Caring for a Cast

Goal: The cast remains intact, and the patient does not experience neurovascular compromise.

1. Review the medical record and the nursing plan of care to determine the need for cast care and care for the affected body part.

2. Perform hand hygiene. Put on PPE, as indicated.

3. Identify the patient. Explain the procedure to the patient.

4. Close curtains around bed and close the door to the room, if possible. Place the bed at an appropriate and comfortable working height, if necessary.

5. If a plaster cast was applied, handle the casted extremity or body area with the palms of your hands for the first 24 to 36 hours, until the cast is fully dry.

6. If the cast is on an extremity, elevate the affected area on pillows covered with waterproof pads. Maintain the normal curvatures and angles of the cast.

7. Keep cast (plaster) uncovered until fully dry.

8. Assess the condition of the cast. Be alert for cracks, dents, or the presence of drainage from the cast. Perform skin and neurovascular assessments according
to facility policy, as often as every 1 to 2 hours. Check for pain, edema, inability to move body parts distal to the cast, pallor, pulses, and abnormal sensations. If the cast is on an extremity, compare it with the uncasted extremity.

9. If breakthrough bleeding or drainage is noted on the cast, mark the area on the cast, according to facility policy. Indicate the date and time next to the area. Follow physician orders or facility policy regarding the amount of drainage that needs to be reported to the physician.

10. Assess for signs of infection. Monitor the patient’s temperature. Assess for a foul odor from the cast, increased pain, or extreme warmth over an area of the cast.

11. Reposition the patient every 2 hours. Provide back and skin care frequently. Encourage range-of-motion exercises for unaffected joints. Encourage the patient to cough and deep breathe.

12. Instruct the patient to report pain, odor, drainage, changes in sensation, abnormal sensation, or the inability to move fingers or toes of the affected extremity.

13. Remove PPE, if used. Place bed in lowest position. Perform hand hygiene.