developmental hip dysplasia clubfoot fractures scoliosis osteogenesis imperfecta ...

of 63 /63

Author: esther-blair

Post on 12-Jan-2016




0 download

Embed Size (px)


  • Developmental hip dysplasiaClubfootFracturesScoliosisOsteogenesis ImperfectaOsgood-Schlatter DiseaseOsteomyelitisMuscular DystrophyJRA

  • Hereditary disorder, more common in girlsFlat acetabulum of pelvisPrevents femur from remaining in the acetabulum and rotating adequatelyHead of femur is dislocated

    May be due to position in utero

  • Limited abduction of the affected hipAsymmetry of the gluteal and thigh fat foldsAffected leg may appear shorterPositive Ortolani clickUneven gait in older children

  • Early detection is key for success

    Treatment depends on age at diagnosisPavlik HarnessHip Spica CastORIF

  • Pavlik harnessKeeps hips and knees flexed, the hips abducted, and the femoral head in the acetabulumWorn continuously for 3 to 6 monthsEffective 90% of time

  • Hip spica cast:For child 3-18 months ageMaintains abduction (frog-like position) Worn for 1 yearMust be changed as child grows

    ORIF (surgical insertion of pin)For child >18mosSuccessful reduction is difficult after age 4

  • Skin careHygieneFeedingHandlingImmobility

    EliminationGrowth and DevelopmentClothingTransportation

  • Congenital deformity of the footCan affect one or both feetPortions of foot and ankle are twisted out of normal positionVarying degrees of severity & combinations of abnormal positions Can range from mild to severe

  • Three areas of deformity: The hindfoot turns inward (varus)The hindfoot turns outward (valgus)The midfoot is directed downward (equinus)

  • Early detection is criticalPart of newborn assessmentMove foot to midline

  • Begins soon after birth, before dischargeManipulation with serial casting for 8-12 weeks (due to rapid growth)Cast extends above infants knee to ensure correction

  • Surgical correction btw 4-12 mos, realignment of bones, pin insertion, cast for 6-12 weeks

    Denis Browne Splints shoes attached to metal bar to maintain correction

  • Break in bone from stressFrequent in children- bones are not as dense and more porousUsually occur fromFallsSportsMVABone disease

  • Symptoms:PainAbnormal limb positioningDecreased ROMEdemaEcchymosisCrepitusRefusal to play with extremity, guarding

  • Cast SurgeryPins and external devicesTraction- used to align boneSkinPull is applied to the skin and muscleSkeletalPull is applied to the bone pins

  • Inspect skinobserve for swelling, pain, discoloration, odorkeep cast free of foreign objects

    Monitor Neurovascular Statuskeep extremity elevated for 1st dayobserve for loss of distal pulse, discoloration, loss of movement

  • Clinical manifestations begin about 30 minutes after tissue ischemia starts. Paresthesia (tingling, burning, loss of two-point discrimination)Pain (unrelieved by medication, characterized by crying in the young child)Pressure (skin is tense or discolored, cast appears tight)Pallor distal to cast (pale, gray, or white skin tone)Paralysis (weakness or inability to move extremity)Pulselessness distal to cast (weak or absent pulse)

  • Promote MobilityCrutchesWheelchairWheeled Carts (hip spica casts)

    Promote Growth and Developmentpromote body image provide diversional activitycast becomes part of body, fear removal

  • Most common type of spinal deformityGirls>BoysNon-painful lateral curvature of spine begins around pre-pubescent growth spurt

    In NYS all children screened in 5th grade

    SymptomsIll fitting clothesUneven shoulders, scapulae, hips

  • Treatment will not correct the curve, but prevent it from worsening

    Mild ScoliosisLife Long monitoring

    Moderate ScoliosisBracingExercises to improve posture and flexibilityElectrical Stimulation to back muscles

  • Surgical correction: spinal realignment & straightening (Harrington Rod), followed by Milwaukee Brace worn 23 hr day

  • Screen and identify childrenRefer to orthopedisist for eval and treatmentAssess respiratory, neurological, cardiovascular as rib cage deformity can affectPromote understanding and compliance of treatmentPromote good body image and self esteem

  • Congenital abnormalityConnective tissue disorder, leads to fragile bone formationBrittle Bone DiseaseCauses recurrent pathological fracturesWill not have normal growth in height

  • Multiple and frequent fracturesThin, soft skinIncreased joint flexibilityWeak musclesSoft, pliable, brittle bonesShort stature

  • Goal protect from trauma and reduce the number of fractures

    Early interventionSplints, Braces, Surgical RodsChildproof home

  • Handle child gentlySupport trunk and extremities as child is moved.Bathing and diapering may cause fracturesUse blanket for additional support when lifting Never pull legs upward when changing a diaperGently slip a hand under the hips to raise

  • Encourage well-balanced diet Additional vitamin C, vitamin D, and calcium to encourage healing and bone growth.

