Nursing Interventions: Post Cast Application and Cast Removal

A. Plaster of Paris casts
    1. Handle fresh cast carefully (first 48 hours) 
        a. Indentations may cause pressure points under the cast
        b. Handle the cast with open palms of hands
    2. Do not apply pressure to the cast
    3. Do not cover the cast – allow to air dry

B. All Casts
    1. Repeated neurovascular checks
        a. Capillary refill time
        b. Warmth
        c. Color
        d. Motion checks
            i. Patient can move toes and fingers of affected limb 
           ii. If not, a nerve is compressed
        e. Sensation: numb or tingling may mean nerve compressed
    2. Drainage
        a. Observe for wound drainage
        b. Record size, color, amount; and circle area on cast with felt tipped marker and date and time
        c. Check odor of drainage

C. Teach client 
    1. Keep cast dry and intact 
    2. To avoid placing any objects inside of or through cast 
    3. Describe indications and therapeutic use of casting for immobilization 
    4. Proper use of assistive devices 
    5. How to assess environment for potential mobility hazards 
    6. To inspect cast daily for foul odor, cracks


Nursing interventions for cast removal with a mechanical saw

A. Explain procedure to client

B. Inform client that 
    1. Cast removal is painless
    2. Client will feel heat and vibration
    3. Saw is noisy but will not cut client
    4. Inspect tissue under cast for signs of inflammation or infection
    5. If skin is intact apply lotion to moisturize skin

C. Teach client
    1. Underlying skin may be scaly and dry
    2. To perform range of motion exercises as ordered
    3. To use moisturizing lotion on dry skin


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