Appropriate care related to a new plaster cast for correction of clubfoot in the newborn is to:
a. keep the newborn snugly wrapped until the cast is dry to prevent hypothermia.
b. sprinkle powder into the dry cast to reduce skin irritation at the edges of the cast.
c. position with the feet lower than the level of the heart until the cast is dry.
d. observe the toes for pallor, cyanosis, reduced capillary refill, or cold temperature.
The correct answer and explanation is:
The correct answer is:
d. observe the toes for pallor, cyanosis, reduced capillary refill, or cold temperature.
Explanation:
When a newborn has a plaster cast for correction of clubfoot, proper care is crucial to avoid complications like impaired circulation, skin irritation, or other issues.
Why option d is correct:
- Circulation monitoring is vital. After applying a plaster cast, the cast can sometimes be too tight, which may impair blood flow to the extremities. Checking the toes regularly for signs such as pallor (paleness), cyanosis (bluish discoloration), reduced capillary refill (slow return of color after pressing), or cold temperature is essential. These signs indicate poor circulation or possible nerve compression and require immediate attention to prevent tissue damage or necrosis.
- Early detection of circulation problems can prevent serious complications such as ischemia or compartment syndrome.
Why the other options are incorrect:
- a. Keep the newborn snugly wrapped until the cast is dry to prevent hypothermia.
Wrapping the newborn tightly to keep the cast dry is not recommended because it can cause pressure on the cast, potentially reducing circulation. The newborn should be kept warm but without constriction on the cast. The cast should be allowed to dry in a way that doesn’t compromise blood flow. - b. Sprinkle powder into the dry cast to reduce skin irritation at the edges of the cast.
This is not advised because powder can create an environment for infection and may irritate the skin further. Instead, proper padding should be used under the cast, and edges can be smoothed or padded to prevent irritation. - c. Position with the feet lower than the level of the heart until the cast is dry.
Elevating the foot slightly above heart level is generally recommended to reduce swelling and improve venous return. Positioning the feet lower than the heart can increase swelling and discomfort.
Summary:
Newborns with a plaster cast for clubfoot correction need careful monitoring, especially of circulation to the toes. Observing for pallor, cyanosis, cold toes, or delayed capillary refill is critical to ensure the cast is not too tight and circulation is maintained. Proper positioning and care help prevent complications while the cast sets and the correction process progresses.