This is an NCLEX cast care review question. This question provides a scenario about a patient with a cast, and you must decide which action performed by the patient’s significant other requires you to re-educate the patient and family about cast care.
This question is one of the many questions we will be practicing in our new series called “Weekly NCLEX Question”.
So, every week be sure to tune into our YouTube Channel for the NCLEX Question of the Week.
NCLEX Cast Care Lecture
NCLEX Cast Care Review Question
Your patient is 2 hours post-op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care?
A. Checking the color and temperature of the right foot.
B. Elevating the cast above heart level with pillows.
C. Gently using the fingertips of the hands to move the cast every 2 hours to help with drying.
D. Using a hair dryer on the cool setting to help with drying and itching.
To answer this question correctly, you have to pull from your nursing knowledge about cast care.
What’s a cast? It is a device used to immobilize a fractured bone, which will allow the bone to heal naturally. They are often placed after a closed bone reduction (a fancy way of saying the bone was manually placed back in it original state) and can be made of plaster or fiberglass.
Nursing Interventions for Cast Care:
- Monitor for compartment syndrome: 6 P’s
- Monitor for infection: hotspots in the cast, severe pain, fever
- Keep the cast and extremity elevated above the heart level (decreases swelling)
- Apply ice packs to the cast for the first 2 days to decrease swelling
- Evenly dry the cast by turning it every 2 hours
- Use palms of hand to handle (not fingertips) when wet:
- WHY? Prevents dent formation in cast by handling with the palms of hand, which can cause skin breakdown overtime
- Maintain skin integrity: petal the cast and use soft tape called moleskin around the edges to prevent skin breakdown
- Keep cast dry and never stick anything inside it to scratch an itch
Now let’s eliminate options (we want to eliminate options that are correct actions performed by the patient’s significant other….so we are looking for something the person performed wrong):
A. Checking the color and temperature of the right foot. ELIMINATED! This is a good thing! We want the patient and the patient’s family to be check the 6 P’s to help catch compartment syndrome early, if it develops.
B. Elevating the cast above heart level with pillows. ELIMINATED! Another good thing! The helps decrease swelling, which is what we want because excessive swelling can lead to compartment syndrome.
C. Gently using the fingertips of the hands to move the cast every 2 hours to help with drying. CORRECT! This is an alarming finding and the significant other should be re-educated on how to handle the wet cast properly. The family member should use the PALMS of the hands….not fingertips. WHY? The fingertips will cause dent formation, which can lead to skin ulcer formation overtime.
D. Using a hair dryer on the cool setting to help with drying and itching. ELIMINATED! This can be done to help the cast dry faster and help with itching. The hair dryer should never be on a warm or hot setting due to the risk of burns.
The answer is C.
- Assessment & Initial Management of the Trauma Patient. (2006). Emergency.cdc.gov. Retrieved 3 October 2017, from https://emergency.cdc.gov/masscasualties/word/blast_curriculum_3H.doc
- Cast Care | HealthReach. HealthReach. Retrieved 4 October 2017, from https://healthreach.nlm.nih.gov/document/546/Cast-Care