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Orthopaedic Essentials
The outcome of an injured extremity is affected primarily by initial assessment and immediate treatment of the extremity. Delaying the recognition of neurovascular compromise can cause the amputation of an extremity, or even the death of the patient. However, having the foundation of knowledge regarding total neurovascular function can equip the nurse with accurate assessment skills and the knowledge of the need for immediate action. This essential orthopaedic knowledge is used daily by the orthopaedic nurse to provide the best patient care possible with the best possible outcome.
Many orthopaedic patients have conditions that involve impairment or injury to one or more extremities. The condition of the extremity should be monitored on a continual basis until stability of the extremity is attained and maintained. If there is a decrease in neurovascular function to the extremity, immediate intervention must take place to prevent permanent damage.
After an injury or damage to an extremity, the unaffected side should be evaluated first, and those findings should be the baseline for the assessment of the affected side. On the injured extremity, the findings distal to the injury should be compared to the findings proximal to the site of the injury.
The initial assessments of the affected extremity involve performing the following assessments and comparing them to the opposite extremity:
1. Assess the presence of peripheral pulses at the pulse points of the brachial, radial, ulnar, femoral, popliteal, or posterior tibialis nerve. Pulselessness is an unreliable sign. Arterial flow may continue, but blood supply to the compartment is compromised.
2. Assess the color of the distal extremity. A pale or white skin color may indicate inadequate arterial supply...