Application or Removal of Prosthetic or Orthotic Devices

Table of Contents

The school nurse, education team, and the child’s family work together to establish routines, ensure proper fit and maintenance, and address potential challenges to ensure a learner’s safe and comfortable use of orthotic or prosthetic devices at school. One of the main concerns with prosthetic or orthotic devices in skin irritation.  The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the learner’s health needs.

Orthotic Devices: A support, brace or splint used to align, prevent, or correct a function of movable parts of the body. Orthotic devices can have several textures. They may be rigid, semi-soft or soft and they may be made from various materials. Some children may wear a cranial helmet for head protection or for molding purposes, as determined by the child’ healthcare provider.

Prosthetic Devices: An addition or attachment to the body that replicates the function of a lost limb or nonfunctioning limb. Children use prosthetics for a variety of reasons, to include but not limited to: a congenital condition where the limb is absent from birth, illness, or following a trauma. 

Prosthetics typically have a protective sleeve that goes over the limb prior to placing the device. The sleeve gives some security to prevent displacement and some security to protect the skin.

Steps

  1. Follow the instructions as delegated by the school nurse that have been provided by the child’s parents from the healthcare provider
  2. Check the orthotic or prosthetic device for function or damage, report to the school nurse immediately if either are noted
  3. Ensure the student’s skin is clean and dry
  4. Explain to the student the procedure of applying or removing of the orthotic or prosthetic
  5. Wash your hands
  6. Have or help the student wash their hands
  7. Encourage the child to participate in the procedure (if developmentally appropriate and as much as possible)
  8. Encourage the student to take deep breathes or other relaxation techniques
  9. Application: Inspect the skin for any irritation, redness, blisters or open areas prior to application
    1. If observed, stop the and contact the school nurse
    2. After applying a prosthetic or orthotic device, always ask the student if wearing the orthotic or prosthesis is comfortable
  10. Removal: Inspect the skin for any irritation, redness, blisters or open areas after removal
    1. If observed, contact the school nurse
    2. After removing a prosthetic or orthotic device, always ask the student if they are comfortable
  11. Have or help the student wash their hands
  12. Wash your hands
  13. Document the date, time, observation of the skin after removal of the device, any communication with the delegating school nurse, the student’s response, your initials and signature.

Remember: Even if an orthotic or prosthetic device is properly fitted, a learner may experience frustration at having to wear the device. Sometimes the learner may be required to wear their device for an extended period of time.