Orthopedic and trauma patients have a high risk of neurovascular complications.
Neurovascular assessments are performed on patients to assess for adequate nerve function and blood circulation to the parts of the body. These assessments are often performed when a patient has suffered an injury or trauma, require a cast or have a restrictive bandage in place. Nurses are often responsible for performing assessments in order to detect signs and symptoms of potential complications. Neurovascular assessments consist of five different checkpoints, which guide medical personnel when assessing circulatory and nerve function.
Instructions
1. Ask the patient if he is experiencing any pain. Note the location, radiation and severity of pain as well as anything that seems to relieve or worsen the pain. Ask the patient to rate his pain on a scale of one to ten with one being no pain at all and ten being the worst pain ever.
2. Monitor for signs and symptoms of compartment syndrome. Compartment syndrome is the buildup of unrelieved pressure in a limb that results in irreversible tissue damage, loss of sensation, infection and amputation. Complaints of severe pain, aggravated by movement and unrelieved by medication, are often the first signs of compartment syndrome and should be reported to the physician immediately.
3. Check capillary refill time by pressing on the tips of fingernails and toenails to ensure proper blood flow. The tissues will turn a pale color while you apply pressure to the area, but digits should return to a normal pink color within three seconds of pressure withdrawal. Assess for color and temperature changes above and below the injured area, which may indicate insufficient blood flow.
4. Assess for weakness or paralysis in the injured limb. Lead the patient through range-of-motion exercises and note any deficits in movement or strength in the injured extremity. Monitor for severe pain and muscle spasms during movement. This may indicate the patient may have tendon or nerve damage.
5. Ask the patient if she is experiencing any changes in sensation, such as numbness or tingling in the extremity. Check for loss of sensation by touching above and below the injured area, then watch for verbal or nonverbal reactions to the stimuli. Document and report any loss of sensation or absence of sensation in the affected area.
6. Check for pulses in the wrists and feet while noting the rate and quality of blood flow in each extremity. Use the pads of your index and middle fingertips to gently press on the pulse to obtain an accurate reading. Check for a decrease or absence of pulse, which indicates reduced blood flow to the area.
7. Compare findings on both sides of the body, as well as above and below the injured area. Changes and inconsistencies are a good indication of reduced blood flow or nerve damage, which should be reported to the physician. If possible, compare your findings to baseline results obtained before the injury for a more accurate neurovascular assessment.
Tags: blood flow, above below, above below injured, below injured, below injured area, injured area, loss sensation
