Cast Care

1. Cast Care Chapter 55, Patient Education Lesson 2 Pearson's Comprehensive Medical Assisting, 2nd ed. Beaman, Fleming-McPhillips, Routh, Gohsman, and Reagan, Pearson 2011 MA100: Instructor Mayra Howells

2. Preparing a Patient for a Cast Application • Explain that casts are a form of inflexible bandage that are applied for the purpose of immobilizing a broken bone or muscle strain and sprain • A cast may be applied after a surgical procedure on a limb to immobilize the area until healing takes place

3. Instruments Used for Cast Application Cast material (bandage roll or tape) Container of warm water Stockinette Webril (sheer wadding) padding rolls Bandage scissors Rubber gloves Sponge rubber (for padding)

4. Assisting the Physician with Cast Application It may be necessary to hold the limb at the joint areas as the cast is being applied Remember to handle a damaged limb gently

5. Assisting the Physician with Cast Application • After the cast has been applied, it must be left uncovered during the drying process • The limb may need to be supported on a pillow at this time • The patient should be cautioned against moving around until the cast is dry • The cast may feel warm or even hot during the drying process – Reassure the patient that this is normal

6. Observations that Patients Should Report • Circulation restricted by the cast • Pain as a result of the cast pinching the skin • Excessive itching under the cast • Numbness or tingling of fingers or toes • Discolored toes or fingers • Swelling of the limb around the edge of the cast • Discoloration soaking through the cast • Loosely-fitting cast • Foul odor coming from the cast

7. Types of Casts Short arm cast (SAC) • Extends from the finger to just below the elbow – Used for a fracture or dislocation of the wrist or forearm Long arm cast (LAC) • Extends from the fingers to the axilla, with a bend at the elbow – Used for a fracture of the upper arm Long and short leg casts • Extend from the thigh to the toes (LLC) or from below the knee to the toes (SLC) – They usually include an embedded walking heel

8. Patient Cast Care • Clean the cast with a damp cloth • Do not cut or trim the cast – If the edge seems sharp, apply masking tape to the sharp edge or use a nail file to trim it down • Elevate the extremity with the cast on it to reduce swelling and pain • Observe the fingers and toes for color changes, temperature changes, pain, tingling, or decreased sensation • When decorating a cast, use only water-soluble paints or marking pens – Otherwise the cast will not be able to breathe

9. Patient Cast Care • Call the physician’s office if you smell a bad odor coming from the cast, lose sensation or blood flow beyond the cast, feel a burning sensation, or notice blood coming from the cast • After being sure that the patient understands the importance of cast care, the medical assistant must document the teaching in the patient chart

10. Equipment Needed for Cast Removal Cast cutter Cast spreader Bandage scissors Bag for disposing of cast materials Drape

11. Procedure for Cast Removal • After washing hands and draping the patient, explain the process to the patient • The cutter vibrates and does not spin • The patient may feel some pressure and warmth • The patient may be shocked to see that the skin under the cast has become white and the muscle tone has decreased, and may need some reassurance that physical therapy will improve the function and appearance of the limb

12. Procedure for Cast Removal • The MA should stand near the physician and hand the necessary equipment as requested • After the cast is removed, the medical assistant should • Provide written instructions for post cast care • Clean the equipment • Wash hands • Document the procedure in the patient chart