# Situation: A 24-year-old man sustained a closed fracture of the left tibia and fibula in a motorcycle crash. After closed reduction, a long-leg plaster cast was applied in the emergency department 1 hour ago, and he is transferred to the orthopedic ward. He has no other injuries and no known drug allergies. On arrival the cast is still damp. Which action by the nurse is appropriate while moving the leg onto the bed?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630331  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 24-year-old man sustained a closed fracture of the left tibia and fibula in a motorcycle crash. After closed reduction, a long-leg plaster cast was applied in the emergency department 1 hour ago, and he is transferred to the orthopedic ward. He has no other injuries and no known drug allergies.

On arrival the cast is still damp. Which action by the nurse is appropriate while moving the leg onto the bed?

## 보기

1. Cover the cast with a blanket so the leg stays warm
2. Place a heat lamp over the cast to speed up drying
3. Set the cast directly on the firm mattress to keep it flat
4. Handle the cast with the palms and rest it on pillows **✔ 정답**

**정답: 4**

## 해설

Wet plaster dents easily; fingertip pressure or a hard surface leaves indentations that press on the skin underneath. The nurse lifts the cast with the palms, supports it along its length on pillows, and leaves it uncovered so it can dry over 24–72 hours.

## 심화 해설

Why the cast must be handled with palms and supported on pillows

A freshly applied plaster cast is not simply “wet on the outside.” The entire thickness of the plaster remains saturated with water immediately after application, and the material undergoes an exothermic setting reaction before it hardens. During this phase, plaster of Paris is highly moldable and conformable, which is precisely why it remains the preferred material when superior contouring is needed [1]. However, that same plasticity means the cast can be permanently deformed by concentrated pressure.

Fingertip pressure on a damp cast creates indentations that remain after the plaster hardens, and those inward bumps press directly against the skin beneath the cast. This can lead to localized pressure injury, impaired circulation, and skin breakdown. Using the palms of both hands distributes the force over a broad, flat surface and minimizes the risk of denting. The same principle applies to the resting surface: a firm mattress or any hard edge creates a pressure point along the cast. Pillows provide continuous, even support along the entire length of the cast and prevent flattening of the plaster against a rigid surface.

Watch out! Covering the cast with a blanket traps moisture and slows evaporation. A heat lamp is contraindicated because plaster dries from the outside inward, and external heat can cause the outer layer to set while the inner layer remains wet, leading to uneven hardening and a burn risk to the skin underneath.

Key point! The cast should be left uncovered and exposed to room air. Full drying of a plaster cast generally requires 24 to 72 hours, depending on thickness, ambient temperature, and humidity. Until that time, the cast must be treated as a vulnerable, shapeable structure.

| Action | Effect on damp plaster cast | Appropriate? |
| --- | --- | --- |
| Cover with blanket | Traps moisture, delays drying, may cause uneven setting | No |
| Heat lamp | Outer layer dries faster than inner layer; burn risk | No |
| Firm mattress directly | Creates hard pressure point, flattens cast contour | No |
| Palms and pillows | Distributes pressure evenly, supports natural contour, allows air circulation | Yes |

The nurse’s immediate priority during transfer is to preserve the structural integrity of the cast so that it continues to provide the intended immobilization without compromising the underlying skin. Even though synthetic casting materials now dominate many settings, plaster remains the mainstay when superior moldability and conformability are required, such as after closed reduction of a tibia–fibula fracture [1]. That same property demands careful handling during the entire drying period.References (research sources)

- [1]Cast changes: synthetic versus plaster.Research articleAdkins LM (1997)

## 임상 시나리오

Fresh Plaster Cast HandlingSafe positioning and drying principles
A damp plaster cast remains moldable and dents easily under concentrated pressure. Lift and move the cast using the palms of both hands to distribute force evenly, never with fingertips.

Rest the cast on pillows that provide continuous support along its entire length. This prevents flattening or indentation from a hard surface such as a firm mattress.

Leave the cast uncovered and allow it to dry by evaporation over 24-72 hours. Plaster dries from the outside inward.

CautionDo not cover the cast with a blanket, as trapped moisture slows drying. Do not apply a heat lamp, which can cause uneven hardening and burn the skin.

## 핵심 개념

- **Plaster of Paris** — A moldable casting material that undergoes an exothermic setting reaction and remains plastic until fully dried.
- **Pressure injury** — Localized damage to skin and underlying tissue caused by sustained pressure, which can result from cast indentations.
- **Exothermic reaction** — A chemical reaction that releases heat, occurring as plaster sets and hardens.
- **Neurovascular assessment** — Evaluation of circulation, sensation, and motor function distal to a cast or injury.
- **Cast drying** — Plaster casts dry by evaporation from the outside inward over 24-72 hours when left uncovered.

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