Cast care
Description
Involves hard molds that encase a body part, usually an extremity, to provide immobilization of bones and surrounding tissue
Used to treat injuries (including fractures), correct orthopedic conditions (such as deformities), or promote healing after general or plastic surgery, amputation, or nerve and vascular repair (see Types of casts for children)
May be constructed of plaster, fiberglass, or other synthetic materials
Fiberglass casts: lighter, stronger, and more resilient than plaster, but more difficult to mold because of rapid drying; can bear body weight immediately, if needed
Cast applied and removed by physician; patient and equipment prepared by nurse who also assists during procedure
Equipment
Casting material ♦ plaster rolls ♦ tubular stockinette ♦plaster splints (if necessary) ♦ bucket of water ♦ sink equipped with plaster trap ♦ linen-saver pad ♦ sheet ♦wadding ♦ cast stand ♦ sponge or felt padding (if necessary) ♦ cast scissors, cast saw, and cast spreader (if necessary, for removal) ♦ moleskin or adhesive tape (optional)
Essential steps
Explain the procedure to allay the child and his parents’ fears.
Cover the appropriate parts of the child’s bedding and gown with a linen-saver pad.
Assess the condition of the child’s skin in the affected area, noting redness, contusions, or open wounds, to aid in evaluating complaints he may have after the cast is applied.
To establish baseline measurements, assess the child’s neurovascular status.
Palpate the distal pulses and assess the color, temperature, and capillary refill of the appropriate fingers or toes.
Support the limb in the prescribed position while the physician applies the tubular stockinette and sheet wadding.
The stockinette, if used, should extend beyond the ends of the cast to pad the edges.
Preparing a fiberglass cast
If using water-activated fiberglass, immerse the tape rolls in tepid water for 10 to 15 minutes to initiate the chemical reaction that causes the cast to harden.
Open one roll at a time.
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