A client with a compound fracture of the left ankle is being discharged with a below-the-knee cast. Which
instruction should the practical nurse (PN) provide to the client prior to discharge?
A.
Apply a cold pack to any “hot spots” on the cast.
B.
Keep the left leg in a dependent position.
C.
Expect some increase in pain.
D.
Never scratch under the cast.
The Correct Answer and Explanation is:
The correct answer is A: Apply a cold pack to any “hot spots” on the cast.
Explanation:
When a patient is discharged with a cast, especially a below-the-knee cast for a compound fracture, there are essential instructions that need to be given to ensure proper healing and comfort. Each option provided involves a critical aspect of post-cast care, but applying a cold pack to any “hot spots” on the cast is particularly crucial.
1. Applying a Cold Pack:
A new cast can often feel warm as the materials set and harden, which can be a normal part of the casting process. However, a patient might also experience areas on the cast that feel unusually hot. This sensation could be due to underlying issues like cast irritation or pressure points. Applying a cold pack to these “hot spots” can help alleviate discomfort and reduce any inflammation. It’s important that the cold pack is applied indirectly, using a cloth or towel to prevent direct contact with the cast and skin, which can lead to frostbite.
2. Keeping the Leg in a Dependent Position:
Keeping the leg in a dependent position (i.e., hanging down) is generally not recommended. Elevation is advised to reduce swelling and improve circulation. The leg should be kept elevated above heart level as much as possible, especially in the initial days after casting.
3. Expecting Some Increase in Pain:
While some discomfort can be expected as the cast settles, significant pain or worsening pain could indicate complications such as cast tightness, swelling, or infection. Pain should be monitored closely, and any severe or increasing pain should be reported to a healthcare provider immediately.
4. Scratching Under the Cast:
It is crucial to avoid scratching under the cast as it can lead to skin irritation or infection. Patients should be advised to use a cast padding or sock to keep the skin protected and to avoid inserting objects into the cast to scratch.
In summary, applying a cold pack to any “hot spots” on the cast helps manage discomfort and potential irritation, making it a priority instruction for the patient.