COURSE TASK - CAST CARE

1. WATCH: https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-
resources/helping-hands/cast-and-splint-care. (This video shows the procedure of cast application)

How do you assess a patient with a cast?

o Assess neurovascular health every 4 hours during the first 48 hours after applying a cast. Every 8 to 12 hours,
assess the skin's integrity.
o Assess pain every 2 to 4 hours during the acute period and monitor vitals.
o Assess the cast's integrity and cleanliness during each shift.
o Circulation Checks: It is important to examine for abnormalities with blood flow (circulation) in the wounded
limb. Every day, check the circulation in the fingers or toes of the afflicted limb. Any of the following alterations
may indicate a problem or that the cast is excessively tight. The fingers or toes should not show any swelling or
alterations in:
o Skin color: - Press the nail bed until it turns white. The color should return to normal after 3 to 4 seconds of
removing your finger off the nail. - Fingers and toes should not be pale or blue.
o Temperature – The fingers and toes should feel warm.
o Sensation – There should be no tingling, numbness, or feeling like the limb is asleep.
o Movement – The fingers or toes should move freely.

What to avoid while wearing a cast?

o Do not apply anything to the cast or splint until it is fully dry.

o Please do not sign the cast until it has been on for 24 hours. The cast can be signed using a marker or an ink pen.
o Do not apply paint, oil-based products, duct tape, or stickers on the cast. These substances will clog the cast's
pores, preventing air from reaching the skin.
o Do not allow the child to move unnecessary movement while wearing cast.
o Putting weight on the cast may injure it or the skin within.

What are the 6 P’s of assessment orthopedic trauma?

1. Pain. While this is to be expected with a muscular injury, pain characterized as deep, continuous, and poorly
localized, which worsens while extending or manipulating the muscle and is not eased by pain medicines, is
not normal and may indicate compartment syndrome.

2. Pallor. If you find your patient's skin is pale and glossy, particularly distal to the injury site, contact a doctor
right once.

3. Pulselessness. compartment syndrome can induce a decreased or absent pulse in an afflicted region by
creating a tourniquet-like effect and cutting off circulation to the limb.
.
4. Paresthesia. The patient may feel pins and needles, tingling, tickling, pricking, or burning.

5. Paralysis. Though it is generally a late discovery, paralysis or numbness in a limb might be an indication of
compartment syndrome. This occurs most frequently when a patient's leg or arm has been crushed in an
accident.

6. Poikilothermia. This phrase refers to a bodily part that controls its temperature in relation to its surroundings
and is very significant. If you detect a limb feeling colder than the surrounding areas, the patient may have
compartment syndrome.
2. Article about compartment syndrome https://www.webmd.com/pain-management/guide/compartment-
syndrome-causes-treatments#1

What is compartment syndrome caused by?

o Compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body.
The condition usually results from bleeding or swelling after an injury. The dangerously high pressure in
compartment syndrome slows the flow of blood , oxygen, and nutrients to and from the affected tissues. It can
be an emergency, requiring surgery to prevent permanent injury.
o Compartment syndrome occurs when there is inadequate blood flow to the muscles and nerves due to
high pressure inside a specific bodily compartment. This may happen in any enclosed place in the body,
but it's most common in the anterior compartment of the lower leg or forearm. It may also appear in
the hands, foot, belly, and buttocks.
How can you prevent compartment syndrome?

o Treatments for compartment syndrome aim to reduce harmful pressure in the bodily compartment. Dressings,
casts, or splints that constrain the injured body portion should be removed.
o Acute compartment syndrome typically need surgery to relieve pressure. A surgeon makes extensive incisions
into the skin and the fascia layer beneath (fasciotomy) to relieve excessive pressure.

Other supportive treatments include:

▪ Keeping the body part below the level of the heart (to improve blood flow into the compartment)
▪ Giving oxygen through the nose or mouth
▪ Giving fluids intravenously
▪ Taking pain medication

3. Watch https://www.youtube.com/watch?v=JZPh9uK30eQ&pbjreload=101

Give necessary precaution in transferring of patient to prevent injury in part of the patient and the part of caregiver.

o Observe body mechanics and back safety (Body mechanics – The way you align, balance, and coordinate your
movements A- Alignment B- Balance C- Coordinate movement

When transferring:

o Know tour patient or client

o Never assume anything about the person’s abilities
o Before proceeding, make sure you have checked to see what type of assistance the person will acquire
o Use the proper equipment to assist with your transfers according to the specific needs of the person (e.g.,
transfer belt or mechanical lift)
o A transfer belt is never used to lift a person who cannot bear weight. A person who is unable to bear weight
should be moved with a mechanical lift device.

Tell the Nurse if the Persons:

o Complains of dizziness, shortness of breath, chest pain, a rapid or irregular heartbeat, or sudden head pain
o Complains of pain when he or she tries to bear weight, and this is new - You observe any changes in the person's
usual grip, strength, or ability
o A usually cooperative person refuses to participate - The equipment is not working properly or is broken
4. Watch
https://www.google.com/search?q=transferring+of+patient&oq=transferring+of+patient&aqs=chrome.0.69i59.6341j0j4
&sourceid=chrome&ie=UTF-8#kpvalbx=_eb05X4MlxqWYBe_xvugG6

List down procedure in transferring immobile patient from bed to wheelchair.

o Place the patient's outside leg (the one farthest from the wheelchair) between your knees for support. Bend
your knees and keep your back straight.
o Count to three and slowly stand up. Use your legs to lift.
o At the same time, the patient should place their hands by their sides and help push off the bed.
o The patient should help support their weight on their good leg during the transfer.
o Pivot towards the wheelchair, moving your feet so your back is aligned with your hips.
o Once the patient's legs are touching the seat of the wheelchair, bend your knees to lower the patient into the
seat. At the same time, ask the patient to reach for the wheelchair armrest.