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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