For cast removal, which of the following instructions should the nurse provide to the patient?
a. Discomfort will be felt from the cast saw.
b. An enzyme wash may be applied to intact skin.
c. The skin will be scrubbed very well after the removal.
d. Aggressive range-of-motion exercises will be performed after removal.
B
If the skin is intact, gently apply a cold water enzyme wash to the skin; let it stay on the skin 15 to 20 minutes. This helps dissolve or emulsify dead cells and fatty deposits on tissues and prevents injury to delicate tissue. A cast saw vibrates the cast loose; the patient will feel heat and vibration. Do not scrub the skin because this may traumatize delicate tissue and lead to skin breakdown. It may take several days before all residue is removed from the skin. Obtain a physician's order to gently put joints through active and passive ROJM. Clarify the level of activity allowed. Joints and muscles will be stiff and weak. Activity is resumed slowly to avoid reinjury.
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