CARE OF CLIENTS WITH CAST AND SPLINTS A cast is a rigid, temporary, immobilizing and protective external device made of layers of plasters or fiberglass material (synthetic material) moulded to the body parts that it encases. PURPOSES: To immobilize, support and protect the fractured extremity. To correct and prevent deformities To stabilize weakened joints To apply uniform compression to soft tissues of an amputated extremity. To promote healing process To prevent injury in case of osteomyelitis To promote early mobilization. SPLINTS Application of an immobilizing devices to stabilize a broken bone or injured body part from moving and to protect it from further damage to body.

1. Care of clients with cast and splints
ABIRAMI.K B.SC (N),
TUTOR,
SRMTCON
TRICHY

2. APPLICATION OF CAST
INTRODUCTION
Casting is a common treatment following closed reduction. It allows to
perform normal activities of daily living and maintain stability.
Definition
A cast is a rigid, temporary, immobilizing and protective external device
made of layers of plasters or fiberglass material (synthetic material) moulded
to the body parts that it encases.

3. purposes
 To immobilize, support and protect the fractured extremity.
 To correct and prevent deformities
 To stabilize weakened joints
 To apply uniform compression to soft tissues of an amputated extremity.
 To promote healing process
 To prevent injury in case of osteomyelitis
 To promote early mobilization.

4. Indication
Fracture immobilization
contra indications
• Skeletal muscle rigidity
• Open wound or draining wounds
• Edeme
• Impaired circulation
• Severe spasticity
• Sensory problems
• Unstable fracture
• Active skin diseases

5. TYPES
 SHORT ARM CASTS
Extends from below the
elbow to the plan
 Long arm casts
Extends from axilla to
palm, with the elbow
normally immobilized at
a right angle
 Short leg casts
Extends from below the
knee to the base of the
toes.

6.  Long leg cast:
Extends from the upper or
middle thigh to the base of the
toes.
 Gauntlet cast (or) thumb Spica:
Extends from below the elbow
to the palm and includes the
thumb.
 Body jacket cast:
Encases the trunk

7.  Spica cast:
 Hip Spica:
A body cast that encases
the trunk & one or both
lower extremities.
 Shoulder Spica:
A body cast that encases
the trunk shoulder and
elbow.

8. Cast materials
 Plaster casts:
Mold very smoothly to the body’s
contours. The cast initially emits heat
& takes about 15 mins to cool and 24
to 72 hours to dry. It must be handled
carefully until dry.
 Fiberglass casts:
These are dry in 10 to 15 mins and can
bear weight 30 mins after application.
 Polyester-cotton knit casts:
Take about 7 to 10 mins to dry and can
withstand weight bearing almost
immediately.

9. ARTICLES
 Casting materials (e.g. POP
or fiberglass bandage)
 Cast padding materials (roll
padding)
 Stockinet, sheet wadding
(depends on cast)
 Plastic bucket or basin
filled with warm water.
 Disposable glove and aprons
 Scissors (cast & bandage)
 Waterproof disposable pads
 Cast saw
 mackintosh

10. procedure
 Explain to the patient that there will be a feeling of warmth as the plaster is applied
 Wash hands & put on apron and gloves.
 Apply soft cotton roll or stockinet, sheet wadding and padding beyond the end of the cast.
 Decide on cast length.
 Assist in immersing POP roll in warm water (70-75 F) 5-6 times until it bubbles & slightly
wring water out. Do not remove too much water.
 Assist in applying casting material. 4-5 layers of plaster or 3-4 layers of fiberglass (in 1 min
and one at a time).
 Assist in applying 2 or 3 layers of cotton padding to bony prominences in spiral fashion with
0.5 inch over lapping to previous layers.
 Instruct the patient not to move the extremity until the cast dries fully and avoid using cast
dries.

11.  Fold the stockinette over the edges of the cast & anchor with cast material.
 After the application of cast, check pulse at points distal to cast.
 Elevate the casted extremity
 Instruct the patient not to insert any object inside the cast in case of itching but to report in case
of pain in sensation or difficulty in moving fingers/toes.
 Assess for six Ps:
 Pain
 Pallor
 Paraesthesia
 Pulselessness
 Paralysis
 Polar (warmthness)

12.  Monitor the cast every 2 hrs for the first 24 hrs.
 Complaints of tightness (indicates edema)
 Sensory changes such as pain and paraesthesia
 Circulatory changes check pulse points distally.
 Increased or decreased movement in cast.
 Severe itching
 Cracks, dents or softening of cast.
 Instruct to cover the cast with plastic wrap during bathing.
 Monitor the pressure areas frequently
 Assess for any complications such as compartment syndrome, disuse syndrome, muscular
atrophy, pressure sore, cast syndrome, contractures.
 Document the time of cast application, type of cast, location, patient’s response to procedure,
neurovascular status, and post procedural teaching given.

13. Assisting with application of splints
Definition
Application of an immobilizing devices to stabilize a broken bone or
injured body part from moving and to protect it from further damage to body.
PURPOSES
 To support body part
 To correct or prevent deformity
 To provide stabilization
 To enable application of traction
 To provide first aid for fractured limb
 To provide an erect posture for weight bearing
 To manage sprains and strains.

14. articles
 Splints
 Cotton for padding
 Bandage
 Adhesive

15. types
 THOMAS SPLINT  BOHLER’S SPLINT

16. materials
 Soft materials
 Towel
 Blankets
 Pillows
 Bandaging material
 Soft cloths.
 Rigid materials
 Board
 Metal strip

17. PROCEDURE
 Before procedure :
 Explain procedure to the patient
 Collect articles at bedside
 Provide privacy and position to the body part in its functional position
 During procedure:
 Check distal pulse and record .
 Separate skin surfaces and pad adequately
 Pad bony prominences or hallow areas if present
 Immobilize joint above &below involved area.
 Secure splint with bandage & strap away from injured area.
 Check neurovascular status.

18.  Instruct patient and relative to inform about any discomfort or
change in colour of skin.
 Remove and reapply splint if pain persists & swelling appears.
 Provide discharge teaching to the patient.
 Document date, time of splinting. Types of splint applied and
purpose of applying such as splint.

19. Pre and post splint checks
F – Function
A – Arterial pulse
C – Capillary refill
T – Temperature
S – Sensation

20. Nursing responsibilities after cast and splint application
 Support an exposed cast with the palms of your hands to prevent
indentations
 Ensure that the stockinet is pulled over rough edges of the cast.
 Elevate the casted extremity above the level of the heart.
 Providing covering & warmth to uncasted areas.
 Expose the fresh plaster cast to circulating air, uncovered, until dry (24 to
72 hrs). Expose the fresh synthetic cast until it is completely set (above 20
mins).
 Instruct him to dry a synthetic cast with a hair dryer on cool setting if it
gets wet.

21.  Initiate pain relief measure if indicated
 Encourage position changes
 Elevate the affected body part
 Provides analgesics as appropriate
 Promote non pharmacologic pain relief measures such as guided imaginary, relaxation and
distraction
 Provide client and family teaching
 Encourage isometric exercise to strengthen muscles covered by the cast. Promote muscle
strengthening exercise for the upper body if crutches are to be used.
 Advise the client to promptly report cast breaks & signs and symptoms of complications.
 Teach the client appropriate cast care, depending on the type of cast.
 Encourage mobility and active participation in self care.
 Re infource health care provider instructions on the amount of weight bearing allowed.