Cast care nursing

1. CARE OF CLIENT
WITH CAST

2. ⦿ CAST is a hard covering that is used
to support fractured arms, legs or
other body parts.

3. ◼ C - Correct deformity
◼ H - Hold a broken bone in place as it
heals
◼ I - Immobilize a bone especially after
surgery.
◼ P - Prevent or decrease muscle
contractions
◼ S - Support, maintain and realign a bone
◼ S - Serve as a mold of a limb in making
an artificial limb.
PURPOSES OF CAST

4. WHAT ARE CASTS MADE OF?
⦿ The outside, or hard part of the cast, is made
from two different kinds of casting materials.
⦿ Plaster of Paris
⦿ Synthetic (fiberglass) material

5. 1. PLASTER OF PARIS
- WHITE IN COLOR,
- MADE UP OF GYPSUM SULPHATE
- DRIES 1-3 DAYS

6. PLASTER OF PARIS

7. 2. SYNTHETIC (FIBERGLASS) MATERIAL
– MOLDABLE PLASTIC WITH VARIETY OF COLORS,
PATTERNS, AND DESIGNS.
- DRIES 20-30 MINUTE
- LIGHTER, COOLER & WATERPROOF

8. CASTING MATERIALS
Plaster of Paris
Drying takes 1-3 days
If dry, it is SHINY, WHITE, hard and resistant
Fiberglass
Lightweight and dries in 20-30 minutes
Water resistant

9. CHARACTERISTICS OF A GOOD CAST
(PLASTER OF PARIS) WHEN APPLIED
•White
•Shiny
•Odorless
•Light in weight
•Not too tight
•Not too loose
•Resonant on percussion

10. CAST APPLICATION
⦿ 1. Apply the stockinet first.
⦿ 2. Apply the wadding/padding
sheet.
⦿ 3. Fiber glass or the plaster cast

12. PRINCIPLES IN APPLICATION OF
CAST
1. Apply stockinet and padding first before
applying a cast
2. Apply cast by including the joint above and
the joint below the affected part
3. Apply cast in circular motion and smoothen
with the palm
4. Support with the palm not the fingertips

13. CARING A CAST WHILE IT DRIES:
⦿ 1. Keep the cast uncover to dry.
⦿ 2. Check for cracks or breaks in the
cast.
⦿ 3. Keep the cast always clean
⦿ 4. Turn patient every 2 hours while
the cast dries
⦿ 5. Prevent any indentation in the
cast due to pressure.
⦿ 6. Avoid resting the cast on hard
surfaces or sharp edges

14. ⦿ 7. Avoid using the abduction bar in lifting or
carrying the patient
⦿ Place a plastic lining at he edge of the cast if
the cast is near the groin to avoid soiling and
wetting the cast

15. CAST TECHNIQUE
⦿ REINFORCING
◼ Reapplication of Plaster for the purpose
of regaining its strength in case of
instability.
Wet
Break
Crack

16. CAST CARE INSTRUCTIONS/
HEALTH TEACHINGS:
⦿ 1. Keep the cast always clean and
dry.
⦿ 2. Report presence of cracks or
breaks in the cast.
⦿ 3. Rough edges should be padded
to protect the skin from
irritations.
⦿ 4. Avoid using any objects in
scratching the skin under the cast.

17. ⦿ 5. May use a hairdryer in a cool setting to
relieve itchiness. Never blow warm or hot
air into the cast.
⦿ 6. Avoid putting powders or lotion inside
the cast.
⦿ 7. Cover the cast while eating to prevent
food spills and crumbs from entering the
cast.

18. ⦿ 8. Elevate the cast on a cloth-covered
pillow above the level of the heart to
decrease swelling.
⦿ 9. Encourage the client to move his/her
fingers or toes to promote circulation.
⦿ 10. Avoid using the abduction bar in
turning, lifting or carrying the client.
⦿ 11. Report alarming signs

19. ALARMING SIGNS
⦿ 1. Fever
⦿ 2. Pain
⦿ 3. Swelling
⦿ 4. Drainage
⦿ 5. Discolorations
⦿ 5. Numbness or tingling sensation
⦿ 7. Cold fingers or toes

20. ASSESSING A CASTED EXTREMITY
⦿ 1. PAIN
◼ 1.1. Asked the patient if he feels any
pain in the casted extremity and if the
pain is increasing.
◼ 1.2. Asked presence of pain on passive
extension.
◼ 1.3. Asked the patient to identify the
exact location, describe the character
and intensity of any pain.

