelvis, hip, or
2. Stockinet To protect the skin leg hip spica chest to the feet. A thigh fractures.
cast: bar is placed Also used to hold
3. Wadding To serve as padding
between both legs the hip or thigh
sheet/gauze
to keep the hips muscles and
bandage
and legs tendons in place
4. Bandage scissor To cut wadding sheet and stockinet immobilized. after surgery to
allow healing.
5. Trimming knife To smoothen the edges of the cast

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J.A.K.E Care of Client with Cast NCMB 316 RLE

• Pantalon Cast – Affection of the pelvis

• Delvit Cast – Affection of the 3rd of the tibia –fibula with

callus formation

1) Pulled the stockinet over the cast and taped down, if edges
of the cast are rough and crumbling to prevent skin
irritation
2) Cut a tape into 4 inch strips
3) Place half of the tape on the inside of the cast and pulled it
over the top of the cast
4) Anchor remaining tape to outside of the cast
Short leg hip spica cast:
• Applied from the chest to the thighs or knees. Cast Brace
• To hold the hip muscles and tendons in place after surgery - Fracture of the distal 3rd of femur and proximal 3rd of tibia
to allow healing. with callus formation

• Walking Cast – Affection of tarsals and metatarsals with

callus formation
• Basket Cast – For massive bone injury of the patella to
facilitate wound dressing

• Patellar Tendon Bearing Cast – Affection of tibia-fibula
with callus formation
• Quadrilateral/ Ischial Weight Bearing Cast – Affection of
the shaft of femur with callus formation
Types of cast in the trunk and neck
1) Body Cast – encircles the trunk, stabilizing the spine,
Affection of the lower dorso-lumbar spine
2) Minerva Cast – Applied around the neck and trunk of the
body. Affection of the cervical and upper dorsal spine
3) Rizzer’s Jacket – Affection of thoraco-lumbar spine and to
correct scoliosis (S-shape)

Shoulder Spica Cast

- Applied around the trunk of the body to the shoulder, arm,
and hand.
- Affection of the upper portion of the humerus and shoulder
joint
Complications of Casts
1) Necrosis, pressure sores and nerve pulses – due to
pressure of a cast on neurovascular and bony
prominences

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J.A.K.E Care of Client with Cast NCMB 316 RLE

2) Compartment Syndrome – this may lead to vascular

insufficiency and nerve and muscle compression due to
unrelieved swelling and can cause irreversible damage to
the extremity
• Pain
• Discoloration
• Tingling sensation
• Absent or diminished sensation
• Swelling
• Coolness
3) Multisystem problems due to immobility
• Digestive system
- Anorexia & constipation
- Nausea, vomiting and abdominal distention
(decrease blood flow to the bowel and possible
intestinal obstruction)
• Respiratory System
- Pneumonia and respiratory atelectasis (ineffective
respiratory effort)
• UTI
- renal and bladder calculi
• Circulatory system
- Thrombophlebitis and pulmonary emboli (due to
immobility and ineffective circulation)
• Psychological reactions
- depression, anxiety

S/S of Compartment Syndrome

• Pain
• Swelling
• Discoloration
• Coolness
• Tingling sensation
• Absent or diminished sensation

Nursing Interventions
• Assess the alarming signs and complications of casted
body and extremities
• Assess neurovascular status hourly during the first 24
hours

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