Question

1. An 8-year-old boy has been brought to the orthopedic clinic by his caregiver after falling from a tree. The child has a broken arm that has been x-rayed and is now being cast.
A. What should this child and the caregivers be taught regarding care of the cast?
B. What instructions should the nurse give the caregiver regarding things to report to the care provider?

Answer 1

ANSWER

A. The caregivers should be informed and educated regarding the following:

• Elevate the affected area to reduce swelling. This to be done for the first 24 to 72 hours of post cast application. Keep the limb in plaster raised above heart level as much as possible.
• Apply ice. Loosely wrap an ice pack covered in a thin towel around your child's cast at the level of the injury. Wrapping the ice is important to keep the cast dry. Ice that's packed in a rigid container and touches the cast at only one point won't be as effective.
• Keep moving. Encourage child to frequently move the fingers of the affected hand
• Do not t allow the child to stick objects, such as a coat hanger, inside the cast to scratch his or her skin. This could cause an injury or infection.
• keep the cast always clean, Avoid application of powder, deodorants, lotions on and near the affected area.
• Do not cut the edges of the cast if protruding always consult with the doctor.
• Cast always needs to be kept dry, in case it gets wet dry it naturally. Do not keep the cast wet.
• Do not paint the cast. Children have the tendency to draw on it.

• It is important to monitor your child for poor blood supply or swelling in their fingers or toes. If this happens: The skin may look pale or bluish in colour, the fingers or toes are cool or hot to touch.The child may say they have pins and needles or numbness,and the child may not be able to move their fingers or toes.

B. The nurse should instruct the caregiver to report to the doctor in the following :

• If the child feels increasing pain and tightness in the injured limb, numbness or tingling in the injured hand or foot, feels burning or stinging under the cast, develops excessive swelling below the cast, can't move the toes or finger is or her injured limb, or they become blue or cold, the child says the cast feels too tight or too loose, develops red or raw skin around the cast, develops a crack, soft spots or a foul odor in the cast, or gets the cast soaking wet and doesn't dry it properly, and if the cast has become damaged in any way.