IV. Nursing Management
Prepare the client for cast application.
-Explain the procedure and what to expect.
-Obtain informed consent if surgery is required.
-Clean the skin of the affected part thoroughly.
Assist the health care provider during application of the cast as needed.
After the cast application, provide cast care.
• 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.
• Provide covering and warmth to uncasted areas.
• Expose the fresh plaster cast to circulating air, uncovered, until dry (24 to 72 hours). Expose the fresh synthetic cast until it is completely set (about 20 minutes).
• Instruct the client to avoid wetting the cast. Instruct him to dry a synthetic cast with a hair dryer on cool setting if it gets wet.
Initiate pain relief measure if indicated.
• Encourage position changes.
• Elevate the affected body part.
• Provide analgesics as appropriate.
• Promote nonpharmacologic pain relief measures, such as guided imagery, relaxation and distraction.
Observe for signs and symptoms of cast syndrome with clients who are immobilized in large casts, such as a body or hip spica cast.
• Report abdominal pain and distention, nausea and vomiting, elevated blood pressure, tachycardia, and tachypnea which are physiologic effects of cast syndrome.
• Any client who is claustrophobic is at risk for psychological cast syndrome, which includes acute anxiety and possible irrational behavior.
Provide nursing care for compartment syndrome, if indicated. Observe for signs and symptoms and discuss and assist with treatments.
Notify the health care provider immediately if signs or symptoms of other neurovascular complications occur.
Notify the health care provider if “hot spots” occur along the cast; they may indicate infection under cast.
Provide client and family teaching.
• Encourage isometric exercises to strengthen muscles covered by the cast. Promote muscle-strengthening exercises for the upper body if crutches are to be used.
• Advise the client to promptly report cast breaks and signs and symptoms of complications (i.e. circulatory compromise, cast syndrome, and hot spots).
• Warn the client against inserting sharp objects (e.g. coat hanger to scratch itchy skin under the cast). Instruct him to use a cool air from a dryer to help alleviate the itch.
• Teach the client appropriate cast care, depending on the type of cast.
• Encourage safety precautions (e.g. avoid walking on wet floors, watch throw rugs, be careful with stairs).
• Teach the client skin care and muscle-strengthening exercises for the affected body part after cast removal.
• Encourage mobility and active participation in self-care.
• Reinforce health care provider instructions on the amount of eight bearing allowed.