2. Objectives: at the end of this lesson, the
learner will be able to:
– Define cast
– Assemble equipments for application and
removal of cast
– Identify the preventive and health teaching
needs of the patient with a cast
– Demonstrate the nursing care for a patient with
cast
3. Cast application
Definition:- A cast is a rigid external immobilizing
device that is molded to the contours of the
body.
Purpose:
• To immobilize a body part in a specific position
• To apply uniform pressure on encased soft tissue
• To immobilize a reduced fracture
• To correct a deformity
• To support and stabilize weakened joints
4. Contraindications (relative)
• Skin diseases
• Peripheral vascular disease
• Diabetes mellitus
• Open or draining wounds
• Susceptibility to skin irritations
•
5. • Equipment
– Drape for patient
– Knitted material (eg, stockinette)
– Nonwoven roll padding
– Casting material (POP)
– Water and basin
– Cast knife or cutter
– Trolly
6. Procedure
• Perform neurovascular assessment
• Explain the procedure
• Wash hands
• Assemble necessary equipments
• Support extremity or body part to be casted.
• Position and maintain part to be casted in
position indicated by physician during casting
procedure.
• Drape patient.
• Wash and dry part to be casted.
• Place at least three layers of knitted material
(eg, stockinette) over part to be casted.
7. • Apply plaster or fiberglass casting material
evenly on body part.
– Choose appropriate-width bandage.
– Overlap preceding turn by half the width of the
bandage.
– Use continuous motion, maintaining constant
contact with body part.
– Use additional casting material (splints) at joints
and at points of anticipated cast stress.
8. • Support cast during hardening.
• Handle hardening casts with palms of hands.
• Support cast on firm, smooth surface.
• Do not rest cast on hard surfaces or on sharp
edges.
• Avoid pressure on cast.
• Promote drying of cast.
– Leave cast uncovered and exposed to air.
– Turn patient every 2 hours, supporting major
joints.
– Fans may be used to increase air flow and speed
drying.
9. Care of patient with cast
• Wash hands.
• Check circulation, movement, and sensation
– Note color and temperature of skin.
– Pinch finger or toe and watch for capillary refill within
2 to 4 seconds.
– Ask client to twist fingers or toes.
– Ask client to tell you if s/he feels you touching the
extremity
• Assess skin.
– Tell client not to put objects under the cast.
– Use powders or creams only outside the cast.
• Assess pain or soreness.
– Reposition the extremity q2h.
– Elevate the extremity and apply ice.
10. • Assess cast for intact cotton padding. Pad or add
additional padding to areas of redness or
irritation
• Assess cast for intact edges.
• Assess safety
• Instruct client and caregiver about symptoms to
report to the physician or qualified nurse:
– An increase in swelling.
– A tingling or burning sensation.
– An inability to move muscles around the cast.
– A foul odor around the edges of the cast.
– Any drainage, which may show through the cast.
– Any cracks or breaks in the cast.
11. • Support the cast.
– Use pillows for arms and legs.
– Use a bed board under the mattress for a spica cast.
• Assess for infection.
– Check for foul odor under cast.
– Check for drainage on cast.
– Mark drainage and date on cast.
• Synthetic casts should be kept dry. If the physician
or qualified practitioner does permit bathing or
swimming, the wet cast should be dried quickly
and thoroughly.
• Dry the cast with a towel and then a hair dryer set
on low. Dry until the padding underneath does not
feel cold or damp to the skin.
• Wash hands
12. Cast Removal
Indication
When a fracture heals
If it requires further manipulation
Less common indications include:
• Cast damage
• Pressure ulcer under the cast
• Excessive drainage or bleeding
• Constrictive cast
