NURS356 Exam 2 Study Guide Alterations in Musculoskeletal Function Developmental Differences Children are inherently at high risk for injury particularly males Bones are more porous longer High number of fractures Lifestyle issues risk takers males Long and lanky risk takers Good news Children heal rapidly But fractures can effect growth plate Effects of immobilization think about the age of the child Cognitive issues same level of education promoting cognitive development Review pain assessment At what age prone to falls car accident sports injury Aspects of Immobility to Consider Goals of care Motor sensory function check pulses motoricity of digits cap refill how swollen Elevate higher then heart when swollen Neurovascular integrity Free from infection Relief of pain May not always complain of pain Safety issues Restraints might have to be used Side rails up Put things on elbows so that can t move Diversional activities think about kids with special learning needs kids with ADHD Assessing neurovascular status Pain with PROM more pain with movement look to see if something is wrong particularly if they are in traction Pallor comparing one side to another prolonged capillary refeill Paresthesia numbness Paralysis Look at integrity of skin Student Goals For each disorder be able to Define the disorder and the underlying pathophysiology Identify assessments and diagnostic tests to detect differentiate disorder 1 NURS356 Exam 2 Study Guide Describe management strategies and essential nursing considerations Consider nursing role with treatments School nurse early identifying role Hospital nurse tx and tx strategies Developmental Dysplasia of the Hip Pathophysiology dislocation of femoral head dx in first month of life Occurs in females breech birth with c sections family history Subluxation most common incomplete dislocation displacement Laxity of supporting capsule Subluxation Abnormal size and or shape of acetabulum Genetic component Limited abduction of the hip Look at symmetry back to front If missed child will limp when older Worry about swelling keep extremity elevated Ensure that you get a pulse when child is in cast Look for drainage on cast if wound underneath circle it Findings Dysplasia of the Hip Assessments Diagnostic Findings Ortolani s hospital 4wks of age OUTWARD or Barlow s sign 4wks hip click of newborn Look for asymmetric gluteal folds Broad perineum in girl Short affected limb one leg shorter Limp toe walking Dx ultrasound clinical picture Developmental Considerations Interventions goal abduct the hip treat before 2 months of age for best success early Pavlik harness 6 months Externally rotates Traction 6mon Surgery 6months hip pinned Hip spica cast 6 18 months Externally rotated and kept that way Hard to maneuver that child Nursing implications Car seats how do you move child Special rental ones available for child with cast Skin straps Diaper area 2 NURS356 Exam 2 Study Guide Positioning Congenital Club Foot Pathophysiology unknown cause Foot abducted ankle equinus Familial 2 children Apparent by appearance Congenital May be syndromic or positional Assessments Diagnostic findings Apparent at birth or shortly thereafter X ray want to make sure that they aren t just packed in Parent issues interventions aren t fun families are upset Interventions Nursing Considerations Exercise at first Serial casting externally rotate the feet Care of child in a cast Cast changed q2weeks Abduct a little further Over correction stretch tight structures of medial side of food Range of motion exercise with every diaper change May put 2 diapers on baby to maintain abduction Overcorrect to come into normal alignment Follow up important q2weeks after cast removed Surgery if casting doesn t work Do as soon as possible before the child starts standing 6 12 weeks Stretching exercise to make sure not defect Get good report from PACU Make cast a little loose to allow room for swelling 3 NURS356 Exam 2 Study Guide Legg Calve Perthes Pathophysiology Unknown cause Aseptic necrosis of the femoral head Dx 3 12 years preschool school age children Related to change in circulation Course of 18 months to several years Reformed head normal or slightly abnormal Assessments Diagnostic findings Limp on the affected side first of findings when tired they begin to limp intermittent Ache in the hip increases with stress Pain at hip and thigh Increased pain after activities Externally rotating hip late sign so pick up early School nurse usually finds this Dx via x ray Interventions Nursing Considerations Rest non weight bearing helps Traction in hospital on bedrest Abduction brace pulls hip away with abduction Surgical reconstruction if picked up late hip replacement Home traction evening night put into traction School activities limited influences cognitive development Slipped Femoral Capital Epiphysis differentiate with above Pathophysiology Coxa Vera another name know both terms Displacement of the femoral head to the posterior and inferior Occurs after puberty in rapid growth period Occurs in obese overlarge or lanky youth male with huge growth spurt GROWTH AND SIZE unexplained With endocrine abnormalities pituitary hormone Dx X ray Assessments Diagnostic findings History of trauma Displacement disability not able to walk possible External rotation with ambulation Increases with fatigue Increases as time progresses look over 2 years big difference 4 NURS356 Exam 2 Study Guide Pain from hip to groin sometimes genital pain Pain decreases with internal rotation adduction Tired more often Interventions Nursing considerations Surgical stabilization with correction Pinning Early diagnosis very important During early childhood may cast or use traction and avoid pinning Scoliosis Pathophysiology Lateral curvature of the thoracic spine Congenital or later diagnosed More common then not Develops with growth Idiopathic or congenital Familial tendency girls pre puberty May be secondary to other conditions such as muscular diseases Ex MD Pain should and back hurts Assessments Diagnostic findings Rib hump Changes in levels of skirts shoulders bra straps Screening tests begin in school and also done by pediatricians 4 6 grades early detection Scoliometer Early detection X rays bone densometry bones spine or muscular Uneven thighs Interventions Nursing considerations Depends on type and magnitude of the curve Exercises do fairly religiously Bracing OJ Milwaukee brace Poor compliance put cast on 16 23 hours day