assisting with cast application

Prepare the skin that will be under the cast, if needed.

Clean skin with mild soap and water. Let skin dry completely before cast application.

How long does it take a Plaster of Paris cast to dry? A. 15 minutes B. 20 minutes C. 2.5 hours D. Up to 72 hours

D Rationale: Plaster of Paris is molded while wet and can take up to 72 hours to dry. Synthetic casting materials set quickly, in about 15 minutes. A patient can place weight on a synthetic cast after only 20 minutes.

ALERT

Excess edema under a cast places pressure on nerves, blood vessels, and muscle tissue, which may lead to compartment syndrome, neurovascular deficit, and tissue necrosis

supplies

Fiberglass rolls or cast materials such as plaster, casting tape, or plastic depending on purpose of cast or specific patient condition Padding material Plastic-lined bucket or basin filled three-fourths full with warm water Clean gloves, apron, or protective cover Cart, chair, and fracture table scissors Paper or plastic sheets Cast cutter Gloves

finishing steps

Assist as needed while the health care provider applies the casting tape. Compress the wrapping lightly with both hands to aid in bonding the cast layers. Supply cast stabilization devices, such cast braces or bars, or walking heels as ordered. Finish the cast by folding the edge of the stockinette over the cast to form a smooth edge. Secure the edge with dampened fiberglass roll and cushion any rough edges with tape or moleskin. If needed, trim the cast around fingers, thumbs, and toes to aid in movement and circulation. Remove gloves and perform hand hygiene. Allow the cast to air dry. Avoid covering the cast, which will delay drying. Do not rest the heel of the cast on the bed or pillows. Provide patient teaching using Teach Back. If the patient is not being immediately discharged, reposition the patient every 2 to 3 hours. Perform neurovascular assessment immediately and repeat every 1 to 2 hours for the first 24 hours. If the patient is being immediately discharged, assist the patient in transferring to a stretcher or wheelchair. After completing the procedure, discard used supplies and dispose of used equipment appropriately. Perform hand hygiene. Document patient teaching, patient's response and expected or unexpected outcomes.

Why is it important to keep the casted extremity elevated and vigilantly assess for edema? A. To detect cast syndrome B. To detect infection C. To prevent and detect compartment syndrome D. To prevent pain and discomfort

C Rationale: It important to keep the casted extremity elevated and vigilantly assess for edema to prevent and detect compartment syndrome. Excess edema under a cast places pressure on nerves, blood vessels, and muscle tissue, which may lead to compartment syndrome, neurovascular deficit, and tissue necrosis. Infection is detected by assessing for a foul odor or discharge coming from the cast. Cast syndrome can occurs with patients in body or hip spica casts; signs of cast syndrome including persistent vomiting and/or severe back or abdominal pain. Preventing edema will reduce pain and discomfort, but the most important purpose is to prevent and detect compartment syndrome.

Which patient is at increased risk for mobility difficulty after cast application? A. A 10-year-old child B. A 16-year-old child C. A 25-year-old adult D. A 75-year-old adult

D Rationale: A 75-year-old patient is at increased risk for mobility difficulty after cast application. Age-related decreased muscle strength in older adults is a result of loss of skeletal muscle and may cause difficulty in ambulating with a cast. A 10-year-old patient is not at increased risk for mobility difficulties. A 16-year-old patient is not at increased risk for mobility difficulties. A 25-year-old patient is not at increased risk for mobility difficulties.

What will the nurse tell the patient to expect while synthetic cast material is being applied? A. Cooling sensation B. Itching C. Numbness and swelling D. Warmth

D Rationale: The nurse tells the patient to expect warmth as synthetic cast material is being applied. The nurse does not tell the patient to expect a cooling sensation. Itching is a sensation the nurse tells the patient to expect after the cast is applied. The nurse tells the patient to report numbness and swelling that occurs after cast application.

When providing skin care to an area will be under the cast, the nurse: A. Applies lotion B. Scrubs the skin vigorously to remove dead skin cells C. Washes the skin gently with soap and water, rinses skin, and vigorously rubs dry D. Washes the skin with mild soap and water and allows to dry completely

D Rationale: When providing skin care to an area will be under the cast, the nurse washes the skin with mild soap and water and allows to dry completely before cast application. The nurse does not apply lotion. The nurse does not scrub the skin vigorously as this can damage the skin. The nurse allows skin to air dry and does not vigorously rub dry as this can damage the skin.

- Explain that the patient may experience warmth as the cast material is applied. - Assist the health care provider with applying padding materials around the patient's extremity. - Assist with cast application as needed:

Provide patient support and encouragement. Stabilize the body part to be casted. Prepare casting materials, if asked. - Plaster: Mark the end of the roll by folding one corner of the material under itself. Submerge plaster roll in water until bubbles stop. Squeeze lightly to remove excess liquid and hand roll to the person applying the cast. - Synthetic: Submerge cast roll in lukewarm water for 10 to 15 seconds or wet material using a water bottle. Squeeze to remove excess water.

beginning steps

Review the patient's medical record for orders and restrictions. Gather the necessary equipment and supplies. Provide for the patient's privacy and perform hand hygiene. Introduce yourself to the patient and family if present. Identify the patient using at least two identifiers, such as name and date of birth or name and account number, according to agency policy. Compare these identifiers with the information on the patient's identification bracelet. Explain the procedure to the patient and ensure that he or she agrees to treatment. Provide the patient with an analgesic as ordered and place the patient in a position of comfort. Allow time for the analgesic to take effect before cast application. Apply clean gloves and don personal protective equipment per your agency's policy. Position the patient and the extremity for the procedure.