    Limit calories to maintain weight Immobility can lead to overweight

  • Support normal growth and developmentSocializationSwimming improves muscle toneWheelchairs and adaptive equipment

  • Thickening & enlargement of tibial tuberosity

    Results from microtrauma (sports-related)

    Bilateral knee pain exacerbated by running, jumping, climbing stairs

  • Self-limiting conditionrest, ice, heat, NSAIDs

    Immobilization of limb may be necessary

    Support other methods of exercise, sports

  • Bacterial infection of boneCommon in children age 1-12 yearsCan follow open fractures, burns, skin abscess, foreign bodyInfecting organism spreads through the bloodstream from the penetrating injury to the bone

  • Pain, warmth, tenderness, limited ROM localized to the area of infectionUsually in the extremitiesIn younger child- more subtle symptoms, irritability

  • Increased WBCs Increased sed rate Increased C-reactive protein Positive blood culture MRI shows bone purulence and edema

  • 4-6 weeks of Antibiotics (PICC line)

    Limit weight bearing on extremity

    Aggressive therapy is needed to preventDisruption of the growth plate, interrupt growth Septic arthritis and joint damageRecurrent infection

  • Administer IV antibioticsTeach care of PICC lineStrict aseptic technique and transmission-based precautions during all dressing changes.Good hygieneTeach signs of spread of infectionincreasing pain, difficulty breathing, increased pulse rate, fever

  • Promote Development

    Provide suggestions for the family if the child will be immobilized at home.

    Assist the family in planning for completion of school tasks

  • Inherited disease with progressive deterioration of muscle cellsCauses progressive muscle weakness and atrophySeveral different typesAll differ by age of onset and severityThe most common form of childhood muscular dystrophy is Duchenne muscular dystrophy

  • X-linked recessive disorderAffects boys, symptoms by age 3Will meet early motor milestones birth to age 3At age 3 see: waddling gait, difficulty climbing stairs, frequent falls; easily tired, when walking and runningAs disease progresses:toe walking, hypertrophied calves, lordosis

  • Speech & swallowing become impairedMore pronounced muscle weakness (scoliosis)Wheelchair by junior highTachycardiaPneumoniaHeart failure age 20

  • Maintain ambulation as long as possiblePhysical therapy, adaptive equipmentBraces to prevent contracturesPromote independencePrevention of injuryPrevention of infection

  • Chronic inflammation of synovium with eventual erosion of articular cartilage Cause is autoimmune+ ANA (antinuclear antibodies) + RF (rheumatoid factor)Girls affected more

  • Stiffness in AMSwellingTendernessPainful to touch Warm to touch, seldom redLoss of motionIncreased WBCs & sed rate

  • Goals of careMaintain joint fx (splints, ROM)Prevent physical deformitiesRelieve symptoms (pain & inflammation)NSAIDs (aspirin, ibuprofen, naproxen)SAARDs Slower Acting Antirheumatic Drugs(gold, D-penicllamine)

  • Facilitate medication compliance Encourage child to be as independent as possibleMoist heat (bath or whirlpool) especially in morningPrevention of injuryPromote functioningMost common complicationsevere hip involvement with loss of function

  • A 3-year-old child is suspected of having Duchennes muscular dystrophy. Which of the following assessment findings by the nurse would support this diagnosis?

    A history of delayed crawlingOutward rotation of the hipsDifficulty climbing stairsWasted muscle appearance

  • A child is admitted to the hospital suspecting osteomyelitis. Which of the following serum laboratory values noted by the nurse supports this diagnosis? (Select all that apply)

    Positive Blood Cultures+ ANAWBC 15,000Sed Rate 5Decreased C-Reactive Protein

  • An adolescent diagnosed with moderate scoliosis describes all of the following symptoms. Which one would the nurse conclude is not associated with the initial diagnosis?

    Back painSkirts that hang unevenlyUnequal shoulder heightsUneven waist angles

  • A 4-year-old child with osteogenesis imperfecta is admitted to the hospital unit. Which of the childs nursing diagnosis has the highest priority?

    Impaired skin integrity related to castPain related to fracturesRisk for injury related to disease stateDisturbed body image related to short stature

  • Which item should the nurse remove from the bedside table of a 4-year-old child who has just been placed in bilateral long leg casts?

    LegosEtch-a-sketchFiremans hatColoring book

  • The nurse is assessing a child in a newly applied cast to the lower leg for a tibia fracture. The nurse medicates the child for pain, which is ineffective. The nurse should further assess:

    Color of toes.Apical pulse.Skin temperature.Blood pressure

  • A 14-year-old states her fingers and wrists are stiff in the morning, hurt, and are swollen. The nurse suspects this adolescent will be tested for:

    OsteomyelitisOsgood-Schlatter DiseaseRheumatoid ArthritisFractures