A patient is placed in a plaster hip spica cast and is returned to the assigned room. The cast is still slightly wet. Which action by the nurse would be appropriate?
A.
Keep the cast covered with a light-weight blanket.
B.
Maintain increased humidity in the patient room.
C.
Use only the tips of the fingers when handling the cast.
D.
Monitor the capillary refill time in the toes on both feet.
The correct answer and Explanation is :
Correct Answer: D. Monitor the capillary refill time in the toes on both feet.
Explanation:
A plaster hip spica cast is used to immobilize the hip and lower extremity, often following surgery or in treatment of fractures. After the cast is applied, it is essential to ensure proper circulation, sensation, and movement of the extremities because swelling can occur under the cast, potentially leading to compartment syndrome—a condition in which pressure buildup within muscles can cause serious complications.
Rationale for Option D:
- Monitoring capillary refill time in the toes of both feet helps assess circulatory status. This should be done frequently, especially during the initial phase after cast application, because poor circulation can lead to complications such as tissue ischemia, necrosis, and nerve damage. Normally, capillary refill should be less than 3 seconds. Any delay indicates impaired blood flow, which requires immediate medical intervention.
Why the other options are incorrect:
- Option A: Keep the cast covered with a lightweight blanket.
This is not recommended because it can trap heat and moisture, slowing the drying process of the cast and potentially causing skin maceration or irritation. The cast should remain exposed to allow for air circulation. - Option B: Maintain increased humidity in the patient room.
Increased humidity would prolong the drying process of a plaster cast. The cast needs to dry fully to harden properly, and humidity could compromise this, increasing the risk of cracks or deformation. - Option C: Use only the tips of the fingers when handling the cast.
This is incorrect because handling a wet plaster cast with the tips of the fingers can create indentations or pressure points, which may lead to skin irritation or damage. Instead, the palms of the hands should be used to avoid pressure points until the cast fully hardens.
Thus, frequent monitoring of circulation through capillary refill time is the priority.