Pediatric Musculoskeletal Disorders Musculoskeletal Development
Infant bones are only 65% ossified Long bones are porous and less dense and canbend, buckle or break easily Growth takes place in Epiphyseal plates, and ifthese are injured, can cause abnormal growth Growing bones heal quickly and decrease needfor treatment Clubfoot A congenital abnormality in which the foot is twistedout of its normal position. Talipes Equinovarus (Clubfoot)
How are muscles, tendons, andbones involved in this abnormality? 1. ______________ 2. _______ 3.____________________ What is the priority goal
Goal of Care Whatis the priority goal of care for the child with a clubfoot? Treatment for Clubfoot
Serial manipulation Corrective casting Splints Surgical correction Serial Casting Cast applied to hold foot in desired position.
Changed every 1-2 weeks until maximumcorrection is achieved. Nursing Care: Cast care Skin Care Education of parents What is included in a Neurovascular Assessment?
Circulation S Sensory M Motion Cast Care Assessment Unusual odor beneath the cast
Tingling, burning, numbness of toes Drainage through cast Swelling or inability to move toes Toes that are cold, blue or white Sudden unexplained fever Pain that is not relieved by comfort measures Cast Care Teaching Petaling the edges of the cast Drying of the cast
Prevention of swelling Protecting the cast When to call the doctor Try this A infant has a cast applied for treatment ofclub foot.Which of the following symptomsrequires immediate attention and should bereported to the health care provider? A. Capillary refill of 4 seconds in the affected toes. B. Edema in the affected toes that improves with elevation. C. Numbness of the toes on the affected foot. D. Skin distal to the cast is warm Splinting is used after casts are removed to maintain the correction.
Dennis Brown Splint Splinting is used after casts are removed to maintain the correction. Care of a child in a splint
Braces should fit snugly but should not interfere withneurovascular function. Before wearing the brace, check the skin for any areasof redness or breakdown. Give parents guidelines for braces. If redness develops, arrange to have the fit of thebrace evaluated and modified. Bar between legs is not a handle. Teach appropriate positioning for safety to preventfalls, and allow mobility and "tummy-time Parent Support Parents are trained and become activeparticipants in the physical therapy treatmentsand childs stretching program Nurses need to help the parents understand thetime commitment involved Assess the parents ability to monitor the childadequately for complications and confirm theyunderstand the signs and symptoms of the complications Question The parents of an infant with clubfoot ask how it is treated.Which of the followingtreatments should the nurse discuss with theparents? Weekly cast changes with manipulation Probably surgery on the affected Abduction device to keep the extremity in alignment Use of a Dennis-Browne splint to achieve correction. Hip Dysplasia The head of the femur is improperly seated in the acetabulum of the pelvis Developmental Dysplasia of Hip Clinical Manifestations
Limited abduction of the affected hip during Ortolani maneuver.May hear a click upon movement. Asymmetry of gluteal and thigh fat folds when lying with legs extended. Telescoping of thigh Limp and abnormal gait in older child Ortolani maneuver Asymmetry ofgluteal folds Treatment and Nursing care of a child with Dysplasia of the Hip:
Pavlik harness What is the purpose? How does it achievethis? Nursing Care Teach parents/caregivers toremove and apply harnessappropriately only remove forbathing and skin checks. Teach skin assessment Encourage cuddling infant topromote cognitive developmentand infant/caregiver bonding Ask Yourself ? A parent asks why the infant must wear aPavlik harness. What is the nurse's bestresponse? This treatment is to: provide comfort and support. shorten the limb on the affected side. maintain the femur within the acetabulum. provide outward displacement of thefemoral head. Treatment and Nursing care of a child with Dysplasia of the Hip:
Spica cast Covers lower half of body except perineal area Nursing Care Elimination/ protection of cast Positioning Neurovascular assessment Skin care Hygiene Fractures Causes of Fractures Increased mobility and immature motor skills
Trauma Bone diseases Manifestations of Fracture
Pain or tenderness at site Immobility or decreased ROM Deformity of extremity Edema Other signs crepitus, ecchymosis, musclespasm and inability to bear weight Repositioning of the bone fragments into normal alignment
Treatment Reduction Repositioning of thebone fragments intonormal alignment Application of a device or mechanism that maintains alignment until healing occurs Retention Retention Application of Cast Traction
Pull or force exerted on one part of the body Question Which of the following nursing interventionstakes highest priority when caring for a child inskeletal traction? Assessing bowel sounds every shift Providing adequate nutrition Assessing temperature every 4 hours Providing age-appropriate activities Complications associated with Orthopedic Trauma/ Fractures
Fat Embolism Particles of fat are carried through circulationand lodge in lung capillaries causing: Pulmonary edema Respiratory distress with hypoxemia and respiratoryacidosis Treatment Increase in IV fluids Respiratory support and adequate oxygenation Orthopedic Trauma / Fracture Complications
Compartment syndrome (very serious) Paresthesia Pain Pallor Paralysis Pulselessness Legal & Ethical implications when caring for a child with a fracture?
All fractures entering the hospital via ER require social service consult for documentation of suspected abuse or neglect. The nurse must report all suspected abuse to the appropriate authority. Do not discuss the possibility of abuse with the parents or guardians!! Do not attempt to prove or disprove abuse. Progressive degeneration of
Muscular Dystrophy Progressivedegeneration of Muscle fibers Manifestations of Muscular Dystrophy
Delayed walking (first sign) Progressive, symmetric muscle wasting Frequent falls Easily tired when walking, running, orclimbing stairs Hypertrophied calves muscle Waddling wide-based gait Uses Gowers maneuver to rise from floor Unable to walk independently by age 9 12. What diagnostic tests are used in confirming the diagnosis?
Diagnostic findings: What diagnostic tests are usedin confirming the diagnosis? Maintain ambulation and independence for as long as possible.
Goal of Care Maintain ambulation and independence for as long as possible. Nursing Care Coordinate a variety of health care services
Maintain activity and self-care functions Skin care Maintain bladder and bowel functioning Protect from respiratory infections Teach dietary modifications to decreaseobesity Question Which of the following interventions is
INAPPROPRIATE to incorporate in the care for a child with muscular dystrophy hospitalized with a respiratory infection? Physical therapy Aggressive antibiotic therapy Passive range of motion exercises Complete Bedrest Lateral S curvature of the spine
Scoliosis Lateral S curvature of the spine What are the manifestations of Scoliosis
Rib Prominenceor hump Prominent scapula lateral Uneven shoulders With uneven hips Diagnosis When does screening for this disorder occur? Braces used in Treatment of Scoliosis
Why would lead to non-compliance in wearing the brace? Quick Question: What is the priority psychosocialnursing diagnosis for theadolescent diagnosed withscoliosis? Treatment and Nursing Care for Scoliosis Spinal Fusion
Pre-operativeteaching Demonstrate incentive spirometer and C&DB Discuss all potential equipment (chest tubes, IV, O2 masks & nasal canula, Foley catheter) Teach use of pumps for PCA or epidural block. Demonstrate log rolling and assist out of bed. Nursing Care for spinal fusion
Post-operative Care Maintain airway Neurovascular Assessment of lower extremities Teach passive and active ROM exercises Encourage independence in ADLs Provide with resources / information onscoliosis support groups Post operative care of an adolescent following a
spinal fusion for scoliosis includes:(select ALL that apply) Oral analgesics for pain Logrolling every 2 hours Nasogastric intubation Bilateral Neurovascular checks of lowerextremities Use of incentive spirometer q 2 hours Assess skin on bony prominences The End