 Explain definition of casts

 Identify purpose of casts.

 Identify casts materials, application, and
drying
 Demonstrate simple casting application
 Explain general nursing care for patient in
a cast.
 Explain complications of casts
 A cast is a rigid dressing that
circumferentially encircles an extremity
(Schoen, 2001)
 Cast application is an essential skill in
the practice of both orthopaedic and
emergency medicine.
 To hold bone fragments in reduction and
alignment.
 To permit early ambulation and weight
bearing.
 To improve function by stabilizing a joint.
 To correct and prevent deformities.
Indication of : Contraindication of:
 Fractures  Open fractures
 Severe sprains  Severe swelling
 Dislocations.  Compartement
 Protection of post- syndrome.
operative repairs.  Insensate limbs.
 Gradual correction  Ulcers or draining
of a deformity with wounds.
serial casting.
 Plastic of Paris
 Fiberglass
1. Plaster of Paris (POP) is CaSO42H2O
eg. Gypsona
1. Syntetic Resin is C6H5NCO
eg. Dynacast
 A stockinette is used
to make the cast
more comfortable
and protect the
patients from sharp
edges of the cast.
 Padding, sometimes
called sheet
wadding, is a cotton
material that is easily
torn and strectched
 Have a container of
water at room
temperature (or
colder for extra-fast-
setting plaster)
available for wetting
the cast materials.
 Temperatur: 25-35
degrees celcius.
 Assessment
 Prepare equipment
 Prepare patient
 Stockinette
 Webril/padding
 Prepare plaster
 Apply plaster
 Mould plaster
 Radiography
 Patient instruction
Before cast application, certain
examination must be performed:
 Complete neurovascular exam of the
affected region.
 Note the quality of the skin in the region
to be cast.
 Radiographs as necessary.
 Start proximally and wrap towards the
hand
 When applying plaster to the palm and
between thumb and index finer, pinch
the plaster to decrease its width.
 Fold the stockinette and webril over the
first layer of plaster to create a smooth
cast edge.
 Continue to apply the final layer of
plaster and smooth out the surface.
 Assessing neurovascular status Five P (Pain,
Paresthesia, Paralysis, Pallor, Pulselessness)
 Assessing for and intervening to relieve pain
and pressure.
 Assessing the amount of drainage into the
cast.
 Assessing for signs and symptoms of tissue
necrosis or infection.
 Turning the patient every 2 hours during the
day and every 4 hours at night.
 Keeping the extremity elevated on
pillows to prevent swelling.
 Keeping the casted extremity off a hard
surface.
 Utilizing ice as needed to prevent or
reduce swelling.
 Providing skin care to prevent irritation
and dryness.
 Encouraging the patient to do as many
activities of daily living as possible.
 Setting up an exercise program to
prevent the effect of immobility.
 Setting up an exercise program for the
affected extremity.
 Providing for patient self care and home
care activities.
 Determining the patient’s emotional
adjustment to wearing a cast.
 Impaired Circulation And Nerve Damage
 Pressure Areas, Tissue Necrosis, and Irritation
 Joint stiffness
 Compartment syndrome is incresed pressure
within a closed space that compromises blood
flow and tissue perfusion can caused ischemia
and reduced capillary flow which leads to
more oedema
 Infection
 Lack of Fracture Immobilization
 Thermal Effect of Plaster
 Tight Cast
 Keep the cast dry.
 Left uncovered cast for at least 2 days
 Elevated above the heart to reduce and
minimize swelling
 Fingers and toes should be wiggled
often.
 Do not put anything down the cast.
 Seek immediate medical attention if:
1. Pain or swelling increases.
2. There is any numbness or tingling
3. There is drainage or an unusual smell.
4. The digits to the cast are purple.
5. There is swelling not relieved by
elevation.
6. The cast breaks.
 A cast is a rigid dressing that circumferentially
encircles an extremity (Schoen, 2001)
 A cast is made of layers of plaster of Paris
bandages or of synthetics materials, such as
polyester cotton knit, polyurethane, fiberglass
or thermoplast.
 The purpose of a cast is to immobilize the
injured extremity for comfort and to maintain
adequate alignment of fractures and/or
ligamentous structures until healing occurs
 Patient education is very important
 Maher, A.B., Salmond, S.W., and Pellino,
T.A. (2002). Orthopaedic Nursing.
Philadelphia: W.B. Saunders Company.
 Schoen, DC. (2000). Adult orthopaedic
Nursing. Philadelphia: Lippincott Williams &
Wilkins
 Smeltzer and Bare (2000), Text Book of
Medical Surgical Nursing, 9 th ,
Philadelphia, Jb Lippincot Company
 Thank you