The nurse is caring for a female client with scoliosis who had a posterior spinal fusion and is in a body jacket cast. Which assessment finding indicates to the nurse the client is developing cast syndrome?

• A. Abdominal distention.
• B. "Hot spot" felt on cast.
• C. Diminished pulses in the foot.
• D. Musty, unpleasant odor to cast.

Answer: (D)

Cast syndrome is a gastrointestinal complication that can occur when a body cast or extensive spinal immobilization exerts pressure on abdominal structures, leading to partial obstruction of the duodenum and resulting in gas and fluid buildup in the intestines. The most telling sign is abdominal distention, which reflects this obstruction and its impact on digestion and gastric emptying. Nausea and vomiting may accompany the distention as the bowel becomes less able to move contents forward.

In contrast, a localized hot spot on the cast points to skin irritation or a potential pressure sore under the cast. Diminished pulses in the foot would raise concern for vascular compromise or an overly tight cast, but not cast syndrome itself. A musty, unpleasant odor from the cast would suggest cast contamination or skin infection rather than a GI obstruction from the cast.

Thus abdominal distention best indicates cast syndrome and should lead to prompt assessment of cast fit and GI function.