21. ⦿ MANAGEMENT
⦿ 1. Elevating the involved part
⦿ 2. applying cold packs
⦿ 3. administering analgesic agents as
prescribed

22. ⦿ 2. BLOOD SUPPLY/CIRCULATORY FUNCTION
/CAPILLARY REFILL
Discoloration
◼ 2.1. Assess capillary refill by applying
pressure to one of the toenails or
fingernails and check for discoloration.
⦿ 3. TEMPERATURE OF THE SKIN
Coolness
◼ 3.1. Assess temperature by touching
fingers or toes if warm to touch.

23. ⦿ 4. NEUROLOGIC FUNCTION
Numbness or tingling sensation/paresthesia
Absence or diminished sensation
◼ 4.1. Asked patient if he/she can move
fingers or toes of the casted extremity.
◼ 4.2. Asked patient for the presence of
numbness or tingling sensation
◼ 4.3. Asked the patient if he feels when
you touch his fingers or toes to assess
nerve paralysis

24. ⦿ 5. INFECTION
Swelling, foul odor, fever
◼ 4.1. Assess presence of swelling below or above
the casted extremity
◼ 4.2. Assess presence of foul odor in the casted
extremity
◼ 4.3. Check for the presence of drainage and
note the color and amount.
◼ 4.4. Mark the circumference of the stain on
the cast as a gauge for any increase in the
amount of drainage

25. CAST TECHNIQUES
⦿ Bivalving
⦿ Windowing
⦿ Reinforcing

26. ⦿ BIVALVING
◼ Cutting the cast into
two halves from the
upper portion to the
bottom part for the
purpose of relieving
tightness of the
casted extremity

27. ⦿ WINDOWING
◼ 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
⦿ REINFORCING
◼ Reapplication of
Plaster for the
purpose of regaining
its strength in case
of instability.
Wet
Break
Crack

28. PETALLING THE CAST
⦿ 1. Pulled the stockinet over the cast and
taped down, if edges of the cast are
rough and crumbling to prevent skin
irritation
⦿ 2. Cut a tape into 4 inch strips
⦿ 3. Place half of the tape on the inside of
the cast and pulled it over the top of the
cast
⦿ 4. Anchor remaining tape to outside of
the cast

29. MATERIAL S & INSTRUMENTS IN CAST
APPLICATION
MATERIALS & INSTRUMENTS USES
1. Plaster of Paris/ Fiberglass Casting materials
2. Stockinet To protect the skin
3. Wadding sheet/gauze
bandage
To serve as padding
4. Bandage scissor To cut wadding sheet and stockinet
5. Trimming knife To smoothen the edges of the cast
6. Newspaper To protect the floor/area
7. Disposable gloves To protect the hands of the
operator
8. Pail of water at room
temperature
To wet the cast

30. MATERIAL S & INSTRUMENTS IN CAST
REMOVAL
MATERIALS &
INSTRUMENTS
USES
5. Stryker cast cutter Used in bivalving &
windowing & removal of
cast
6. Cast spreader To widen a bivalve cast
3. Bandage scissor To cut wadding sheet and
stockinet

31. PLASTER CAST CUTTER

33. Type of Cast Location Uses
Unilateral hip spica cast: Applied from the chest to
the foot on one leg.
Thigh fractures. Also used
to hold the hip or thigh
muscles and tendons in
place after surgery to
allow healing.
One and one-half hip
spica cast:
Applied from the chest to
the foot on one leg to the
knee of the other leg. A
bar is placed between
both legs to keep the hips
and legs immobilized.
Thigh fracture. Also used
to hold the hip or thigh
muscles and tendons in
place after surgery to
allow healing.
Bilateral long leg hip
spica cast:
Applied from the chest to
the feet. A bar is placed
between both legs to
keep the hips and legs
immobilized.
Pelvis, hip, or thigh
fractures. Also used to
hold the hip or thigh
muscles and tendons in
place after surgery to
allow healing.

35. ⦿ SHORT LEG HIP SPICA
CAST:
⦿ Applied from the
chest to the thighs or
knees.
⦿ To hold the hip
muscles and tendons
in place after surgery
to allow healing.

