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Tales Equinovarus
Tales equinovarus or
Club foot
Obvious deformity notedat birth.
Surgical correction
Bowden & Greenberg
Tales Equinovarus Club Foot 1 to 2 per 1000 Males more affected Involves both the bony structures
and soft tissue. The entire foot is pointing
downward.
Interventions
Manipulation and serial casting immediately
Surgery is performed between 4 to 12 months if full correction is not achieved with casting
Nursing Diagnosis Impaired physical mobility related to
cast wear Altered parenting related to emotional
reaction following birth of child with physical defect
Risk for impaired skin integrity related to cast wear.
Knowledge deficit: cast care and home care
Metatarsus Adductus Most common foot deformity 2 per 1000 Result of intrauterine positioning Forefoot is abducted and in varus,
giving the foot a kidney bean shape.
Metatarsus Adductus
Bowden & Greenberg
Turning in of foot
Treatment:
Passive manipulation
Soft shoes at night
Serial casts
Dysplasia of the Hip Abnormality in the development of
the proximal femur, acetabulum, or both.
Girls affected 6:1 Familial history Breech presentation Maternal hormones Other ortho anomalies
Congenital Hip Dislocation
Asymmetry of the gluteal
and thigh fat fold is a
sign of dysplasia of the Hip
Ball & Bindler
Clinical Manifestations Head of femur lies outside the
acetabulum
+ Ortolani maneuver
Asymmetrical lower extremity skin folds
Discrepancy in limb length
Pavlik Harness
Maintain hips in flexed position
Pavlik harness
Traction to stretch muscles
Hip surgery
Bowden & Greenberg
Nursing Diagnosis Knowledge deficit Impaired physical mobility Risk for impaired skin integrity
related to pressure from casts or braces
Altered skin perfusion due to casts or braces
Risk for altered growth and development due to limited mobility
Osteogenesis Imperfecta Genetic disorder Caused by a genetic defect that affects
the body’s production of collagen Collagen is the major protein of the
body’s connective tissue Less than normal or poor collagen
leads to weak bones that fracture easy
Osteogenesis Imperfecta Often called “brittle bone disease” Characteristics
Demineralization, cortical thinning Multiple fractures with pseudoarthrosis Exuberant callus formation Blue sclera Wide sutures Pre-senile deafness
Genetic Defect Type I: autosomal dominant: age
at presentation 2 – 6 years. Common age for child abuse. Often present as suspected child
abuse
Nursing Diagnosis Risk of injury related to disease
process Risk for altered growth and
development Knowledge deficit: disease process
and care of child
CaReminder Signs of a fracture, especially in an
infant, are important items to teach caregivers. In a baby, these signs are general symptoms, such as fever, irritability, and refusal to eat.
Bowden, 1998
Cerebral Palsy Group of disorders of movement
and posture Prenatal causes = 44% Labor and delivery = 19% Perinatal = 8% Childhood = 5%
Assessment Developmental surveillance is key Diagnoses often made when child
is 6 to 12 months of age Physical exam:
Range of motion Evaluation of muscle strength and
tone Presence of abnormal movement or
contractures
caReminder Reflexes that persist beyond the
expected age of disappearance (e.g., tonic neck reflex) or absence of expected reflexes are highly suggestive of CP.
Bowden, 1998
Cerebral Palsy
Mental retardation
Language disorders
Learning disabilities
Visual disturbances
Hearing disorders
Seizures
Legg-Calve-Perthes Self-limiting disease
Femoral head loses blood supply
Four times more common in males
Peak age 4 to 7 years
Clinical Manifestations Pain
Limping
Limited hip motion especially internal rotation and abduction is classic sign
Management Goal of care is to: Keep femoral
head in the hip joint
Traction
Anti-inflammatory
Physical therapy
Assessment Tip: Asking the child to squat or
extend his or her knee against resistance usually elicits pain and is a good indicator of Osgood-Schlatter Disease.
