CARING FOR CAST

PREPARATION RATIONALE
1.      Gather materials needed for the
procedure.
·        clean gloves
·        pillows
- To save time and ensuring materials
·        waterproof pads
are complete prior to the procedure.
·        plaster cast
·        antiseptic or antimicrobial agent

 
2.      Review the medical record and the
- Reviewing the medical record and
nursing care plan of care to determine the
plan of care validates the correct
need for cast care and care for the affected
patient and correct procedure
body part.
3.      Prior to performing the procedure,
- Patient identification validates the
introduce self and verify the client’s
correct patient and correct procedure.
identity using agency protocol. Explain to
Discussion and explanation help allay
the client what you are going to do, why it
anxiety and prepare the patient for
is necessary, and how he or she can
what to expect.
cooperate.
- Hand hygiene and PPE prevent the
4.      Perform hand hygiene and put on gloves, spread of microorganisms. PPE is
if necessary. required based on transmission
precautions.
5.      Provide privacy by closing the room door - Closing the door or curtains
or curtains. Place the bed at an provides privacy. Proper bed height
appropriate and comfortable working helps reduce back strain while you are
height, if necessary. performing the procedure.
6.      If a plaster cast was applied, handle the - Proper handling of a plaster cast
casted extremity or body area with the prevents dents in the cast, which may
palms of your hand for the first 24 to 36 create pressure areas on the inside of
hours until the cast is fully dry. the cast.
- Elevation helps reduce edema and
enhances venous return. Use of a
7.      If the cast is on an extremity, elevate the waterproof pad prevents soiling of
affected area on pillows covered with linen. Maintaining curvatures and
waterproof pads. Maintain the normal angles maintains proper joint
curvatures and angles of the cast. alignment, helps prevent flattened
areas on the cast as it dries, and
prevents pressure areas.
- Keeping the cast uncovered allows
8.      Keep plaster cast uncovered until fully
heat and moisture to dissipate and air
dry.
to circulate to speed drying.
9.      Wash excess antiseptic or antimicrobial - Its residual antimicrobial activity is
 maintained stably while side effects
agents, such as povidone iodine, or associated with iodine such as
residual casting material from the exposed irritation and brown staining on the
skin. Dry thoroughly. skin and mucous membranes are
reduced.
10.   Assess the condition of the cast. Be alert - Assessment helps detect abnormal
for crackles, dents, or the presence of neurovascular function or infection
drainage from the cast. Perform skin and and allows for prompt intervention.
neurovascular assessment according to Assessing the
the facility policy, as often as 1 to 2 hours.
Check for pain, edema, inability to move neurovascular status determines the
body parts distal to the cast, pallor, circulation and oxygenation of
pulses, and the presence of abnormal tissues. Pressure within a cast may
sensations. If the cast is on an extremity, increase with edema and lead to
compare with the uncasted extremity. compartment syndrome.
11.   If breakthrough bleeding or drainage is
noted on the cast, mark the area on the
cast. Indicate the date and time next to - Marking the area provides a
the area. Follow physician orders or baseline for monitoring the amount of
facility policy regarding the amount bleeding or drainage.
drainage that needs to be reported to the
physician.
12.   Assess for signs of infection. Monitor the
- Infection deters healing. Assessment
patient’s temperature, the presence of foul
allows for early detection and prompt
odor from the cast, increased pain, or
intervention.
extreme warmth over an area to the cast.
- Repositioning promotes even drying
of the cast and reduces the risk for the
development of pressure areas under
13.   Reposition the patient every 2 hours. the cast. Frequent skin and back care
Provide back and skin care frequently. prevent patient discomfort and skin
Encourage range of motion for unaffected breakdown. Range of motion
joints. Encourage the patient to cough and exercises maintains joint function of
breathe deeply. unaffected areas. Coughing and deep
breathing reduce the risk for
respiratory complications associated
with immobility.
- Pressure within a cast may increase
with edema and lead to compartment
14.   Instruct the patient to report pain, odor,
syndrome. The patient’s
drainage, changes in sensation, abnormal
understanding of signs and
sensation, or the inability to move fingers
or toes of the affected extremity.
symptoms allow for early detection
and prompt intervention.
15.   Remove gloves and dispose of them - Proper removal of PPE minimizes
appropriately; place the bed in the lowest transmission of microorganisms.
 Placing bed in lowest position
position, if necessary.
promotes patient safety.
16.   Perform hand hygiene. Document all
assessments and care provided. - Hand hygiene minimizes
Document the patient’s response to the transmission of microorganisms.
cast, repositioning, and any teaching.