Quantcast General Nursing Management of the Patient with a Cast - Nursing Care Musculoskeletal System

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(1)
Make a shallow groove to indicate the cutting lines on both sides of the
cast.
(2)  Apply water or peroxide along the cutting lines to soften the plaster. Use
a syringe to apply.
(3)  With the knife, cut through the layers of plaster along the cutting line. Do
not attempt to slice through all layers at once and do not use the knife to cut through the
base material.
(4)  With the bandage scissors, cut through the base material down to the
skin. Cut every thread of the lining material completely through since the lining is
sometimes the source of the trouble.
(5)  Use tape or an elastic bandage to loosely hold the bivalve cast together
in order to maintain support of the casted part until further instructions are obtained.
b. Windowing the Cast. This procedure is done on specific order of the
physician. It is a potentially dangerous procedure because the underlying tissue may
bulge through the window opening, causing "window edema." If a window is cut, the
piece of plaster removed should be saved.
(1)
The physician indicates the area to be windowed.
(2)  The physician or orthopedic technician cuts the window, usually a
square or rectangular area, out of the cast. Once the plaster has been cut out, the
lining material is carefully cut away from the skin.
(3)  After the physician examines and treats the underlying area, a dressing
may be applied over the exposed skin area and the cutout piece of plaster bound in
place again. Replacing the cutout plaster section will prevent window edema.
1-20. GENERAL NURSING MANAGEMENT OF THE PATIENT WITH A CAST
a. Although a patient with an arm or leg cast is much more self-reliant than a
patient in a body or spice cast, it is a nursing responsibility to monitor all patients and
assist as needed. Nursing management includes the following actions to assess the
effectiveness of the cast.
(1)  Check the edges of the cast and all skin areas where the cast edges
may cause pressure. If there are signs of edema or circulatory impairment, notify the
charge nurse or physician immediately.
(2)  Slip your fingers under the cast edges to detect any plaster crumbs or
other foreign material. Move the skin back and forth gently to stimulate circulation.
MD0916
1-23



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