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Caring for a Patient with Cast
Cast - It is a form of plaster or fiberglass which holds broken bones in place as it heals.
A shell, frequently made from plaster of Paris or fiberglass to encase a limb or body parts to stabilize
and hold anatomical structures—most often a broken bone in place until healing is confirmed.
Purposes
Prevents neurovascular impairment of areas encircled by cast
Maintains cast for immobilization of injured area
Prevents infection
Types of Casts
1.Plaster cast
This is made from gauze and plaster strips soaked in water.
These are wrapped around the injured body part over a stockinette and cotton padding. As they dry, the
strips harden. The cast takes 24 to 48 hours to harden fully.
Plaster of paris – Made of powdered calcium sulfate crystals formed into bandages that must be soaked
in tepid water before applying. Wait for 48 hours drying period, handled with care uncovered and heavy
2.Synthetic cast
This is made from polyester, cotton, fiber glass or plastic strips.
This are wrapped around the injury over a stockinette and cotton padding.
Synthetic casts can be different colors.
A synthetic cast is lighter than plaster.
Set much more quickly. It dries in a few minutes, but may take a few hours to harden fully.
These can get wet for bathing or swimming
3.Cast brace
This is made of hard plastic.
Soft pads inside the brace push against (compress) the injury.
The brace is held in place with Velcro strips and can be removed.
A cast brace may be used right after the injury occurs. Or, it may be used toward the end of healing,
after another cast has been
4.Splint (also called a half cast)

This is made from slabs of plaster or fiberglass that hold the injury still.
A bandage is wrapped around the injury to hold the plaster slabs in place.
Splints are often used when swelling is present, or you have a risk of swelling.
In most cases, the splint is eventually replaced with another type of cast.
Casts according to location
1.Short arm cast

Applied below the elbow to the hand.
Indications
Forearm or wrist fractures.
Also used to hold the forearm or wrist muscles and tendons in place after surgery.
2.Arm cylinder cast
Applied from the upper arm to the wrist
Indications
*To hold the elbow muscles and tendons in place after a dislocation or surgery.
3.Shoulder spica cast

Applied around the trunk of the body to the shoulder, arm, and hand.
Indications
Shoulder dislocations
Used after surgery on the shoulder area
4.Minerva cast
Applied around the neck and trunk of the body.
Indications :
Used after surgery on the neck or upper back area to stabilize positions
5.Short leg cast

Applied to the area below the knee to the foot.
Indications
Lower leg fractures, severe ankle sprains and strains, or fractures. Also used to hold the leg or foot
muscles and tendons in place after surgery to allow healing.
6.Leg cylinder cast

Applied from the upper thigh to the ankle.
Indications :
Knee, or lower leg fractures, knee dislocations, or after surgery on the leg or knee area.
Leg casts … see the difference ?
7.Unilateral hip spica cast

Applied from the chest to the foot on one leg.
Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow
healing.
8. One and one-half hip spica cast
Applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both
legs to keep the hips and legs immobilized.
Indication :
Thigh fracture. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow
healing.
9.Bilateral long leg hip spica cast

Applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs
immobilized.
Indication :
Pelvis, hip, or thigh fractures. Also used to hold the hip
What are the differences ?
Materials for Plaster Cast:

Plaster of paris, gloves , basin of water , scissors
Wading sheets
Splints
Are soft casts or temporary casts used in the early stages of a fracture when swelling is likely to occur.
Purpose of splints:
To stabilize fractures that may have potential for swelling. This allow room for swelling to prevent
compartment syndrome
Splints are often used when more rigid immobilization is not necessary.
Nursing care for Patients with casts

A. Immediate or Initial Cast
Allow cast to be exposed to air to dry.
Assess movement and circulation
Assess and report any pain severe pain
Turn patient every 2 hours while cast is drying
Explain to patient that there is warm sensation at the casted part for about half hour .
B. Intermediate Care or Ongoing Cast Care

Performance of neurovascular assessment after 30 minutes for several hours after the cast is
applied and every 4-6 hours the first day or two.
Check skin color and temperature, pulse, swelling and sensation in fingers and toes of the casted
leg or arm. 5 Ps are: Pain, pulselessness, pallor, paresthesia and paralysis.
Note drainage or unusual odor from the cast. Inform client to report to the doctor immediately.
B. Intermediate Care or Ongoing Cast Care
If the client is allowed to get his cast wet, use a mild soap when showering ,apply only a small amount in
the cast.
If he has a leg cast, stress that he should be sure that he has a good footing when getting in or out of the
tub or shower- a wet cast can be slippery. After swimming or bathing, he should flush the cast with
water and dry it thoroughly to prevent skin irritation and maceration.
To dry a wet cast the client should first remove excess water by blotting the cast with towel. Then use a
hair dryer set on a cool or warm setting in a sweeping motion over the entire cast until it’s completely
dry
Inform the client to keep dirt, sand and other foreign materials from becoming trapped under the casts.
After cast-care:
Check for skin irritations
Encourage to use warm water soak to clean flaky skin
Instruct to apply lotion and avoid scrubbing the skin.
Instruct to avoid contact sports -to prevent skin injuries to fragile skin
D. Complications
Vascular compromise /Compartment syndrome

Pressure injuries
Pain
Swelling
Infection underneath cast

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Caring for a Patient with Cast

4.Splint (also called a half cast)

1.Short arm cast

3.Shoulder spica cast

5.Short leg cast

6.Leg cylinder cast

7.Unilateral hip spica cast

9.Bilateral long leg hip spica cast

Materials for Plaster Cast:

Nursing care for Patients with casts

B. Intermediate Care or Ongoing Cast Care

B. Intermediate Care or Ongoing Cast Care

Vascular compromise /Compartment syndrome

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