Page 235 - Orthopedic Casts and Splints2

Performance Steps
d. Place palm of hand on the planter arch and apply pressure. Hold until contour takes shape.

16. Check range of motion (ROM ) of phalanges and knee.
a. Have patient extend and flex toes.
b. Gave patient extend and flex knee.
17. Check alignment of injured ankle with goniometer.
a. Place the stationary arm of the goniometer parallel to the fibula.
b. Place the moving arm of the goniometer bisecting the fifth metatarsal ( little toe )
c. Place the protractor of the goniometer on the lateral malleolus.
d. The goniometer should measure 90 degree of dorsiflexion.
NOTE: If the malleolus is not at 90 degree of dorsiflexion, everted or inverted remove splint and go to
step 8 to repeat process.
18. Check splint dimensions.
a. The tips of the toes are visible.
b. The splint edges rest one inch below the fibula head or 3 inches distal to the popliteal region
and to the tips of the phalanges.
19. Check patient's capillary refill.
a. Squeeze patient's toes and nail beds will turn white.
b. Release patient's toes and nail beds will return pink
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.
c. Go to step 30.

20. Prepare Bulky Jones(Compression Dressing) for upper extremity.
a. Place hospital pad or bed sheet on patient's lap.
NOTE: All patients should be given a covering (e.g. chux, bed sheet ) to reduce damaging their clothing
during the casting process and for privacy.
b. Open box of 4 x 15 plaster reinforcement sheets. Remove sheets from box and unwrap
package . Peel back the edges of (10-15) sheets, remove from the stack. Place on work
cart/station.
NOTE: The technician may choose to use 4 inch plaster rolls.
c. Locate DPC, thenar muscle and the cubitum space on the uninjured arm.
d. Remove (1) plaster sheet from the stack of (10-15).
e. Place sheet next to uninjured arm to obtain sheet length, the DPC and thenar muscle contours
.
NOTE: To increase patient cleanliness the sheet does not have to rest on the patient skin.
f. Draw a diagonal line on the plaster sheet that matches with the DPC of patient's hand.
NOTE: The diagonal line will be cut to facilitate free ROM of the fingers (extension and flexion).
g. Draw a curved line(half moon shape) on the plaster sheet that matches with the outer
border of the thenar muscle on the patient's hand
NOTE: The half moon pattern enables the thenar muscle to be observable and the thumb to adduct to all
fingers promoting free range of motion (ROM).
h. Place sheet on stack , cut the outlined patterns and excess length for all sheets, and place on
work cart/station for later use.
NOTE: Discard excess material in the trash receptacle.
21. Measure patient's injured wrist w/ goniometer.
a. Position the patient's injured elbow on the bump at a 45 degree angle to the upper torso.
b. Place the stationary arm of the goniometer bisecting the lateral aspect of the ulnar.
c. Place the moving arm of the goniometer bisecting the 5th phalange.
d. Place the protractor of the goniometer on the ulnar styloid.
e. Set the wrist until the goniometer measures between 0-15 degrees of dorsal extension.
22. Prepare kerlix fluff's.
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