Plaster cast and its type

it explain about introduction, definition, purpose of applying cast, indcation, type of cast, procedure of application and removal of plaster and management.

1. Assist in Application & Removal of Plaster Cast MS. BHARTI SHARMA NURSING TUTOTR BECON JAMMU.

2. INTRODUCTION OF ASSIST IN APPLICATION OF CAST/SLAB These procedures are being done to immobilize the injured injured part in the conditions or problems like soft tissue injury , fracture, weakened bone, etc. For this procedure cast/slab can be made from POP or fiber glass can be used.

3. DEFINITION OF CAST & SLAB A plaster cast / fiber glass cast is a rigid immobilizing device that is moulded to countour of body to encase an injured part.

4. A POP slab / fiber glass slab can be applied firstly for temporary period while waiting for definitive treatment or it could be definitive treatment in itself.

5. PURPOSE OF CAST / SLAB FOR SLAB: Applied as first treatment to immobilize the bone or joints. Acts as a splint, to apply pressure on bone. To correct further complications. To observe signs & symptoms after application (minimum one week after making cast).

6. FOR CAST: Applied after slab, means (full observation of injured part). To immobilize the body part in specific position. To apply uniform pressure on bone. To provide support / stability for weakened joints. To prevent micro-movements in joints, bone fracture.

7. INDICATIONS FOR CAST / SLAB Bone fracture / dislocation. Soft tissue injury. Bone weakness. Ligaments injury. Joint swelling due to disease. Nerve, tendon or vessel repair. Congenital talipes equinovarus ( CTEV ) or clubfoot. Achilles / calcaneus tendon (its tear, rupture or inflammation).

8. TYPES OF CAST /SLAB Upper extremity: Long arm cast : (A/E cast) It is applied to arm from the hand to about lower two thirds of arm till the level below arm pit, leaving fingers & thumb free.

9. Short arm cast : (wrist plaster) It is just below the elbow.

10. Arm cylinder cast : It covers upper and lower arm & elbow, but leave wrist & hand free.

11. Lower extremity : Short leg cast : (B/K cast) it include the encasing of foot, ankle and lower leg ending below knee

12. 2) Long leg cast : (A/K cast) it includes the encasing of foot and leg to the hip.

13. 2) Leg cylindrical cast : (used in knee injuries) It is similar to long leg cast but in some cases it may end just above the ankles.

14. 3. Hip Spica : It include the trunk of body and one or more legs. It is extended till navel (hollow area) in trunk. It is of three types:

15. Shoulder spica : In this the trunk is covered from shoulder of the involved side (other side is below arm pit), to ileac crest and involved limb is covered till wrist or hand.

16. Finger or thumb spica : It includes long arm cast and short arm cast covering thumb or fingers

17. Body cast / plaster jacket: ( Rarely used) (In spinal problem) An encasement or covering for trunk, especially thorax. In this cast the anterior thorax and anterior abdomen area is remained open.

18. Minerva cast / Minerva jacket: (Rarely used) It is applied to trunk and head , with spaces cut out for face and ears. It extends from sternum and distal rib border anteriorly & across the distal rib border posteriorly

19. Bivalve cast: A cast cutted into two halves When frequent inspection is needed.

20. ARTICLES REQUIRED FOR APPLICATION OF CAST A TRAY CONTAINING RATIONALE QUANTITY POP bandages / fiber glass bandages To make cast 1 or 2 Stockinet To cover skin before cast 1 Cotton roll (generally used) To cover the body part 1 or 2 Soft cotton roll (medicated with glycerin) To cover or to prevent allergy 1 or 2 Cotton bandage To dress the part 1 Scissor To cut the bandage 1 Short trimming knife To remove hairs before cast 1 Mackintosh To protect bed sheet 1 or 2 Plastic apron / gown To protect ourselves 1 Gloves To protect hands from POP 2 Bowel with lupe warm water To rinse the POP bandage 1 Fracture table To support extremity 1 Measuring tape To measure the part 1

21. Gypsum POP

22. POP / Fibreglass bandage

23. Fracture bad

24. PROCEDURE FOR APPLICATION OF CAST Assess client’s health status (not be diabetic / malnourished). Explain the procedure to client and start IV line as advised. Immobilize the part by applying splint to affected part and provide position on bed. Assess the affected part for rashes , breakdown and bruising. Provide skin care before the cast / slab application (if it is open/ compound fracture then prepare client for surgery).

25. Determine client’s pain status (provide analgesics 20-30 minutes before as advised). Arrange the articles. Place the mackintosh. Prepare the client by removing splint & positioning the body part on bed or fracture table as required. Wash hands and don gloves. Part preparation. Apply glycerin to prevent swelling , lactamine lotion to prevent allergy, apply betadine gauze piece if any wound , and cover or apply stockinet over the part to be casted.

