©EVERLY 2024/2025 ALL RIGHTS RESERVED.
Timby Chapter 61 Caring for Clients
Requiring Orthopedic Treatment. Exam
Questions And Answers (Guaranteed A+)
Casts - Answer✔: rigid mold that immobilizes an injured structure while it heals.
Musculoskeletal disorders are common in - Answer✔any client population and contribute to
temporary or permanent disability. Clients with orthopedic disorders often cannot meet all of
their ADLs. Management of MS d/o involves the use of casts, splints and braces, traction, and
various types of ortho surgery. Amputation may also be done following a traumatic injury or
because of disease or disability.
Three types of cast - Answer✔Cylinder: encircles arm/leg, leaving the fingers/toes exposed
Body cast: larger form of a cylinder cast that encircles the trunk from about the nipple line to the
iliac crests
Hip spica cast: surrounds one or both legs and the trunk. May be strengthened by a bar that spans
a casted area btw the legs (See fig 61.1 p 1132). Anal & genital areas are trimmed open to
facilitate elimination.
Box 61.1 p 1132, "Examples of types of casts"
Materials used: plaster of Paris (takes several hours to dry), molds better to pt, used until
swelling subsides
fiberglass, polyester, thermoplastic material (can bear weight, unless contraindicated) dry more
quickly, lighter in weight, longer lasting, breathable, fewer skin problems
Cast Application - Answer✔•Applied from joint above break to one below it
•Joint slightly flexed to decrease stiffness
•"Applying a Cast" Box 61.2 p 1132
•
1|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
**Feels warm when applied d/t water used**
•Intense heat never used: why?!
•Reposition ONLY with palms, never fingertips
cast application - Answer✔To keep aligned bone fragments form becoming displaced, the cast is
applied from the joint above the break to the one below it. The joint is slightly flexed to decrease
stiffness. Some fractures (stress fx)
do not require surgical reduction or manual manipulation to realign the bone because the
fractured bone still remains perfectly aligned. If a closed or open reduction is required, the client
receives an analgesic or a general or local anesthetic to relieve pain.
In general the physician or NP/PA applies a cast as follows:
Clean & dry skin surface of the part to be casted
**Cover the skin with stockinette, a tubular knitted material***
Wrap padding around the limb, esp over bony prominences
Apply rolls or strips of plaster or nonplaster cast material evenly over the stockinette and
padding
Smooth the layer and edges of the cast
Fasten the stockinette in cufflike fashion to outside of the cast
Arrange for an Xray study after casting to check bone alignment
The drying cast should be supported on pillows. Reposition with palms. Using fingertips or
compressing cast on a hard surface can lead to pressures sores later.
**Cast windows** - Answer✔opening cut after cast dries. Done when discomfort or wound
needing dressing change. The window permits direct inspection of the skin, a means to check the
pulse in a casted arm/leg. Once a window is cut, the solid piece of cast is replaced in its original
site and secured with adhesive tape or a roller bandage. Leaving the window open may allow the
skin and soft tissue to bulge through the opening.
Once a cast has been applied - Answer✔, it may be bivalve, or cut in two. Fig 61.2 p. 1133.
This may be necessary if the arm or leg swells, causing the rigid cast to compress the tissue and
interfere with its blood supply. A bivalve cast also may be used for a client who is being weaned
from a cast, when a sharp Xray is needed, or as a splint for immobilizing painful joints when a
client has arthritis.
2|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
*Cast removal: removed with mechanical cast cutter* - Answer✔Noisy ***reassure client that
will not cut skin.***
One off, the skin appears mottled and may be covered with a yellowish crust composed of
accumulated body oil and dead skin. The client usually sheds this residue in a few days. Lotions
and warm baths/soaks may help to soften the skin and remove debris. May feel weak or stiff. The
limb may need support. Can wrap an elastic bandage, use cane, sling, etc until progressive active
exercise and PT help regain normal strength and motion
Assess prior to cast application to - Answer✔establish baseline. Assess after cast application
every 1-2 hours.
*What are possible complications with cast* ? - Answer✔**Impaired tissue perfusion ,by
looking at their circulation, sensation, mobility**
Elevate casted ext. so that it is higher than the heart
Repo client frequently while cast is drying so that the cast dries as evenly as possible
Circle areas where blood seeped through and write the time on the circle
Cast Guidelines - Answer✔•Petal cast edges with strips of adhesive tape to prevent chipping and
to cover any rough areas
•
•Ensure cast window is covered
•
•AMBULATE ASAP! (teach how to safely ambulate) as ordered and once dry
•
•Exercise proximal AND distal joints as indicated to prevent muscle atrophy, weakness, and loss
of joint mobility
•
•Report complications
**Keep cast clean & dry.** - Answer✔Damp cloth may be used.
Explain skin under may feel itchy... DO NOT INSERT OBJECTS.
