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1-21. NURSING MANAGEMENT OF PATIENTS WITH EXTREMITY CASTS
a. After a leg cast is applied, prevent or alleviate swelling by elevating the extremity above the level of the heart. After the patient begins to ambulate, he should be encouraged to elevate the casted extremity when he is seated or resting in bed.
b. To control swelling with an arm cast, elevate the extremity on pillows or suspend in stockinet from an IV pole when the patient is lying or sitting. When the patient is ambulatory, a sling may be used for support. The type of sling required will depend upon the type of cast applied. A standard short arm cast or long arm cast can normally be adequately supported with the triangular bandage sling. See figure 1-13. [Note: Cast is not shown.] A sling does not support the arm above heart level so, in order to promote drainage and reduce swelling, the patient should be encouraged to remove the sling and raise the arm above his head periodically.
Figure 1-13. Triangular bandage sling.
c. If permitted by the physician, the patient should be encouraged to exercise his muscles. Isometric muscle contractions (contracting the muscle without moving the part) may be done to prevent atrophy and maintain muscle strength.
(1) If the patient is in a leg cast, have him lie down, place your hand under his knee and instruct him to "push down" toward your hand.
(2) If the patient has an arm cast, instruct him to make and release a tight fist.
(3) Encourage the patient to wiggle his fingers and toes frequently.
