Newborn held skin-to-skin with client who is breastfeeding for 1 hr and breastfed vigorously for 30 minutes. Large ecchymotic caput succedaneum noted on occiput with molding of the skull. Anterior fontanel level and soft. Respirations shallow and irregular. Crepitus palpated over left clavicle. Skin color consistent with infant's genetic background. Acrocyanosis noted. Active and moves all extremities except for left arm. Limited spontaneous movement of the left arm noted. Wrist unflexed. Left arm remains at side during Moro reflex. Palmar grasp reflex equal bilaterally. For each assessment finding, click to specify if the findings is consistent with a clavicle fracture or Erb-Duchenne paralysis. Clavicle: birth history, crepitus, decreased movement, absent moro reflex, palmar grasp reflex present
Answer (2)
The assessment findings indicate that crepitus over the left clavicle points to a clavicle fracture, while the absent Moro reflex in the left arm suggests Erb-Duchenne paralysis. Decreased movement of the left arm relates to both conditions. The palmar grasp reflex being equal bilaterally leans more towards a clavicle fracture diagnosis.
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Assessment Findings
Let's break down the assessment findings and determine if they are consistent with a clavicle fracture or Erb-Duchenne paralysis:
Crepitus over left clavicle : Consistent with Clavicle Fracture
Decreased movement of left arm : Consistent with both Clavicle Fracture and Erb-Duchenne Paralysis
Absent Moro reflex in left arm : Consistent with Erb-Duchenne Paralysis
Palmar grasp reflex present and equal bilaterally : More consistent with Clavicle Fracture (as Erb-Duchenne paralysis might affect grasp reflex)
Conclusion
Based on the assessment findings:
Clavicle Fracture is likely due to crepitus over the left clavicle and decreased movement of the left arm.
Erb-Duchenne Paralysis is also a possibility, given the decreased movement of the left arm and absent Moro reflex in the left arm.
The presence of crepitus strongly suggests a clavicle fracture, while the absent Moro reflex in the left arm is more indicative of Erb-Duchenne paralysis. Both conditions could be related, as a clavicle fracture can sometimes be associated with brachial plexus injury leading to Erb's palsy. Further evaluation and possibly imaging would be needed to confirm the diagnosis. ;
