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1-22. NURSING MANAGEMENT OF PATIENTS WITH BODY OR SPICA CASTS
a. When a large cast, such as a body cast or spice cast, is applied, the curves of the cast must be supported in order to prevent sagging and pressure. Support should be given to the entire cast, especially at weak areas such as the shoulder, hip, and knee. Small plastic-covered pillows should be placed under the cast in such a manner that there are no gaps between pillows.
b. A patient in a large cast will not be able to bathe without assistance. However, the patient must be
encouraged to do as much for himself as is possible. Nursing personnel assist with those hygiene needs that the patient cannot manage alone. Each time the patient is turned to the prone position, wash the exposed back and buttocks and dry thoroughly. Apply lotion or powder and gently massage the skin to stimulate circulation.
c. When assisting with a urinal or bedpan, elevate the back and shoulders slightly higher than the buttocks to prevent dampening or soiling of the cast. Pillows may be used for support or, if the physician permits, the bed may be gatched up.
(1) Assist male patients with placement and removal of the urinal, if necessary.
(2) An emesis basin, slipped in place lengthwise, may be used by female patient for voiding. The basin is easier to place and remove than a bed pan.
(3) When assisting a patient with a bedpan, be certain that the buttocks are resting on the rim of the bedpan. The patient's head, shoulders, and back should be higher than the buttocks if at all possible.
(4) When a trapeze can be used, instruct the patient to lift straight up in order to avoid friction on the skin when placing and removing the bedpan.
(5) After using the urinal or bedpan, assist the patient to clean himself thoroughly. Check cast edges for soiling or dampness.
