A 2-week-old infant presents with asymmetric hip clicks and a positive Ortolani test, indicating developmental dysplasia of the hip (DDH). As a nursing officer, what is the next appropriate intervention?

Appeared in: NORCERT 8 Mains-2025

Explanation

A positive Ortolani test is a key clinical sign of a dislocated but reducible hip in an infant, confirming Developmental Dysplasia of the Hip (DDH).
The standard of care requires immediate evaluation by a specialist to confirm the diagnosis (typically with ultrasound) and initiate treatment.
The nurse's primary professional responsibility is to recognize this significant abnormal finding and facilitate a prompt referral to a pediatric orthopedic surgeon.
Early diagnosis and intervention are critical to ensure normal hip development and prevent long-term complications such as chronic pain, limp, and arthritis.

Option A: This provides false reassurance and constitutes unsafe practice. A positive Ortolani test indicates a hip dislocation that requires active treatment.
Option B: This action is premature. The Pavlik harness is a prescribed medical device. Education should only occur after a specialist has diagnosed the condition and ordered the harness.
Option C: Surgery is not the first-line treatment for DDH in a 2-week-old infant. It is reserved for older children (typically over 6 months) or when conservative methods fail.

Visual 1: Diagram: Illustration of the Ortolani and Barlow maneuvers to help differentiate between a dislocatable (Barlow) and a dislocated but reducible (Ortolani) hip.
Visual 2: Image: An infant correctly fitted in a Pavlik harness, showing the hips held in flexion and abduction.
Visual 3: Ultrasound Image: Comparison of a normal infant hip versus a hip with DDH, showing the femoral head outside the acetabulum.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management of Developmental Dysplasia of the Hip (DDH) in a newborn to guide bedside assessment, documentation, and the next nursing action.
Early detection and referral for DDH are crucial nursing responsibilities. Delays in treatment can lead to the need for more invasive surgeries and increase the risk of long-term complications like avascular necrosis, chronic pain, and premature arthritis.
A key patient safety aspect is distinguishing between a benign, soft 'hip click' and the definitive 'clunk' of an Ortolani sign, which mandates referral.
What if the infant was 7 months old? The answer would still be referral, but the likely treatment would change. A Pavlik harness is less effective after 6 months, so the specialist would likely consider a closed reduction under anesthesia followed by a spica cast.

How to Approach the Question

First, identify the key information provided in the clinical scenario: a 2-week-old infant with a positive Ortolani test.
Recognize that a positive Ortolani test is a significant and abnormal finding, indicating a dislocated hip that requires medical intervention.
Consider the scope of practice for a nursing officer. The role involves assessment, identification of abnormalities, and referral to a specialist, not prescribing specific treatments or making definitive prognoses.
Evaluate each option based on the nurse's role and the clinical urgency. Informing the parent it will resolve, educating on a specific device without a prescription, or assuring about surgery are all outside the immediate scope or are premature.
Conclude that the only appropriate and safe next step is to facilitate specialist care by referring the infant to a pediatric orthopedic surgeon.

Concept Tested & Keywords

Concept Tested: Nursing management of Developmental Dysplasia of the Hip (DDH) in a newborn.
Stem keywords: 2-week-old infant, asymmetric hip clicks, positive Ortolani test, developmental dysplasia of the hip (DDH), nursing officer
Lead-in keywords: next appropriate intervention
Clinical cues: Positive Ortolani test: Indicates a dislocated but reducible hip, a definitive sign requiring specialist intervention.
Negative lead-in flag: false

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