Page 173 - Orthopedic Casts and Splints2

Performance Steps
d. Place the edge of (1) sheet from the 3rd stack beginning at the lateral end of the iliac crest
and extending past the medial end. Place sheet on top of remaining stack of 4 and tear/cut
other sheets to obtained length. Place on work cart/station for later use.
e. Place the edge of (1) sheet from the 4th stack sheet to the sacrococcygeal region. Place
sheet on top of remaining stack of 4 and tear/cut other sheets to obtained length. Place on
work cart/station for later use.
10. Prepare felt pads.
a. Using instruments of measurement ,obtain the needed length of the patient's upper thigh
from medial to lateral.
b. Measure length of both anterior iliac crest.
c. Measure length of sacrococcygeal region.
d. Measure the circumference of the wrist.
e. Measure from the acromioclavicular joint (ac) diagonally across the chest under the axilla
region posteriorly across the back ending opposite from the start.
f. Measure the circumference of the elbow.
g. Place orthopaedic felt next to the measured lengths , cut off excess amount and place on
work cart/station.
NOTE: Discard excess material in the trash receptacle.
11. Apply stockinette to patient's upper torso.
a. Place bed sheets on floor and have patient stand on sheets.
NOTE: Bed sheets are used to keep the floor clean.
b. Have patient remove gown.
CAUTION: Always use the same gender chaperone.
c. Place 4x4 pads in the axilla region .
NOTE: Pads are used to reduce chafing of the patient's skin.
d. Hold open sides of the stockinette.
e. Place the stockinette on patient.
NOTE: The patient can either step in the stockinette and pull it on, or have patient place arms above
head and pull stockinette down.
f. Pinch the stockinette at the base of the shoulder and cut the stockinette at a 45 degree
angle.
g. Have patient place arms through the pre cut hole and adjust stockinette.
NOTE: Stockinette should be 3 inches above the nipple line and 3 inches distal to the iliac crests.
Separate stockinette may be used for the arm.
12. Measure patient's injured arm with goniometer.
NOTE: All Velpeau casts are applied as directed by physician's order.
a. Have patient stand erect.
NOTE: Family members, nursing staff, orthopaedic technician or support stand may be used to assist
in positioning the patient.
b. Place patient's injured arm across the chest with fingers pointing towards the uninjured
shoulder.
c. Place the stationary arm of the goniometer so that it bisects the deltoid muscle or humerus.
d. Place the moving arm of the goniometer so that it bisects the forearm.
e. Place the protractor of the goniometer on the olecranon process ( elbow ).
f. Set elbow until the goniometer measures between 85-110 degrees of flexion.
NOTE: Physician's order will specify elbow flexion requirement.

13. Apply felt padding to the iliac crests, shoulder, elbow and axilla region.
NOTE: The felt pads are used to reduce chaffing of the skin. The patient or nursing personnel can hold
pads/towel in place prior to webril application.
14. Place folded towel over the area of the diaphragm.

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