CAST – immobilizing device molded to the parts of the body (plaster & fiber glass)
- plaster of Paris (gypsum sulfate) mixed with water (forms into a hard cement)
- prevents area around it from moving as it heals, apply uniform pressure on soft tissue
- to correct a deformity, helps prevent muscle contractions
- support & maintain realigned bone
Principles – provide maximal comfort & alleviation of complications
- application of padding is the first step (wadding sheet, roll of cotton stockinette)
- maintain position during cast application (depending on type of cast being applied and loc of
injury)
- can be applied as a combination (stockinette & sheet wadding)
- include the joint above and below injured part
- apply in circular motion and mold it
Contraindications – Pregnancy (growing size of abdomen, edematous legs and feet
- skin disease (lesions, vesicles, infection, inflammation)
- open wound, infection, swelling
Materials: Plaster of Paris, polyester fiberglass, thermoplasts
Application (circular):
- check doc’ order, identify, explain, assess area to be casted
- perform pain assessment and asses muscle spasm (administer medication)
- cleanse (bath and shampoo, soap and water then dried. if wound, have it dressed)
- prepare things, position the extremity
- apply padding including joints above and below the fracture line
- soak the plaster cast into a bucket w/ water (leave until bubbles cease)
- grasp both ends of the cast towards the center w/o squeezing
- free the end of cast and hand it to the operator
- apply circular motion until covered and mold it by the palm
Handle the cast with care
- avoid moving the pt or transferring w/ wet cast
- care must be taken to maintain integrity of cast
- excess plaster trimmed by trimming knife
- cast spilled removed by wiping w/ damp cloth
- to dry it fast (expose to open air/ electric fan, heat lamp, warm room)
- protect pt from rapid drying of the cast, to prevent pneumonia and body fluid loss from
excessive sweating
- complains of discomfort should be investigated (appropriate measure to be given)
- Spica cast should be turned every 4-6 hrs to promote even drying
- roughed edges should be smoothed w/ cast knife (covered with adhesive petals)
Care of pt w/ cast
- duration of cast at least one month
- factors influence the duration: age of pt, part of body affected, degree of injury
- Neuro-vascular checks- color, motion, temperature, sensation of toes/fingers observed every
30 mins for several hrs
- observe hot spot or musty odor, infection
- assess for vascular occlusion
- circulatory impairment results in coldness, edema, cyanosis pain, numbness of toes/fingers
- pt w/ arm and leg cast should be able to move and feel each toe/finger cause same nerve
does not innervate each one
- preservation of efficiency of cast
- maintenance & promotion of integrity of system of the body
- maintain cleanliness of cast
Turning pt in cast
- casted trunk & lower extremities must be done carefully
- pt must be lifted not rolled
- support should be provided to the part and whole body
- first changing of position depends on condition of the case and body involve
- first turning usually is to dry the posterior surface of cast
- provide comfort and protect against respiratory complication (pneumonia, PD)
REMEMBER:
- after cast removal, support the part w/ pillow, maintaining same position
- move extremity gently
- observe skin for any abrasions & plaster sores
- wash skin w/ mild soap followed by oil and lanolin as prescribed
TYPES of cast:
1. short arm – below the elbow to palmar crease, (thumb Spica) wrist injuries
2. long arm – upper level of axillary to palmar crease, immobilized at right angle, aft elbow surgery
3. feunster’s – wrist and fingers w/ compound affection,
4. long arm posterior mold – radius / ulna compound affection
5. hanging – shaft of humerus
6. airplane – humerus and shoulder joint w/ compound affection, severe sprains
7. shoulder Spica – humerus & shoulder joint, aft major surgery
8. functional arm – humerus (allows abduction & adduction)
9. collar cast – cervical affection
10. Minerva – upper dorsal cervical spine, undergone spinal injury
11. body cast – lower dorso-lumbar spine, dislocations
12. rizzer’s jacket – scoliosis
13. double hip Spica – hip and femur
14. double hip Spica posterior mold – pelvic affection w/ callus formation plus 2 femur
15. 1 ½ hip Spica – hip and femur
16. 1 ½ hip Spica posterior mold – w/ compound fracture
17. single hip Spica – hip & one femur
18. posterior mold – pelvic bone fracture w/ callus formation
19. pantalon cast – pelvic bone fracture
20. frog cast – congenital hip dislocation
21. long leg cast – tibia and fibula, knee dislocations
22. long leg posterior mold – w/ compound affection
23. basket cast – severe leg trauma w/ open wound
24. cylindrical leg cast – patella
25. quadrilateral ischial bearing cast – shaft of the femur w/ callus formation
26. cast brace – fracture of the femur distal 3rd femur
27. short leg – ankle & foot
28. patellar tendon bearing – tibia & fibula w/ callus formation
29. delbit – tibia and fibula
30. short leg posterior mold – w/ compound affection
31. internal rotator splint – post hip operation
32. boot leg – hip and femoral fracture
33. night splint – post polio (plantar fasciitis)
