CAST CARE tissue injuries, fractured tibia, knee injuries - extends from base of the toes

MC DONALD VALLEDOR, FSTTCasting to the groin and gluteal creases

Provides rigid immobilization of
affected body part for support and •Short leg cast- primarily used for stable ankle and foot injuries
stability - extends from groin to the malleoli of the ankle
May be plaster or fiberglass (lighter weight, stronger, water-resistant,
porous; diminishes skin problems,
does not soften when wet) • other material include synthetic acrylic,
fiberglass-free, latex-free polymer, or a hybrid of materials Cast Care
•Application gen. incorporates the joints above and below a fracture to
restrict tendoligamentous movement• DO NOT
 Get plaster cast wet.
 Remove any padding.
Cast Application  Insert any objects in the cast.
 Bear weight on a new cast for 48 hours; handle with palms, not
fingertips
Affected parts of bony prominences are padded with stockinette & elastic  Cover cast with plastic for prolonged periods.
bandages
• Plaster of Paris is wrapped and molded around affected part after
immersion in water
• Number of layers of plaster bandage and technique determine cast DO
strength
• Plaster sets w/in 15 minutes, but not strong enough for weight bearing  Apply ice over fracture site for first 24 hr (avoid getting cast wet by
until 24-72 hours keeping ice in plastic bag and protecting cast with cloth
 Fresh plaster cast never covered with a blanket  Dry cast thoroughly after exposure to water (blot dry w/towel; use hair
 During drying period, cast should be kept dry and clean and direct dryer on low setting)
pressure avoided  Elevate extremity above the level of the heart
 Edges of cast may be petaled= skin irritation, pressure necrosis
• Move joints above and below cast regularly.
• Report signs of possible problems to health care provider: increasing
Short Arm Cast pain, swelling assoc. w/pain and discoloration of toes/fingers, pain during
movement, burning or tingling under cast, sores/foul odor under cast
 For treatment of stable wrist or metacarpal fractures • Keep appointment to have fracture and cast checked
 Extends from the distal palmar area to the proximal forearm
 Provides wrist immobilization
 Permits unrestricted elbow motion Complications of Casts

Long Arm Cast • Compartment Syndrome

 distal humerus & proximal tibia
 For stable forearm or elbow fractures and unstable wrist fractures  6 P’s: paresthesia, pain distal to theinjury, pressure increase, pallor,
 Extends to the proximal humerus, restricting motion in the wrist and paralysis, pulselessness/diminished late and ominous signs= severe
elbow  Infection
 Nursing measures directed toward supporting extremity & reducing  Venous Thrombosis
effects of edema= use of sling  Fat embolism syndrome
 Proximal humerus fracture= sling contraind.  Impaired circulation
 Peripheral nerve damage
 Pressure necrosis
Sling Use

 Ensure that axillary area is well-padded

 Should not put undue pressure on posterior neck
 Movement of the fingers should be encouraged= decrease edema
 Encourage patient to move non-immobilized joints of the upper
extremity= prevent stiffness and contractures

Body Jacket/Brace

 Immobilization and support for stable spineinjuries of the thoracic or

lumbar spine
 Applied around the chest & abdomen, &extends from the nipple line to
the pubis
 Nurse must assess for cast syndrome after cast application

Hip Spica

 Treatment for femoral fractures

 Securely immobilize affected extremity and trunk
 Includes two casts together= body
jacket cast and long leg cast

Types of Hip Spica

Single spica- above nipple line to base of foot

Spica and a half- single spica plus opposite extremity up to an area
above the knee
Double spica- both extremities

Nursing Considerations with the Spica

Casts

Assess same problem as with body jacket cast

Patient= no prone position until cast is dry
Patient= place in oblique sideposition and support with pillows
Support bar= never use to assist in Moving
• Turn patient to prone when cast has dried; pillow support under the
chest and immobilized extremity
• Skin care around cast edges
• Fracture bedpan
• Ambulation techniques by PT

•Long leg cast- unstable ankle fracture, soft