A client arrives at the clinic for a follow-up after an emergency department visit the night before. The client sustained an ulnar fracture, and a fiberglass cast was applied. Which of the following teachings related to cast care should the nurse reinforce? Select all that apply.

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Casts (eg, fiberglass, plaster) are applied to immobilize fractured extremities during healing. Instructions for cast care include: Report foul odors or hot areas (hot spots) in the cast, which may indicate infection (Option A). Avoid getting the cast wet, which may damage the cast and cause skin irritation/infection (Option B). Elevate the affected extremity above heart level for the first 48 hours to reduce edema (Option C). Regularly perform isometric and range of motion exercises to prevent muscle atrophy. (Option D) The client should also be instructed to contact the health care provider about symptoms of impaired circulation in the affected extremity, including numbness or tingling, pallor, coolness, loss of pulse distal to the cast, or pain that is unrelieved by ice, elevation, and pain medication. Swelling within the cast may result in compartment syndrome, a condition that involves limb-threatening tissue ischemia due to compression of blood vessels and nerves within the extremity's internal compartments. (Option E) The client should never insert objects inside the cast due to the risk of tissue injury and infection. Directing air inside the cast with a hair dryer on the cool setting may help relieve itching. Educational objective: Cast care instructions include reporting foul odors or hot areas in the cast; preventing the cast from getting wet; elevating the affected extremity above heart level for the first 48 hours; regularly exercising the affected extremity; and reporting symptoms of impaired circulation (eg, numbness, tingling, pallor, coolness). Clients should never insert objects inside the cast.

A Client Arrives at the Clinic for a Follow-Up After