1-17
1-17. CARE OF THE PATIENT WITH A NEWLY APPLIED CAST
a. Expose a newly applied cast to air circulation. It should never be covered, because the cover will restrict the escape of moisture and heat. This is essential, as a drying cast generates heat within the plaster as the moisture evaporates and the cast hardens.
b. Handle a wet cast carefully. A newly applied cast is set and firm when the patient leaves the cast room, but it is still damp and easily damaged. It takes 24-48 hours for a cast to become dry and hard. Handle the cast by lifting and supporting it on a pillow or with the palms of the hands. Never use fingers as they will leave indentations, which cause pressure areas within the cast.
c. Provide plastic-covered pillows to support the cast along its entire length. Never permit the wet cast to rest directly on a flat or firm surface as this will flatten the contours of the cast and cause pressure within the cast.
d. Review the patient's clinical record for the type of cast and the reason the cast has been applied. Interview the patient to determine his knowledge of the cast purpose and whether he has had a cast before. Instruct the patient on care of the cast that is wet and after it is dry.
e. After a cast has cooled and begins to harden, elevate the casted extremity to reduce swelling which often occurs after application of a cast. When a newly applied cast is elevated, it should be supported along its entire length, on an inclined plane, with the distal joints higher than the proximal joints. For example, hand higher than elbow, elbow higher than shoulder.
f. Observe all edges of the cast for any areas that cut or put pressure on the skin.
g. Observe the extremity encased in plaster for circulatory impairment by comparing fingers or toes of the casted extremity with the uninvolved extremity. The primary concern following new cast application is to prevent complications. Circulation should be checked hourly during the first 24 to 48 hours, then every 4 hours.
(1) Check the skin temperature of the injured extremity. It should not be colder than the unaffected limb.
(2) Check and compare the pulses. They should be equal.
(3) Check for complaints of numbness, tingling, burning, swelling, pain, pressure, or inability to move the fingers or toes.
(4) Report presence of the above signs and symptoms IMMEDIATELY to avoid possible tissue necrosis; these findings indicate possible ischemia.
h. Perform the blanching (capillary refill) test. The nail beds of the fingers or toes are compressed lightly and released to check how quickly the color returns.
(1) With pressure applied, the nail bed should turn pale (blanch). When pressure is released, the color should return within the time it takes to say "capillary refill," indicating return of capillary action.
(2) Failure to blanch, or a blue tinge, indicates impaired venous circulation and congestion of tissues.
(3) Failure of color to return, or cold, pale fingers or toes suggests impaired arterial circulation.
(4) In either case, report findings IMMEDIATELY. Do not wait. Permanent damage can result from impaired circulation caused by cast pressure.
