Nursing Clinical Practice Guide
Clinical Scenario: You are a nurse in the newborn nursery. During your routine assessment of Baby Girl Rodriguez, born at 39 weeks via breech delivery, you note her left thigh fold appears higher than the right when she is prone. You perform a focused hip assessment.
Nursing Intervention Strategy:
1. Assessment: Place the infant supine on a firm surface. Flex the hips and knees to 90 degrees. Perform the Barlow maneuver first (adduct the hip and apply gentle downward pressure) to check for instability/dislocation. Then perform the Ortolani maneuver (abduct the hip while lifting the femur) to check for reducibility. Listen and feel for a "clunk," not a soft click.
2. Action: If either maneuver is positive (clunk), this is NOT a "wait and see" situation. You must immediately notify the pediatrician or pediatric orthopedist. Document the exact finding: "Positive Ortolani sign with palpable clunk on left hip."
3. Education & Preparation: If a Pavlik harness is prescribed, your role shifts to parent education. Teach them: how to properly position the infant in the harness, the importance of 23-hour/day wear, how to check skin under straps for redness/breakdown, that only the provider adjusts the straps, and to dress the baby in a onesie under the harness to protect the skin.
Patient Safety and Precautions:
* Perform hip exams gently. Forcing movement can damage the hip.
* The harness must be correctly applied. Improper application can cause avascular necrosis (AVN) of the femoral head by putting pressure on blood vessels.
* Never place a diaper under the harness straps, as this changes the corrective angle.
Nursing Procedure & Medication Flow
Procedure: Performing the Ortolani and Barlow Maneuvers
1. Explain the procedure to parents.
2. Ensure the infant is calm, supine, on a firm surface.
3. Flex the infant's hips and knees to 90 degrees.
4. Barlow (Test for Dislocation): Stabilize the pelvis with one hand. With the other hand, adduct the hip (bring thigh toward midline) and apply gentle posterior (downward) pressure. A "clunk" means the hip dislocates.
5. Ortolani (Test for Reduction): From the adducted position, abduct the hip (lift thigh out to the side) while applying gentle anterior (upward) pressure. A "clunk" means a dislocated hip reduces into the socket.
6. Document findings clearly and report abnormalities immediately.
A Word from Your Senior Nurse
"Newborn assessments are where we nurses are the first line of defense for a child's future mobility. That 'clunk' you feel during an Ortolani isn't just a finding in a textbook—it's the sound of a hip that's out of place, and your quick recognition and action are what will get that baby into a harness and on the path to a normal, active childhood. In clinicals and on the NCLEX, think of the 'clunk' as a red-alert siren. Everything else (asymmetric folds, limited motion) is a yellow caution light telling you to look harder. Trust your assessment skills!"