Page 300 - Orthopedic Casts and Splints2

Performance Steps
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.

Performance Measures GO NO GO

1. Received the order from the physician( reviewed if in writing) —— ——
2. Identified yourself to the patient. —— ——

3. Explained the procedure to the patient. —— ——
4. Inspected patient's arms. —— ——

5. Checked capillary refill of patient's hands/fingers. —— ——
6. Gathered equipment. —— ——
7. Assembled materials. —— ——

8. Prepared stockinette. —— ——
9. Prepared plaster reinforcement splint for the radial aspect of the cast. —— ——

10. Applied stockinette to patient's injured arm. —— ——
11. Measured patient's injured phalanges and wrist with goniometer. —— ——
12. Applied cast padding( webril) to injured phalanges, wrist and forearm —— ——

13. Prepared casting materials. —— ——
14. Placed fiberglass casting gloves on hands. —— ——

15. Opened fiberglass casting package. —— ——
16. Applied 1st plaster/fiberglass roll. —— ——

17. Laminated the casting material. —— ——
18. Applied reinforcement splint to radial aspect of cast. —— ——

19. Applied 2nd plaster/fiberglass roll. —— ——
20. Molded casting material to forearm/wrist. —— ——
21. Molded cast material to phalanges. —— ——

22. Checked range of motion ( ROM ) of phalanges and thumb. —— ——
23. Checked alignment of wrist with goniometer. —— ——

24. Checked cast dimensions. —— ——
25. Applied 3rd plaster roll. —— ——

26. Checked patient's capillary refill. —— ——
27. Cleaned plaster resin off patient's skin using a damp wash cloth, towel or alcohol —— ——
pad.

28. Gave patient verbal and written instructions on cast care. —— ——

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