Page 259 - Orthopedic Casts and Splints2

Performance Steps
b. Place lateral aspect of both thumbs ( forming a triangle) on the tibia and apply even pressure
up/down the tibia. Hold until contours take shape.
CAUTION: Excessive pressure may result in further patient injury. Talk to the patient while performing
this procedure ( e. g. How do you feel?, Is the pressure too much ? )
c. Place lateral aspect of both thumbs on tibia and apply pressure. Hold until contour takes
shape.
d. Place lateral aspect of both thumbs on the malleolus and apply even pressure. Hold until
contours take shape.
e. Place palm of hand on calcaneus and apply pressure. Hold until contour takes shape.
f. Place index finger and thumb on achilles and apply even pressure. Hold until contour takes
shape.
g. Remove hands from the cast when contours of the malleolus, tibia, calcaneus, achilles have
been shaped and the cast is cured.
NOTE: All casts require a mold. Crooked casts equal straight.

23. Check alignment of ankle with goniometer.
a. Place the stationary arm of the goniometer horizontally, bisecting the fibula
b. Place the moving arm of the goniometer in vertically, bisecting the lateral side of the 5th
phalange.
c. Place the protractor of the goniometer on the lateral malleolus.
d. The ankle is measured at 90 degrees of dorsal flexion.
NOTE: If ankle is not at 90 degrees of dorsiflexion, everted or inverted, remove cast and go to step
10.
24. Check cast dimensions.
a. Tips of toes are covered by the cast.
b. The cast edge rests 3 inches distal to the popliteal space
c. Fold and tack down the webril and stockinette.

25. Apply 3rd plaster roll( repeat steps 18-19 )
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work.
26. Clean plaster resin off patient's skin using a damp wash cloth, towel or alcohol pad.
Note: Fresh water from the faucet and not from the casting bucket should be used .
27. Apply cast shoe
28. Administer a crutch ambulation instruction ( See task number 081-836-0041)

29. Give patient verbal and written instructions on cast care.
a. Instruct the patient to call the cast clinic should they have any concerns or questions
regarding their cast . Provide patient with a copy of the clinic hours and telephone number.
After duty hours instruct patient to report to emergency room.
b. Present patient with cast care booklet( or written instructions).
c. Instruct patient to elevated the extremity above the heart , extend, flex and wiggle
fingers(demonstrate for patient) to reduce swelling.
d. Instruct patient not to stick anything down the cast, do not remove the cast and do not alter
the cast( e.g. writing on it, coloring.)

30. Annotate the procedure applied to patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to patient in medical record or
Standard Form 513 and sign your name.
31. Escort patient or direct patient to front desk to make a follow up appointment.

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