Plaster of Paris is used to Immobilize fractures, create accurate impressions in Orthopedic casts, dental molds, surgical splints
Definition
A plaster cast of plaster of Paris (POP) is a rigid immobilizing device that is melded to contours of body to encase an injured part or limb.
Purposes
- To immobilize a body part in specific position.
- To apply uniform pressure or encase soft tissue.
- To correct or prevent deformity.
- To provide support/stability for weakened joints.
- To immobilize a reduced fracture.
Types of Plaster of Paris
- Short arm cast (wrist plaster)
- Long arm cast (above- elbow plaster)
- Arm cylinder cast.
- Short leg cast (below –knee plaster)
- Long leg cast (above-knee plaster)
- Leg cylinder cast
- Shoulder Spica cast.
- Minerva cast
- Bivalved cast.
Articles
Tray containing:
- Plaster bandages.
- Stockinette.
- Short trimming Knife.
- Scissors
- Dressing supplies
- Measuring tape.
- Protective sheet.
- Plaster apron/gown.
- Glove
- Newspaper.
- Bowel of warm water and washcloth.
- Shaving set.
Procedure for Application of Plaster of Paris
| 1 | Before procedure Assess patient’s health status, including conditions affecting wound healing (eg, diabetes, malnutrition) | Patient’s health status is pertinent to potential healing of tissues enclosed by cast. |
| 2 | Explain to patient the purpose and procedure of cast application, according to his level of understanding. | Relieves patient’s anxiety and helps nurse determine whether additional information is needed. |
| 3 | Assess condition of tissues to be in the cast including circulation to extremities. Note presence of skin breakdown, bruising, rash and irritation. Skin of babies, children, and older persons may contain less subcutaneous fat. | Determines need for additional skin care before cast application |
| 4 | Determine patient’s pain status | Fractures are painful. Patient’s responses vary as does need for analgesic prevent soiling. |
| 5 | Determine patient’s pain status | Prevents soiling |
| 6 | Administer analgesics 20-30 minutes before cast application. | Reduces pain during cast application |
| 7 | During procedure Wash hands and don gloves. | Reduces transmission of microorganisms. Synthetic cast can leave glue-like stain on hands |
| 8 | Position patient as desired. Patient may be lying, sitting or standing depending on type and body part to be casted. | Parts to be put in cast must be supported and placed in optimal position for cast application. |
| 9 | Prepare the skin for cast, if necessary; may involve cleansing with soap and water, Chaning dressing and trimming or shaving long hair. use gentle strokes to maintain skin integrity. | Reduce transmission of microorganisms. Synthetic cast can leave glue-like stain on hands. |
| 10 | Place stockinette over the skin where casting material will be applied | Reduces skin irritation. |
| 11 | Wrap the site with cast padding | |
| 12 | Depending on type of cast material being applied, do one of the following. Hold plaster roll under water in a casting bucket or plastic basin until bubbles stop, then squeeze slightly and had over to person applying cast submerge synthetic cast roll in lukewarm water for 10-15 second and squeeze to remove excess water.Hold body part or parts to be put in cast position requested, for applying cast. | Dampened plaster rolls are unrolled and molded to fit part being casted. Some have resin for easy moldability. Initiates chemical reaction that produce heat and hardens the cast roll. Support of body part may involve applying manual traction if desired to maintain optimal position. |
| 13 | Continues to apply dampened roll of plaster to hold parts as necessary until cast is finished. | Plaster must be of sufficient thickness to give strength to cast. |
| 14 | Assist with finishing the cast by folding stockinette or other padding down the edge of cast provide smooth edge to cast. | Smooth edges lessen possible skin irritation. Finishing cast with stockinette provide smooth edges. petaling is not required when cast is dry. |
| 15 | Using scissors trim plaster roll around thumb. finger or toes as necessary. | Casts should be snug but should not constrict joint movement or circulation. |
| 16 | Depending on tissues casted do one of the following: Place damp cat on cloth- covered pillows to prevent deformation or pressure points as it sets. Handle the damp plaster cast with only the palm of the hand and not the fingers. | Pillows should be snug but should not from hardening in undesirable position. Handling plaster cast with finger can cause indentation. |
| 17 | Remove and dispose off gloves. Assist with transfer of patient to stretcher or wheelchair for return to nursing unit. | Safety in transfer requires of pillow to support cast, side rails, restraints and sufficient personal to support patent and cast. |
