over the side, flexed at the knee. Instruct the patient to hold the affected leg, with the ankle in a neutral position (90°). Make sure that the foot is not rotated medially or laterally. Beginning at the toes, apply webril (figs. 5-5A, 5-5B, and 5-5C) in the same manner as for the short-arm cast, ensuring that there are no lumps or wrinkles. Apply the plaster beginning at the toes (fig. 5-5 E), using the same technique of tucks and folds and smoothing as for the short-arm cast. Before applying the last layer, expose the toes and fold back the webril. As the final step, apply a footplate to the plantar surface of the cast using a generous thickness of plaster splints secured with one to two rolls of plaster (fig. 5-5F). This area provides support to the cast and a weight-bearing surface when used with a walking boot.
Whenever a cast is applied, you must provide the patient with written and verbal instruction for cast care and circulation checks, i.e., numbness, cyanosis, tingling of extremities, and instruct him or her to return immediately should any of these conditions occur. When a leg cast is applied, the patient must also receive instructions in the proper usage of crutches. The cast will take 24 to 48 hours to completely dry and must be treated gently during this time. Since plaster is water-soluble, the cast must be protected with a waterproof covering when bathing or during wet weather. Nothing must be stuck down the cast, i.e., coat hangers, as this can cause bunching of the padding and result in pressure sores. If swelling occurs, the cast may be split and wrapped with an ace bandage to alleviate pressure.
A cast can be removed in two ways: by soaking in warm vinegar/water solution until it dissolves or in the usual way by cutting. To remove by cutting, cast cutters, spreaders, and bandage scissors are necessary. Cuts are made laterally and medially along the long axis of the cast and are widened with the use of spreaders. The padding is then cut with the scissors.
The terminal patient has many needs that are basically the same as those of other patients: spiritual, psychological, cultural, economic, and physical. What differs in these patients may be best expressed as the urgency to resolve the majority of these needs within a limited time frame. Death comes to everyone in different ways and at different times. For some patients, death is sudden following an acute illness. For others, death follows a lengthy illness. Death not only affects the individual patient; it affects family and friends, staff, and even other patients. Because of this, it is essential that all health care providers understand the process of dying and its effect on all people.
People view death from their individual and cultural value perspectives.
An individuals personal perception of death often affects their moral and religious attitude toward it. Many people find the courage and strength to face death through their religious beliefs. These patients and their families often seek support from representatives of their religious faith. In many cases, patients who previously could not identify with a religious belief or the Supreme Being concept may indicate (verbally or nonverbally) a desire to talk with a spiritual representative. There will also be patients who throughout the whole dying experience will neither desire nor need spiritual support and assistance. In all these cases, it is the responsibility of the health care provider to be attentive and perceptive to the patients needs and provide whatever support personnel that may be required. An individuals cultural system influences behavior patterns. When we speak of cultural systems, we refer to certain norms, values, and action patterns of specific groups of people to various aspects of life. Dying is an aspect of life and is often referred to as the final crisis of living. In all of our actions, culturally approved roles frequently encourage specific behavior responses. For example, in the Caucasian, Anglo-European culture a dying patient is expected to show peaceful acceptance of his/her prognosis; the bereaved is expected to communicate grief. When people behave differently, the health care provider frequently has difficulty responding appropriately.
Within the last 10 years or so, a theory of death and dying has developed that provides all persons involved with the experience highly meaningful knowledge and skills. In this theory of death and dying (as formulated by Dr. Elizabeth Kubler-Ross in her book On Death and Dying), it is suggested that most people (both patients and significant others) go through five stages: denial, anger, bargaining, depression, and acceptance. The first stage, denial, is one of nonacceptance. No, it cant be me, there must be a mistake! It is not only important for the health care provider to recognize the denial stage with its behavior responses but also to realize that some