3|Page
Timby Chapter 61 Caring for Clients
Requiring Orthopedic Treatment. Exam
Questions And Answers (Guaranteed A+)
Casts - Answer✔: rigid mold that immobilizes an injured structure while it heals.
Musculoskeletal disorders are common in - Answer✔any client population and contribute to
temporary or permanent disability. Clients with orthopedic disorders often cannot meet all of
their ADLs. Management of MS d/o involves the use of casts, splints and braces, traction, and
various types of ortho surgery. Amputation may also be done following a traumatic injury or
because of disease or disability.
Three types of cast - Answer✔Cylinder: encircles arm/leg, leaving the fingers/toes exposed
Body cast: larger form of a cylinder cast that encircles the trunk from about the nipple line to the
iliac crests
Hip spica cast: surrounds one or both legs and the trunk. May be strengthened by a bar that spans
a casted area btw the legs (See fig 61.1 p 1132). Anal & genital areas are trimmed open to
facilitate elimination.
Box 61.1 p 1132, "Examples of types of casts"
Materials used: plaster of Paris (takes several hours to dry), molds better to pt, used until
swelling subsides
fiberglass, polyester, thermoplastic material (can bear weight, unless contraindicated) dry more
quickly, lighter in weight, longer lasting, breathable, fewer skin problems
Cast Application - Answer✔•Applied from joint above break to one below it
•Joint slightly flexed to decrease stiffness
•"Applying a Cast" Box 61.2 p 1132
•
1|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
**Feels warm when applied d/t water used**
•Intense heat never used: why?!
•Reposition ONLY with palms, never fingertips
cast application - Answer✔To keep aligned bone fragments form becoming displaced, the cast is
applied from the joint above the break to the one below it. The joint is slightly flexed to decrease
stiffness. Some fractures (stress fx)
do not require surgical reduction or manual manipulation to realign the bone because the
fractured bone still remains perfectly aligned. If a closed or open reduction is required, the client
receives an analgesic or a general or local anesthetic to relieve pain.
In general the physician or NP/PA applies a cast as follows:
Clean & dry skin surface of the part to be casted
**Cover the skin with stockinette, a tubular knitted material***
Wrap padding around the limb, esp over bony prominences
Apply rolls or strips of plaster or nonplaster cast material evenly over the stockinette and
padding
Smooth the layer and edges of the cast
Fasten the stockinette in cufflike fashion to outside of the cast
Arrange for an Xray study after casting to check bone alignment
The drying cast should be supported on pillows. Reposition with palms. Using fingertips or
compressing cast on a hard surface can lead to pressures sores later.
**Cast windows** - Answer✔opening cut after cast dries. Done when discomfort or wound
needing dressing change. The window permits direct inspection of the skin, a means to check the
pulse in a casted arm/leg. Once a window is cut, the solid piece of cast is replaced in its original
site and secured with adhesive tape or a roller bandage. Leaving the window open may allow the
skin and soft tissue to bulge through the opening.
Once a cast has been applied - Answer✔, it may be bivalve, or cut in two. Fig 61.2 p. 1133.
This may be necessary if the arm or leg swells, causing the rigid cast to compress the tissue and
interfere with its blood supply. A bivalve cast also may be used for a client who is being weaned
from a cast, when a sharp Xray is needed, or as a splint for immobilizing painful joints when a
client has arthritis.
2|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
*Cast removal: removed with mechanical cast cutter* - Answer✔Noisy ***reassure client that
will not cut skin.***
One off, the skin appears mottled and may be covered with a yellowish crust composed of
accumulated body oil and dead skin. The client usually sheds this residue in a few days. Lotions
and warm baths/soaks may help to soften the skin and remove debris. May feel weak or stiff. The
limb may need support. Can wrap an elastic bandage, use cane, sling, etc until progressive active
exercise and PT help regain normal strength and motion
Assess prior to cast application to - Answer✔establish baseline. Assess after cast application
every 1-2 hours.
*What are possible complications with cast* ? - Answer✔**Impaired tissue perfusion ,by
looking at their circulation, sensation, mobility**
Elevate casted ext. so that it is higher than the heart
Repo client frequently while cast is drying so that the cast dries as evenly as possible
Circle areas where blood seeped through and write the time on the circle
Cast Guidelines - Answer✔•Petal cast edges with strips of adhesive tape to prevent chipping and
to cover any rough areas
•
•Ensure cast window is covered
•
•AMBULATE ASAP! (teach how to safely ambulate) as ordered and once dry
•
•Exercise proximal AND distal joints as indicated to prevent muscle atrophy, weakness, and loss
of joint mobility
•
•Report complications
**Keep cast clean & dry.** - Answer✔Damp cloth may be used.
Explain skin under may feel itchy... DO NOT INSERT OBJECTS.
3|Page