| 18 | Clean equipment used, return to usual place; discard used material and wash hands. | Facilitates use of article and area for next patient. Reduces transmission of infection. |
| 19 | Explain purpose of exposure for faster drying. Use elevation if pertinent apply ice bags if ordered, or use fans or hairdryer and set to cool setting to facilitate drying. | Cast must dry from inside out for through drying. Elevation and use of ice decreases edema formation. |
| 20 | Have patient turn every 2-3 hours. | Prevent any one area of cast from receiving continuous pressure. Avoids indention of the cast. |
| 21 | Observe patients for sings of pain or anxiety; hypertension, swallowing air, tachycardia or BP increase. | These are sing of devolvement of” cast syndrome” of which may occur when body cast is applied. |
| 22 | Assess neuromuscular status by preforming neurovascular check: Observe color of tissues distal to cast. Observe for edema distal to cast Feel temperature of tissue above and below the cast. Palpate the distal pulses of the casted extremity. Note presence and strength of pulse. Ask patient to move parts distal to cast in range of motion. (ROM) if possible if patient cannot do active ROM, perform passive ROM on these joints noting responses or complaints of increases pain. Ask patient to describe sensation or feeling of tissue in cast; listen for description, such as pins and needles, asleep, numb, burning or throbbing. | Neurovascular status determines circulation and oxygenation of tissues pink colour indicates blood supply, and bluish color signifies reduced venous circulation. Edema result from trauma or venous stasis Warmth of tissues distal or proximal to cast usually indicates ad equates perfusion. Weak or absent pulses may indicate decreased circulation to casted area. Range of motion should be possible within limitations imposed by casts. Passive movements decrease edema. May signify pressure or anoxia affecting normal transmission of nerve impulse. |
| 23 | After procedure Record application of cast condition of skin and circulation status. | |
| 24 | Record patient ability or inability to preform actives of daily living (ADL) and specific requirements for care. | Independence is value for continuity of care and self -care |
| 25 | Teach patent about cast care in home setting: Cast should be kept dry, clean and dirt free all times. While bathing, the splint can be protected from water using large plastic bags secured at the top end; use waterproof shield or holding the area outside the bathtub or shower. Use hairdryer on the cool setting to dry the splint in case it gets wet. Hot or warm setting should not be used to avoid burns. Cast should be kept away from open flames, heater prolonged sunlight. Do not cut or tear the cast Exercise all nearby free moving joints, parts not secured by the splint. Elevate the part of body that is in the splint to reduce swelling. Promptly inform the doctor in case of tingling or numbness, sever pain not relived with medicine, tightly or loosely applied cast, swelling paleness or cyanosed finger or toes of the affected area, pressure sores and blisters. |
*Petaling: Application od adhesive tape 3 or 4 inches in length by tucking the straight end inside cast and by bringing the rounded end over the cast edge to the outside.
Complication of plaster cast using plaster of paris
| Complication | Signs and symptoms | |
| 1 | Impaired blood flow | Absence of pulse the extremity below the cast, Blanching or cyanosis of the skin, Pain, Coldness of the skin, Swelling, Numbness |
| 2 | Nerve damage | Persistent an increasing pain, Numbness, Motor paralysis |
| 3 | Tissue necrosis and infection | Unpleasant Odor Feeling of hot sensation drainage through the cast Sudden unexplained elevation of body temperature |
| 4 | Volkmann’s ischemic contracture | All the signs and symptoms of impaired blood flowAbsence of radial/pedal pulseAbsence of finger toe movementAbsence of pain which was intense in the beginning |
| 5 | Complication due to immobility | Hypostatic pneumonia, foot drop Renal calculi, Decubitus ulcers on pressure points, stiffness of joints. Constipation and retention of urine, Lethargy, loneliness and depression, insomnia |
| 6 | Medical complication | Phlebothrombosis, pulmonary embolism, and wound infection |
Special consideration
- it is important to inform the patient that sensation of heat may occur at the time of drying of the plaster cast.
- Plaster cast is never applied over areas with open wounds.
- After application, the cast take about 36-72 hours of fully dry.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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