c. One person should remain at the patient's affected side, while the others
move to the opposite side of the bed to straighten the bed linen and position another set
of pillows along side the patient. The pillows should be arranged so that they will
support the cast and the patient's head and shoulders when you turn the patient.
d. The patient should be instructed to raise the arm on his unaffected side above
e. The person on the patient's affected side should place his hands, with palms
up, under the patient's torso.
f. The assistants on the patient's unaffected side should reach across the bed
and place their hands, with palms down, on the patient's affected side. The person
nearest the patient's head should place his hands on the patient's shoulder while the
person nearest the patient's feet should place his hands on the patient's hip and leg.
g. Moving simultaneously, the person on the patient's affected side should
gently draw the patient toward himself while the assistants on the opposite side ease
the patient over toward themselves. Care should be taken to support the leg and arm
on the affected side of the body.
h. After the patient has been turned, check the placement of the supporting
pillows. Be sure that there are no gaps between pillows. When the patient is turned to
the prone position, place a pillow under the lower legs to allow the feet to rest in the
position of function and avoid having the toes pushed against the mattress.
i. Position a pillow under the patient's head and shoulders and be sure to place
the call bell within his reach.
1-24. PATIENT CARE AFTER CAST REMOVAL
a. After a cast has been removed, continue to provide support to joints and
normal body curves. The muscles will have become weakened from disuse and,
although movement is encouraged, support is necessary. Use firm pillows to support
the patient while in bed and use elastic bandages or an arm sling, if necessary, when
the patient is up and about.
b. Avoid vigorous attempts to remove skin exudate and crusts of dead skin cells,
which are present when a cast has been in place for several weeks. Gentle soaking
and applications of oil to soften the skin and loosen crusts may be recommended.
c. After the cast is removed, the physician or physical therapist may prescribe
exercises to increase strength. If the patient has been doing isometric muscle
contractions, he will not have to "relearn" to contract his muscles and will progress more
rapidly through rehabilitation. Atrophy of the part may be noticed, but this should
gradually disappear with the return of muscle function. Swelling may develop for a
while, but decreases with improved muscle tone and circulation as the patient becomes