Ateneo de Zamboanga University College of Nursing NURSING SKILLS OUTPUT (NSO) Report No.

4 Cast care Description: A cast is a rigid dressing used to immobilize a fractured bone or soft tissue injury. It is made of strips impregnated with plaster or fiberglass material. The injured area is first covered with a layer of padding made of cotton or synthetic materials to protect the skin from irritation. The plaster or fiberglass strips are then dipped in water and applied over the padding to form the cast. Purpose: In general, casts are applied to injured limbs to support and protect the bones and soft tissue. The cast helps to reduce the pain, swelling, and muscle spasms following the injury. If the bone is broken, the cast holds the fractured bone ends in correct alignment during the healing process. A cast, because of its rigid properties, will also provide protection from further injury. Body casts are used to prevent movement of the vertebrae of the back and may be used after a traumatic injury to the spine or a surgical repair of the vertebrae. Materials: Of the two types of materials used for the hard supportive layer of cats, fiberglass has the advantages of being lighter, longer-wearing, and better able to "breathe" than plaster. Fiberglass is less trouble for the patient, because plaster casts are more likely to lose their shape if they become wet than fiberglass casts. It is also easier for x rays to penetrate fiberglass than plaster casts. Plaster, on the other hand, is less expensive and is easier to mold or shape to the body. A plaster cast will harden in 1530 minutes but takes 2448 hours to dry completely. A fiberglass cast will dry faster, in 1530 minutes, but the force of the patient's full body weight may cause the cast to crack in the first 24 hours after application. Application: Casts are usually applied by physicians or orthpedic technicians, with the assistance of other health professionals. If the bone is broken, the physician will first place the fractured bone into alignment. Stockinette cut to size is applied to the limb and then cast padding (cotton batting) is wrapped around the extremity. The physician dips the casting material in water, squeezes out excess water, and then applies it wet over the cast padding to form the cast. After applying the cast, the physician will roll the stockinette over the edges of the cast to provide smooth edges at the top, bottom and any openings on the cast. The patient's toes and fingertips are not covered by the cast. The cast is then usually placed on pillows elevated above the patient's heart level for 1520 minutes to dry. Preparation: A health professional will assist the patient in removing any clothing that will be difficult to pull over the cast later. The patient is positioned with the affected extremity resting on a pillow. The skin around the affected area is gently cleansed and thoroughly dried. The patient may be given medication for pain as directed by the physician. After the cast has been applied, extra pillows are placed under the cast to elevate it. The patient should be kept warm and comfortable while the cast is drying. It is helpful to explain to the patient that the cast will feel warm at first but then cool and damp as the material dries. Aftercare Aftercare includes measuring the patient for crutches or a sling as appropriate. In addition, patients should be given aftercare instructions as follows: The cast should be kept dry. Water weakens plaster casts and may cause skin irritation beneath the cast. The patient should use two layers of plastic to keep the cast dry while bathing or showering. To decrease swelling and pain in the first 2448 hours, the patient should place crushed ice in a plastic bag, covered with a pillow case or towel, on the cast over the injury every 15 minutes per hour while awake.
December 11,2010 Date Lim, Melissa Roselle F. Ms. Rowena Mendez, RN Clinical Instructors Initials Page 1 of 3

Dirt, sand, or powder should be kept away from the inside of the cast. Cast boots can be purchased to cover the foot area of a leg cast. Padding should not be pulled out of the cast. In addition, the patient should not stick coat hangers, knitting needles, or similar items inside the cast in order to scratch itchy skin. The patient should not break off or trim the edges of the cast without consulting the physician. The cast should be inspected regularly. If it develops cracks or soft spots, the physician should be notified. The patient should never attempt to remove the cast. The physician will remove the cast at the appropriate time with a special saw that cuts through the casting material but will not damage skin. Diagram/Illustration:

December 11,2010 Date Lim, Melissa Roselle F.

Ms. Rowena Mendez, RN Clinical Instructors Initials Page 2 of 3

Nursing Responsibility: Before Procedure: Explain the procedure Introduce yourself to client (and family), including both your name and title or role. Gather equipment and complete necessary charges according to agency policy. Many different sizes and shapes of casts are available depending on what body part needs to be protected. A doctor decides which type and shape is best for each person. Perform hand hygiene. During Procedure: Ensure clients comfort. Handle wet cast with palms of the hands, not the fingers. Doing so may cause flattering or indentions in the cast that might cause pressure problems. Observe hot spot and musty color. These are signsa and symptoms of infection. Maintain skin integrity. Do neurovascular checks: Skin color, Skin temperature , Sensation , Mobility, Pulse Assess for vascular occlusion Adhesive After Procedure: Perform hand hygiene. Cast should be allowed to air dry. Tape petals reduce irritation at cast edges Elevate the cast on one to two pillows during drying. Document and report clients response and expected or unexpected outcomes. References: www.enotes.com/nursing-encyclopedia/cast-care http://www.fraserhealth.ca/your_health/conditions_%26_diseases/cast_care/cast_care http://www.scribd.com/doc/2191737/CAST-CARE http://www.kidshealth.org.nz

December 11,2010 Date Lim, Melissa Roselle F.

Ms. Rowena Mendez, RN Clinical Instructors Initials Page 3 of 3