Cast Care

• A cast is a hard covering used to support fractured arms, legs or other body parts.
• The purposes of a cast are to correct deformity, hold a broken bone in place as it heals, immobilize a bone especially after surgery, prevent or decrease muscle contractions, support, maintain and realign a bone, and serve as a mold of a limb in making an artificial limb.
• The outside, or hard part of the cast, is made from two different kinds of casting materials: Plaster of Paris and Synthetic (fiberglass) material.
• Plaster of Paris is white, made up of gypsum sulphate, dries in 1-3 days, is shiny, white, hard and resistant, and has an odorless, lightweight, not too tight, not too loose, and resonant on percussion.
• Synthetic (fiberglass) material is a moldable plastic with a variety of colors, patterns, and designs, dries in 20-30 minutes, is water resistant, and has a cooler, lighter, and waterproof characteristic.
• The principles in the application of a cast are to apply stockinet and padding first before applying a cast, apply the cast by including the joint above and the joint below the affected part, apply the cast in a circular motion and smoothen with the palm, support with the palm not the fingertips, and to keep the cast uncovered to dry.
• Caring a cast while it dries involves keeping the cast uncovered to dry, checking for cracks or breaks in the cast, keeping the cast always clean, turning the patient every 2 hours while the cast dries, preventing any indentation in the cast due to pressure, avoiding resting the cast on hard surfaces or sharp edges, and avoiding using the abduction bar in lifting or carrying the patient.
• Reapplication of Plaster for the purpose of regaining its strength in case of instability is known as reinforcing.
• A person can move around while in a cast with the use of assistive devices such as crutches, walkers, wagons, wheelchairs, and reclining wheelchairs.
• Rizzer’s jacket is used for thoraco-lumbar spine and to correct scoliosis (S-shape).
• Complications of casts include necrosis, pressure sores, and nerve pulses due to pressure of a cast on neurovascular and bony prominences.
• Compartment Syndrome can lead to vascular insufficiency and nerve and muscle compression due to unrelieved swelling and can cause irreversible damage to the extremity.
• The fiberglass type of cast dries for 20 – 30 minutes.
• Body cast encircles the trunk, stabilizing the spine and is used for affection of the lower lumbar spine.
• Delvit cast is an affection of the 3rd of the tibia-fibula with callus formation.
• Pantalon cast is an affection of the pelvis.
• Identification of a cast includes short arm circular cast, Minerva cast, arm cylinder cast, short leg circular cast, long leg posterior mold, bilateral hip spica cast, and basket cast.
• The Plaster of Paris is made up of gypsum sulphate.
• Shoulder spica cast is applied around the trunk of the body to the shoulder, arm, and hand for affection of the upper portion of the humerus and shoulder joint.
• Nursing interventions for complications of casted body and extremities include assessing the alarming signs and complications of casted body and extremities, and assessing neurovascular status hourly during the first 24 hours.
• Minerva cast is applied around the neck and trunk of the body for affection of the cervical and upper dorsal spine.
• Signs and symptoms of Compartment Syndrome include pain, swelling, discoloration, coolness, tingling sensation, and absent or diminished sensation.
• Multisystem problems due to immobility can affect the digestive system, respiratory system, urinary system, and circulatory system.
• The health teachings for a cast involve keeping the cast always clean and dry, reporting presence of cracks or breaks in the cast, padding rough edges to protect the skin from irritations, avoiding using any objects in scratching the skin under the cast, using a hairdryer in a cool setting to relieve itchiness, never blowing warm or hot air into the cast, avoiding putting powders or lotion inside the cast, covering the cast while eating to prevent food spills and crumbs from entering the cast, elevating the cast on a cloth-covered pillow above the level of the heart to decrease swelling, enco
• Assessing a casted extremity involves asking the patient if he feels any pain in the casted extremity and if the pain is increasing, asking presence of pain on passive extension, and asking the patient to identify the exact location, describe the character and intensity of any pain.
• The management for a casted extremity involves elevating the involved part, applying cold packs, and administering analgesic agents as prescribed.
• Discoloration in the capillary refill is an alarming sign.
• Reinforcing involves reapplication of Plaster for the purpose of regaining its strength in case of instability.
• Capillary refill is assessed by applying pressure to one of the toenails or fingernails and checking for discoloration.
• Windowing involves putting a window on a cast at the site of an open wound of the casted extremity for the purpose of visualization, inspection, dressing as well as application of medication.
• Bivalving involves cutting the cast into two halves from the upper portion to the bottom part for the purpose of relieving tightness of the casted extremity.
• Unilateral hip spica cast is applied from the chest to the foot on one leg and is used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
• One and one-half hip spica cast is applied from the chest to the foot on one leg to the knee of the other leg and a bar is placed between both legs to keep the hips and legs immobilized.
• Basket cast is used for massive bone injury of the patella to facilitate wound dressing.
• Numbness or tingling sensation/paresthesia is assessed by asking the patient if they can move fingers or toes of the casted extremity, asking the patient if they can feel when you touch their fingers or toes, and checking for the presence of numbness or tingling sensation.
• Petalling the cast involves pulling the stockinet over the cast and taping down the edges to prevent skin irritation, cutting a tape into 4 inch strips, placing half of the tape on the inside of the cast and pulling it over the top of the cast, anchoring the remaining tape to the outside of the cast, and cutting wadding sheet and stockinet with bandage scissor and trimming knife.
• Walking cast is used for tarsals and metatarsals with callus formation.
• Materials used in casting include Plaster of Paris/ Fiberglass, Stockinet, Wadding sheet/gauze bandage, Bandage scissor, Trimming knife, Newspaper, and Disposable gloves.
• Short leg hip spica cast is applied from the chest to the thighs or knees to hold the hip muscles and tendons in place after surgery to allow healing.
• Quadrilateral/ischial weight bearing cast is used for affection of the shaft of femur with callus formation.