Care for a Client with Cast

A. Types of cast: long arm, short arm, long leg, short leg, walking cast with rubber heel, body cast, shoulder spica, hip spica

B. Casting materials
1. plaster of paris – traditional cast
a. takes 24- 72 hours to dry
b. precautions must be taken until cast is dry to prevent dents, which may cause pressures areas
c. signs of dry cast: shiny white , hard , resistant
d. must be kept dry since water can ruin a plaster cast
2. synthetic cast ( fiberglass)
a. strong, lightweight ;sets in about 20 minutes
b. can be dried using dryer or hair blow-dryer on cool setting; some need special lamp to hardened
c. water-resistant; however, if cast become wet, must be dried thoroughly to prevent skin problems under cast

C. cast drying – plaster cast
1. use palms of hands, not fingertips, to support cast when moving or lifting client
2. support cast on rubber – plastic protected pillows with cloth pillowcase along length of cast until dry
3. turn client every 2 hours to reduce pressure and promote drying
4. do not cover the cast until it is dry ( may use fan to facilitate drying)
5. do not use heat lamp or hair dryer on plaster cast

D. Assessment
1. perform neurovascular checks to area distal to cast
a. report absent or diminished pulse, cyanosis, or blanching, coldness, lack of sensation, inability to move finger or toes, excessive swelling
b. report complains of burning , tingling or numbness
2. note any odor from the cast that may indicate infection
3. note any bleeding on cast in a surgical client
4. check for “hot spots” that may indicate inflammation under cast

E. general care
1. instruct client to wiggle toes or fingers to improve circulation
2. elevate affected extremity above heart level to reduce swelling
3. apply ice bag to each side of the cast if ordered

F. Providing client teaching and discharge planning concerning
1. isometric exercises when cleared with physician
2. reinforcement of instructions given on crutch
3. do not get cast wet; wrap cast in a plastic bag when bathing or take a sponge bath
4. if a cast that has already dried and hardened does become wet, may use blow dryer on low setting over wet spot; if large area of plaster cast becomes wet, call physician
5. do not scratch or insert foreign bodies under cast; may direct cool air from blow dyer under cast for itching
6. recognize and report signs of impaired circulation or of infection
7. cast cleaning
a. clean surface soil on plaster cast with a slightly damp cloth; mild soap may be used for synthetic cast
b. to brighten a plaster cast, apply white shoe polish sparingly