Osgood-Schlatters Due to repetitive motion Affects children 10 to 14 years old Males 3:1 Diagnosis is based on clinical signs
and symptoms Pain, heat, tenderness, and local
swelling
Management
Reduce activity
Stretching before activity
Anti-inflammatory
Avoid activity that cause pain
Knee pads / sleeve
Slipped Capital Femoral Epiphysis
Top of femur slips through growth plate in a posterior direction.
Ages 10 to 14 in girls
Ages 10 to 16 in boys
High proportion are obese
Scoliosis
Later curvature of spine
Medline.com
•Pain is not a normal findingfor idiopathic scoliosis.
Nursing Diagnoses Body image disturbance related to
bracing Risk of injury related to brace Impaired physical mobility related
to brace wear Risk for non-compliance with
treatment regimen
Assessment Alert: If pain is a reported symptom
of the child’s scoliosis, it should be investigated immediately. Pain is not a normal finding for idiopathic scoliosis, and the presence of this symptom could be signaling an underlying condition such as tumor of the spinal cord.
Osteomyelitis
Infection of bone andtissue around bone.
Requires immediate treatment
Can cause massive bonedestruction and life-threatening sepsis
Webmd.lycos.com
Clinical Manifestation Localized pain Decreased movement of area With spread of infection
Redness Swelling Warm to touch
Diagnosis
X-ray
Bone scan
CBC
ESR / erthyrocyteSedimentation rate
C-reactive protein
18-year-old boy with painful right arm
Management Culture of the blood Aspiration at site of infection Intravenous antibiotics x 4 weeks Monitor ESR
Decrease in levels
Pathogeneis of Acute Osteo
Under 1 yearthe epiphysis is nourished byarteries.
In children 1 yearto 15 years theinfection is restrictedto below the epiphysis.
Septic Arthritis Infection within a joint or synovial
membrane Infection transmitted by:
Bloodstream Penetrating wound Foreign body in joint
Septic Arthritis of Hip Difficulty walking and fever Diagnosis: x-ray, aspirate fluid
from joint, ESR
Medscape.com
WBC 31,700
bands 4%
segs 85%
monos 6%
lymphs 5%
HgB 12.4
MCT 35.4
Platelets 394,000C- reactive protein
8.2 mg
ESR /sed rate
39
Erythrocyte Sedimentation Rate ESR Used as a gauge for determining the
progress of an inflammatory disease. Rises within 24 hours after onset of
symptoms.
Men:0 - 15 mm./hr Women: 0 – 20 mm./hr Children: 0 – 10 mm./hr
C-Reactive Protein During the course of an inflammatory
process an abnormal specific protein, CRP, appears in the blood.
The presence of the protein can be detected within 6 hours of triggering stimulus.
More sensitive than ESR / more expensive
Joint Space FluidWBC 80,000
Segs 88%
Monos 1%
Lymphs 11%
RBC 16,000
Gram Stain Gram-positive cocci in chains
Management Administration of antibiotics for 4 to
6 weeks. Oral antibiotics have been found to
be effective if serum bactericidal levels are adequate.
Fever control Ibuprofen for anti-inflammatory
effect
Juvenile Rheumatoid Arthritis Chronic inflammatory condition of the
joints and surrounding tissues.
Often triggered by a viral illness
1 in 1000 children will develop JRA
Higher incidence in girls
Clinical Manifestations Swelling or effusion of one or more
joints Limited ROM Warmth Tenderness Pain with movement
Diagnostic Evaluation Elevated ESR / erythrocyte
sedimentation rate + genetic marker / HLA b27 + RF 9 antinuclear antibodies Bone scan MRI Arthroscopic exam
Goals of Therapy To prevent deformities
To keep discomfort to a minimum
To preserve ability to do ADL
Management ASA NASAIDS around the clock Immunosuppressive drugs:
azulvadine Enbrel: new class of drugs to treat
JRA Attacks a specific aspect of the
immune response
ASA Therapy Alert: The use of aspirin has been highly
associated with the development of Reye’s syndrome in children who have had chickenpox or flu. Because aspirin may be an an ongoing p art of the regimen of the arthritic child, parents should be warned of the relationship between viral illnesses an aspirin, and be taught the symptoms of Reye’s syndrome.