Transcript Orthopedic Assessment

Orthopedic Assessment
Jan Bazner-Chandler
CPNP, CNS, MSN, RN
Musculoskeletal Differences in Children
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Epiphyseal growth plate present
Bones are growing / heal faster
Bones are more pliable
Periosteum thicker and more active
Abundant blood supply to the bone
The younger the child the faster the healing.
Focused Physical Assessment
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Inspect child undressed
Observe child walking
Spinal alignment
ROM
Muscle strength
Reflexes
Assessment
Concerns:
 Pain or tenderness
 Muscle spasm
 Masses
 Soft tissue swelling
CoREminder
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If an injury has occurred, examine that area last and be
gentle when palpating the injury site.
Nursing Alert
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A child younger than 1 year who presents with a fracture
should be evaluated for possible physical abuse or an
underlying musculoskeletal disorder that would cause
spontaneous bone injury.
Neurovascular Assessment
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Circulation
Nerve function
Neurovascular Assessment
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Sensation
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Motion
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Can the child feel touch on the affected extremity
Can the child move fingers or toes below area of injury / nerve
injury
Temperature
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Is the extremity warm or cool to touch
Neurovascular Assessment
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Capillary refill
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Color
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Sluggish capillary refill may signal poor circulation
Note color of extremity and compare with unaffected limb
Pulses
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Assess distal to injury or cast
Neurovascular Impairment
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Restriction of circulation and nerve function from injury
or immobilizing device.
Clinical Manifestations
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Increased pain
Edema
Decreased movement or sensation
Diminished or absent pulses distal to injury
Patient often described as restless – pain medication does
not work – pain described as deep
Interventions
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Assess area distal to injury, surgical site, cast, splint, or
traction
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Notify physician
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Release pressure by splitting the cast or loosening
restrictive bandage per physician order.
Compartment Syndrome
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A painful condition that results when pressure within the
muscles builds to dangerous levels. This prevents
nourishment from reaching nerve and muscle cells.
Muscle groups in legs, arms, hands, feet and buttocks can
be affected.
Clinical Manifestations
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The classic sign of acute compartment syndrome is pain,
especially when the muscle is stretched.
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There may also be a tingling or burning sensation
(paresthesias) in the muscle.
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A child may report that the foot / hand is “a sleep”
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If the area becomes numb or paralysis sets in, cell death has
begun and efforts to lower the pressure in the
compartment may not be successful in restoring function.
Physical Assessment
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Assess pain and if pain medication is working.
The muscle may feel tight or full.
Measure the affected muscle group and compare
with the unaffected side.
Check pulses below area of injury
Treatment
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Prevention!!!!
Don’t elevate the affected limb above or below the level
of the heart.
Dressings should be removed or loosened if CS is
suspected.
Current standards: a split is applied for the first 48 hours
until swelling from injury / surgery has gone down.
Surgical Management
Siumed.edu
Fasciotomy to relieve pressure. The fascia is divided along
the length of the compartment to release pressure within.
Nerve Assessment
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Important to do on admission from ER or to the unit and
pre and post surgical procedure
Radius and ulna nerve assessment
Ulnar Nerve Injury
Medial Nerve Injury
Radial Nerve Injury
Peroneal Nerve Distribution