Care of cast is an important topic in the musculoskeletal system. This review of the care of cast is explaining the types of casts, how to take care of a patient who has a cast, and interventions. This review is part of the series focused on nurses preparing for the nursing licensing exams including NCLEX-RN, HAAD, MOH, Prometric, and DHA exams.
Care of cast
Even before we start talking about how to take care of a patient who has a cast, let’s first look at a question.
A Question about the care of cast
Mr John is 2 hrs post-op from a cast placement on the right leg. The client has family in the room. Which action by the significant other requires you to re-educate the client and family about cast care?
- Gently moving the cast with the fingertips of the hands every 2 hours to help with drying
- Elevating the cast above heart level with pillows
- Checking the colour and temperature of the right foot
- Using a hair dryer on the cool setting to help with drying
Mr John has a cast placement on his right leg which has happened just two hours back. And there is the family in the room and the significant others, let’s say spouse, mother or the father, whoever it is, doing a certain action which is indicating to you that Mr John and the family members need to get education or instruction regarding cast care. The actions that they are doing as given as four options. So you need to find out which among these four actions if performed by the family member or performed by Mr John at this point in time is not good for the client. And the client requires to be given more instructions or educated about how to take care of his cast.
How to take care of a cast?
Care of cast – Rinta Rajan – Nurse Educator
Before we go on to discuss the answer we will go through how to take care of a cast. As you already know, you might have seen a cast, cast is mainly used to immobilize a joint or an extremity following an injury. That is a basic function of a cast.
3 Types of casts
There are mainly three types of casts.
- Plaster of Paris cast (POP Cast)
- Synthetic/Fiberglass cast
- Air Cast
1. Plaster of Paris cast
The first one is the normal Plaster of Paris cast. That is most commonly used, so that is the POP cast.
2. Synthetic/Fiberglass cast
The second kind of cast which is widely available these days and widely used these days is the Synthetic cast. This is also known as Fiberglass cast. This is kind of a bowl with polyurethane embedded into it. This dries up faster and it’s much more convenient to use in comparison to the POP cast.
3. Air Cast
The third kind of cast that is also available these days in the market is Air Cast. There is a splint which is got air in it and there is a hard cast outside. This allows more convenience for the client because there is nothing put onto the foot, this can be removed, and the straps can be removed. So that’s basically the air cast.
These are the three different types of cast.
Care Of Cast Interventions
Today what we are going to be dealing with you for the purpose is going to be mostly related to the POP cast and certain aspects of the synthetic cast.
Keep the extremity elevated
Coming to interventions that you need to provide to a client who has a cast, keep the extremity elevated. You can use pillows to keep the extremity that is cast, in an elevated position. This is to ensure that there is a reduction in the swelling and oedema that has formed.
Use palms to handle wet cast
So you need to use your palms to handle a wet cast. Do not use fingertips to handle the wet cast because that is going to leave intense wetness on the wet cast. And you do not want indentation of your fingertips on the wet cast because you want it to be very uniform and want to try uniformly. So use palms when handling a wet cast.
Allow the required time to dry
Allow 24 to 72 hrs for the wet cast to dry. The synthetic cast takes up to 20 minutes.
A hairdryer may be used in cool settings, but avoid heat
If you want to facilitate faster drying of the cast you can use a hairdryer but you need to keep it in the cool settings. Do not put it onto the heated settings because the cast can get heated up and that heat can be transmitted to the skin underneath and may cause burns to the client. So you do not want to use heating settings but you can use cool settings with the hairdryer.
Monitor for circulatory impairment
Now you know that there is an extremity that is cast. So there is a chance that the applied cast is too tight and that is compromising the blood supply and nerve supply to that particular leg. So you need to monitor for neurovascular status, you need to monitor for circulatory impairment. How do you monitor? That is simple, you need to check the pulse, you need to check the colour of that extremity, you need to check for the nerve function, functioning basically you need to check for sensations of that extremity, check the colour, in this case, the colour of the sensations of the toes of the legs to make sure that there is no circulatory impairment. And if you find that there is circulatory impairment, or there is a colour change you need to inform the health care practitioner immediately.
Petal the cast to protect the client’s skin
This picture shows you how to petal the cast. This can be done very simply with the help of adhesive tape. You need to cut the tape into thin strips and petal the cast this way so that the rough edges of the cast do not irritate the skin of the client and do not cause any excoriation or any kind of laceration on the skin of the client. So you need to petal the cast.
Maintain the smooth edges
When you petal the cast, you know that the edges are going to be much smoother.
Monitor for signs of infection
Now we know that the signs of infection are there, commonly it can be systemic signs such as a fever increase in WBC count and all of those things. Apart from that when we are talking specifically about the cast what you can do is you can check for any hot spots in the cast.
Hot spot simply means that there must be an area that is particularly to touch on the cast. What will be happening is the skin underneath this area might be inflamed and because of inflammation there is the warmth which is transmitted to the cast and you may feel that this particular area is warmer as compared to the other areas of the cast. That is known as the hot spot.
If you find that there is a hotspot it could indicate that there is some kind of inflammation or infection happening in that particular area.
A window may be created if there is an open wound
So if suppose there is an open wound, then a window will be created by your health practitioner on the cast. This is so that you can monitor the wound and you can do the dressing of the wound.
Instruct the client not to stick objects inside the cast
Sometimes the client may feel like there is some kind of itching inside the cast, and may try to poke a pin or anything sharp into the cast. Instruct the client not to do that.
Instruct on keeping the cast clean and dry
The cast must not become wet, it has to be kept very clean and dry.
Instruct on isometric exercises
So these are the interventions that have to be done for a client who is having a cast.
The answer to the question at the beginning
Now let’s come back to the question that we had seen at the beginning of the section.
Mr John to ask post-op has a cast college write like his family is in the room and significant other is doing a particular action which requires you to reach educate Mr John or the significant other
Let’s take a look at these options.
Option A – The first option says gently moving the cast with the fingertips of the hands every 2 hours to help with drying. We have already seen that if there is a wet cast the palm of the hand has to be used and not the fingertips. So this action that is performed by the significant other is not right. This means that if you see that this action is being done it indicates that the client and the family members need re-education. For this question, the right option is option A. The fingertips are not to be used to handle the cast, it is the palm because the fingertips are going to leave indentation it is a wet cast and it has only been 2 hrs since the cast has been placed.
Option B – Elevating the cast above heart level with pillows. That is the right thing to do
Option C – Checking the colour and temperature of the right foot. Yes, this is the right thing to do because you need to check for circulatory impairment. You can teach the significant other how to check for circulatory impairment that there is a colour change, if there is a change in temperature or if there is excess pain then it indicates that there is some kind of circulatory impairment.
Option D – Use a hairdryer on the cool setting to help with drying. Yes, that is the right thing to do.
So among these four options, options B, C, and D are the right things to do. And if you see the client or the significant other performing these three actions, it means that they have understood how to take care of the cast.
But if you find that the client or the significant other is performing the action of option A, it indicates that they need to learn more about how to take care of the cast. Hence, option A is the right option for this particular question.
Thank you very much for taking your time to read and watch this review. Hope that you have understood this topic clearly.
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Reference: YouTube Rinta Rajan
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