The neurovascular check is the single most repeated assessment in orthopaedic nursing, and it only saves a limb if you know which of the six Ps still buys you time and which one means the tissue is already dying. Sort the six Ps against the four-to-six hour ischaemia clock, then build a note the next nurse can actually compare against — and finish by choosing the right study for seven questions where the obvious test is the wrong one.
Bed 12 · day one after a tibial nailYou are doing the hourly circulation, motion and sensation check. Each of the six Ps below is a real thing you do with your hands. Decide whether the finding is one that still leaves you time to act, or one that tells you damage is already under way.
Finding
Write the 0900 neurovascular noteSame patient, right leg. Tick every element that belongs in the note. Watch the right-hand panel assemble your entry as you go — and notice what happens to the score when you reach for a comfortable adjective instead of a finding.
Elements available
Which study, and what happens next?
The ischaemia clock
Early — act on these
Nothing sorted yet.
Late — damage under way
Nothing sorted yet.
Compartment pressures. Normal is 0 to 8 mmHg. An absolute pressure above about 30 mmHg, or a delta pressure (diastolic blood pressure minus compartment pressure) below 30 mmHg, indicates fasciotomy.
Your 0900 entry
Tick elements on the left and the note builds here.
0 of 8 elementsadjective, not a finding
Why this study
Pick a question on the leftSeven orthopaedic questions where the intuitive test is the wrong one. Choose, and the reasoning lands here.
0 correct of 7
Reference ranges from this chapter. ESR roughly under 20 mm/h in men and under 30 mm/h in women. CRP under 1.0 mg/dL (10 mg/L). Synovial fluid WBC under 200/mm³ normal, 2,000–50,000/mm³ inflammatory, over 50,000/mm³ with high neutrophils suggests septic arthritis. CK 30–170 U/L; over 5,000 U/L after crush suggests rhabdomyolysis. DEXA T-score above −1.0 normal, −1.0 to −2.5 low bone mass, −2.5 or lower osteoporosis.