Page 333 - Orthopedic Casts and Splints2

Performance Steps
d. Instruct patient not to stick any objects down the splint, do not remove the splint, and do not
alter the cast ( e. g. cutting,removing padding ).
26. Annotate the procedure applied to patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to the patient in patient's medical
record or Standard Form 513 and sign your name.

27. Escort 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 cast padding ( webril) for 1st splint. —— ——
9. Prepared cast padding ( webril) for 2nd splint. —— ——

10. Prepared plaster splint for the volar and dorsal aspects of the —— ——
11. Prepared plaster splint for the anterior and posterior aspect of the upper arm. —— ——

12. Measured patient's injured wrist w/ goniometer. —— ——
13. Measured patient's injured elbow w/ goniometer. —— ——

14. Applied 1st splint to injured wrist and forearm. —— ——
15. Applied 2nd splint to injured upper arm. —— ——

16. Secured double sugar tong splint to injured arm. —— ——
17. Molded splint to forearm/wrist. —— ——
18. Molded splint to elbow. —— ——

19. Checked range of motion ( ROM ) of phalanges/ shoulder. —— ——
20. Checked alignment of injured wrist/elbow with goniometer. —— ——

21. Checked splint dimensions. —— ——
22. Checked patient's capillary refill. —— ——

23. Cleaned plaster off patient's skin using a damp wash cloth, towel or alcohol pad. —— ——
24. Fitted patient with a sling. —— ——

25. Gave patient verbal and written instructions on cast care. —— ——
26. Annotated the procedure applied to patient in medical record or SF 513. —— ——
27. Escorted patient to front desk to make a follow up appointment. —— ——
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