26. Wrap the part to be casted by the cotton roll or by using soft cotton (anti-allergic), In case of Slab, prepare the POP bandage by measuring the size to be casted (measuring tape), and then that measured POP bandage is then placed again and again onto each layer (in S-shape manner) of POP (15 layers minimum). then dip it into lupe warm water. In case of cast, dip the rolled POP bandage into lupe warm water. Then in both cases (cast or slab) wait till bubbles stop coming out of bandage (it takes 15- 20 seconds).

27. Take it out of the warm water and squeeze the POP bandage gently (don’t apply more pressure). Rule of thumb for plaster application blocks a joint above and below the fracture, to prevent mobilization. Hold the part to be casted by application of force as required onto opposite side. In case of slab apply measured POP bandage onto affected part posteriorly , then wrap it around by wet cotton bandages. In case of cast apply rolled dipped POP bandage onto the affected part to be casted , if required then take another POP bandage to complete the cast.

28. If fiberglass cast /slab is applied then open the packing and apply the rolled bandage over the part to be casted by wrapping it as in POP cast and make layers and apply in case of slab making. Continue apply the force on opposite side of affected part by pulling it. Both ends of stockinet sleeve may be folded back over the cast padding to give attractive ending to cast. Wait till the time it hardens. (fiberglass takes less time to fix). (handle the damped plaster cast with only palm of hand not the fingers)

29. If the cast/slab/fiberglass become harden then tell the assistants to leave the pressure on to cast area. Position the casted part by placing a pillow under it to elevate the part. Remove gloves and replace articles. The cast /slab should not be to much hard that it can decrease the blood supply to affected part. So ask client to move his /her fingers to confirm the sensation or control. Record application of cast and condition of skin & circulation. Record the client’s ability to perform ADL’s .

30. COMPLICATION OF THE CAST/ SLAB Impaired blood flow Nerve damage Tissue necrosis and infection Cast syndrome (nausea, vomiting & abd . distension). Complications due to immobility including joint stiffness, foot drop, decubitus ulcers, depression, insomnia, etc.. Medical complications including phlebothrombosis , pulmonary Embolism, wound enfection , etc..

31. DOCUMENTATION OF PROCEDURE

32. INTRODUCTION OF ASSIST IN REMOVAL OF CAST/SLAB Removal of slab is being done after complete observation of body part for any complication for minimum 1 week after (1 month or 45 days after). Cast is being removed after the joining of the fractured bone (confirming by X-ray exma .)

33. DEFINITION The removal of cast / slab is a procedure that is done by qualified and experienced medical personnel involving different methods of cast removal.

34. PURPOSE OF CAST/SLAB REMOVAL Slab is removed to apply cast for further treatment. Cast is removed when there is sign of full recovery or completion of time duration as advised by Doctor. To prevent or treat any complication the cast is removed.

35. ARTICLES REQUIRED FOR CAST/SLAB REMOVAL NAME OF ARTICLE RATIONALE QUANTITY Mackintosh To prevent soiling of bed sheet 1 Clean gloves To pr otect our hands 1 Water in bucket To dissolve cast 1 Plaster cutter scissors To cut the plaster 1 Vibrator To cut plaster by vibrations 1 Dilator To dilate the cutted cast 1 Sand bags To hold body part 2-3 Handle blade To erode or cut the cast 1

36. Plaster cutter scissors

37. Plaster cutting instrument

38. Vibrator

39. Dilators

40. Handle blade

41. Sand bags

42. PROCEDURE FOR CAST/SLAB REMOVAL Assess the patient’s condition. Explain the procedure to patient. Provide the proper position to patient as required (sitting or lateral), and place the sandbags as required. Spread the mackintosh over the bed . Arrange all articles as needed. Don gloves and start the procedure. Place the casted part into the water bucket, this helps in dissolving and softening the POP bandage.

43. If you are using plaster cutter scissor to cut the POP cast/slab or fiber glass cast/slab. In this one blade is placed inside the cast under the padding wool and another blade over the cast, then start cutting the plaster slowly slowly , the handle should be in parallel to the skin position. After each cut the blade should be realigned before next cut is made. Never try to cut round corners. Always remove the blades and cut from opposite side end of line.

44. If you are using the vibrator to remove POP or fiberglass cast/slab: first mark the area line by which you have to make cut , then apply vibrator over the marked line and start it , and change the placement of vibrator according to marked lines. After the cut has been made then use dilator to dilate the cast and easily remove it out. Remove the gloves, replace the articles. Remove the stockinet and examine the skin condition (any trauma due to cast removal).

45. Wash and dry the part , massage with oil or cream to restore normal elasticity. If there is edema then apply crepe bandage as advised.

46. DOCUMENTATION FOR PROCEDURE

47. SUMMARIZATION

48. CONCLUSION

49. REFERENCES Annamma Jacob, Rekha R, A textbook of Clinical Nursing Procedures: The art of Nursing practice, 1 st Edition, Published by Jaypee Publication ,2007. http:// www.boneandspine.com /removal-of-plaster- http:// www.m.healthkids.org /en/parents/cast-removal- http://en.m.wikipedia.org/wiki/ortho ..//-

50. Thankyou