36. ⦿ WALKING CAST
◼ Affection of
tarsals and
metatarsals with
callus formation

38. ⦿ BASKET CAST
◼ For massive bone injury of the patella to
facilitate wound dressing

39. ⦿ PATELLAR TENDON BEARING CAST
◼ Affection of tibia-fibula with callus formation
⦿ QUADRILATERAL/ISCHIAL WEIGHT BEARING CAST
◼ Affection of the shaft of femur with callus
formation

40. ⦿ PANTALON CAST
◼ Affection of the
pelvis

41. ⦿ DELVIT CAST
◼ Affection of the 3rd
of the tibia –fibula
with callus formation

42. ⦿ CAST BRACE
◼ Fracture of the
distal 3rd
of
femur and
proximal 3rd
of
tibia with
callus
formation

43. TYPES OF CAST IN THE TRUNK AND
NECK
⦿ 1. BODY CAST
◼ encircles the trunk, stabilizing the spine
◼ Affection of the lower dorso-lumbar spine
⦿ 2. MINERVA CAST
◼ Applied around the neck and trunk of the
body.
◼ Affection of the cervical and upper dorsal
spine
⦿ 3. RIZZER’S JACKET
◼ Affection of thoraco-lumbar spine and to
correct scoliosis (S-shape)

44. ⦿ SHOULDER SPICA
CAST
◼ Applied around
the trunk of the
body to the
shoulder, arm,
and hand.
◼ Affection of the
upper portion of
the humerus and
shoulder joint

46. COMPLICATIONS OF CASTS
⦿ 1. Necrosis, pressure sores and nerve pulses
– due to pressure of a cast on
neurovascular and bony prominences
⦿ 2. Compartment Syndrome – this may lead to
vascular insufficiency and nerve and muscle
compression due to unrelieved swelling and
can cause irreversible damage to the
extremity
2.1. Pain 2.5. Swelling
2.2. Discoloration 2.6. Coolness
2.3. Tingling sensation
2.4. Absent or diminished sensation

47. ⦿ 3. Multisystem problems due to immobility
3.1 Digestive system
- Anorexia & constipation
- Nausea, vomiting and abdominal
distention (decrease blood flow to the
bowel and possible intestinal
obstruction)
3.2. Respiratory System
- Pneumonia and respiratory atelectasis
(ineffective respiratory effort)

48. 3.3. UTI
- renal and bladder calculi
3.4. Circulatory system
- Thrombophlebitis and pulmonary emboli
(due to immobility and ineffective
circulation)
⦿ 3.5. Psychological reactions
- depression, anxiety

49. S/S OF COMPARTMENT SYNDROME
⦿ Pain
⦿ Swelling
⦿ Discoloration
⦿ Coolness
⦿ Tingling sensation
⦿ Absent or diminished sensation

50. NURSING INTERVENTIONS
⦿ Assess the alarming signs and complications
of casted body and extremities
⦿ Assess neurovascular status hourly during the
first 24 hours

51. ⦿ How can a person move around while in a
cast?
⦿ With the use of assistive devices :
◼ crutches
◼ walkers
◼ wagons
◼ wheelchairs
◼ reclining wheelchairs

52. ◉quiz

53. I. IDENTIFY THE FOLLOWING:
___1. Applied from the upper arm to the wrist
to hold the elbow muscles and tendons in
place after a dislocation or surgery.
___2. Applied to the area below the knee to
the foot for fracture of the lower leg,
severe ankle sprains/strains, or fractures.
___3. Affection of tibia-fibula with open
wound, inflammation or swelling
___4. Applied below the elbow to the hand and
is used for fractures of forearm or wrist.
___5. Applied around the neck and trunk of the
body for cervical and upper dorsal spine
fracture or affectation

54. ___6. Used for pelvis, hip, or thigh fractures.
Applied from the chest to the feet and a bar is
placed between both legs to keep the hips and
legs immobilized.
___7. Cast used for massive bone injury of the
patella to facilitate wound dressing
___8. Equipment used in windowing or bivalving
___9. The fiberglass type of cast dries for how
long?
__10. The Plaster of Paris is made up of what?

55. II. ENUMERATION
⦿ 1 – 3 Enumerate at least 3 cast care
instructions
⦿ 4 – 7 Enumerate at least 4 alarming signs of
compartment syndrome
⦿ 8 – 10 What are the 3 types of cast
techniques
⦿ 11 – 12 Principles of application of cast
⦿ 13 – 15 Purposes of cast
⦿ 16 – 18 3 Layers of casting
⦿ 19 – 20 Types of cast
⦿

56. I. IDENTIFICATION
1. Short arm circular cast
2. Minerva cast
3. Arm cylinder cast
4. Short leg circular cast
5. Long leg posterior mold
6. Bilateral hip spica cast
7. Basket cast
8. Stryker Cast cutter
9. 20 – 30 minutes
10. Gypsum sulphate