(3) Lean down and smell the cast to detect odors indicating tissue damage.
A musty or moldy odor at the surface of the cast may be the first indication that necrosis
from pressure has developed underneath.
Check the integrity of the cast by looking for cracks, breaks, and soft
b. The casted body part must be examined and assessed frequently in order to
prevent complications. Assess the casted part by checking the following.
(1) Assess circulation by performing the blanching test and comparing the
skin temperature and blanching reaction of the affected limb to that of the unaffected
(2) Assess the presence of sensation in the affected limb by touching
exposed areas of skin and instructing the patient to describe what he felt.
(3) Assess the motor ability of the affected limb by having the patient wiggle
his fingers or toes.
c. Patient education will do much to prevent complications. Instruct the patient
to do the following.
(1) Avoid resting cast on hard surfaces or sharp edges that may dent the
cast and cause pressure areas.
(2) Never use a coat hanger or other foreign object to "scratch" inside the
cast. This may cause skin damage and infection.
(3) Report any danger signs to the nursing staff immediately. Danger signs
include pale, cold fingers or toes, tingling, numbness, increased pain, pressure spots,
odor, or feeling that the cast has become too tight.
Report any damage to the cast such as cracks, breaks, or soft spots.
Never attempt to remove or alter the cast.
1-21. NURSING MANAGEMENT OF PATIENTS WITH EXTREMITY CASTS
a. After a leg cast is applied, prevent or alleviate swelling by elevating the
extremity above the level of the heart. After the patient begins to ambulate, he should
be encouraged to elevate the casted extremity when he is seated or resting in bed.
b. To control swelling with an arm cast, elevate the extremity on pillows or
suspend in stockinet from an IV pole when the patient is lying or sitting. When the
patient is ambulatory, a sling may be used for support. The type of sling required will