Neurovascular observation group assessmentscript PDF

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Neurovascular observation is the assessment of peripheral integrity and circulation. In other word, it is combined assessment of both peripheral neurological and peripheral vascular condition of the patient. (lewis medical surgical). Generally, neurovascular assessment is done on patient after musculoskeletal injuries. Moreover, after the use of constrictive bandage or cast, orthopaedic surgery and spinal injury, patient requires neurovascular observation. This assessment includes:

Peripheral neurological assessment patient may report loss of sensation, decreased sensation, numbness, tingling and needles and pins which may be late signs of neurovascular deterioration. The abnormal sensation should be documented on the neurovascular chart and medical team must be notified (rch). Furthermore, it is important to assess the active movement which means voluntarily stretch and flex limb or extremities, and the passive movement. Also, comparison of both unaffected and injured extremities is required. The assessor should also compare the movement to the baseline observation and pain while moving (RCH). Pain assessment is another major component of neurovascular observation. Appropriate pain assessment must be done including location, quality and severity of pain RCH). If pain is getting worst or unmanaged pain after administration of analgesics is occurred, the patient is at increased risk of compartment syndrome (lewis).

Peripheral vascular assessment Colour of the extremities represents the arterial and venous blood supply to those areas. If the colour is pale, cyanotic or dusky, there is lack of blood supply. Moreover, the temperature of the both limb should be assessed and compared. Cold extremities are because of the poor arterial blood supply and hot extremities could be sign of neurovascular compromise. The degree of swelling should also be assessed. Excessive swelling is the sign of compartment syndrome (RCH). Capillary refill must be observed by pressing on the digits for about 5 seconds. The normal time to get back into the original form is normally less than 3 seconds (gosh. nhs. uk). Ensure there is presence of pulse on foot or hand carefully. Check for the strength of pulse distal to the injured part. (RCH).

Why it is important to do neurovascular assessment in matt’s case? Generally, neurological assessment is carried out on patient who had musculoskeletal injury. As matt had accident from the quad bike and had fractured tibia and fibula. At the time of the admission to the emergency department, it is important to do the neurovascular observation on him to establish a baseline which should include the assessment of the both fractured and unaffected limb. Also, to recognise the possible signs and symptoms of compartment syndrome it should be done. Compartment syndrome is a condition in which the pressure between the muscle compartment increases hence decline in the capacity of compartment, which eventually raises the volume of fluid between the interstitial space. That results the necrosis of the muscle tissue and significant harm to the nerve cells ( https://www-uptodate-com.ezproxy1.acu.edu.au/contents/acute-compartmentsyndrome-of-the-extremities?search=compartment %20syndrome&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 ). They have also suggested that patient aged below 35 years are more prone to development of

compartment syndrome followed by traumatic injury. This can lead to prominent damage to the limb, severe pain and ultimately ended up with amputation of the leg. Therefore, the thorough neurovascular assessment is very important in matt’s case for the early recognition of the compartment syndrome and prevention from the potential harm. (lewis)if any abnormal signs appears, the medical team should be notified and surgical treatment is needed.(up to date).

References

1. Zsiros, D. , Wollon, M. , & Hopper, BA. (2015) . Nursing management : musculoskeletal trauma and orthopaedic surgery. In D. Brown, H. Edwards, L. Seaton & T. Buckley (Eds.), Lewis’s medical-surgical nursing (pp 1566-1604). Elsevier Australia. Retrieved from https://www-clinicalkey-com-au.ezproxy2.acu.edu.au/nursing/#!/content/book/3-s2.0B978072954177050066X 2. The royal children’s hospital Melbourne. (2015). Neurovascular observations. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neurovascular_observatio ns/#Aim 3. Great Ormond street hospital for children. (2017). Neurovascular observations. Retrieved from https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/neurovascularobservations 4....