Care of the pediatric client with mobility needs

ScoliosisCongenital club footMetatarsus adductus

CHD/DDHNeural tube defects

Physiological problems of immobility

• Many systems affected:– Muscular system– Skeletal system– Cardiovascular system– Respiratory system– Gastrointestinal– Renal system– Metabolism– Skin– Neurologic

Psychological impact of immobility

• Experience losses – result in sensory deprivation

• Responses with aggression/regression

• Experience depression

Nursing interventions

• To assist a child to cope with the psychological problems of immobility:– Provide substitution for one form of motion

for another– Allow to express anger

Scoliosis

• Most common spinal deformity

• May be congenital or develop during childhood

• Multiple potential causes, most cases idiopathic

• Generally becomes noticeable after pre-adolescent growth spurt

Scoliosis diagnostic evaluation

• Standing radiographs to determine degree of curvature

• “S” or “C” curve• Asymmetry of shoulder

height, scapular or flank shape, or hip height

Treatment

• Observation - if curve < 20 degrees monitor q 3-6 months

• Brace - will not correct curvature but hopefully will decrease curvature - wear 20-23hrs daily

• Psychological impact of brace• Surgery - > 50 degrees; series of rods,

hooks, screws or wires to straighten spine

Harrington rods

TLSO brace

Nursing Considerations

• Concerns of body image

• Concerns of prolonged treatment of condition

• Preoperative care

• Postoperative care– TCDB, log roll, foley, pain control, IV fluids

Congenital clubfoot

• True clubfoot • 95% are talipes

equinovarus (TEV)• Ankle turned inward

and toes are lower than the heel

Nursing interventions

• Initial treatment should be non-operative

• Begin 1st or 2nd week of life.

• 5-6 cast applications over 6-8 weeks

• 7 day intervals

Club foot

Metatarsus adductus(also called metatarsus varus)

• Most common congenital foot deformity

• Often result from abnormal position in uterus, usually evident at birth

• To distinguish from true club foot is that the heel and ankle remain in neutral position

• Treatment – PT, orthotics

CHD/DDH

• A condition of abnormal development of the hip

• Resulting in hip joint instability

• Potential dislocation of the femur from the acetabulum in the pelvis.

Cause & symptoms

• Clinical studies show a familial tendency toward hip dysplasia, with more females affected than males.

• Higher in infants born by caesarian and breech position births

• Hormonal changes within the mother during pregnancy, resulting in increased ligament laxity, is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the uterus

Signs of Developmental Dysplasia of the Hip

1. Asymmetry of gluteal and thigh folds 2. Limited hip abduction3. Apparent shortening of the femur 4. Ortolani click

Clinical manifestation of DDH

• Infant– Shortened limb on affected side– Restricted abduction of hip on affected side– Unequal gluteal folds when infant prone– Positive Ortolani test– Positive Barlow test

• Older infant & child– Affected leg shorter than the other– Trendelenburg sign– Waddling gait

Treatment

• Objective is to replace the head of the femur into the acetabulum

• Newborn to 6 months: Pavlik harness

• Age 6 to 18 months: use traction & spica cast (surgery may be necessary)

Prognosis

• If corrected soon after birth may have no apparent effect on ambulation.

• Early diagnosis is essential

• If go untreated - will have difficulty walking, which would result in life long pain

• Bone structure damage

Nursing interventions

• Early detection – early intervention to prevent complications

• Parental education and understanding

• Client follow-up

• Managing child care with infant in cast

Review the following content

• Fractures

• Cast care

• Tractions

Samuel’s story

Neural tube defects

• Failed closure of neural tube

• May involve entire length of the neural tube or small portion

• Types:– Spinal bifida (myelomeningocele)– Meningocele

Myelomeningocele(Spina bifida)

• Neural tube fails to close

• Defect contain meninges, CSF, and nerves

• May be anywhere along the spinal column, lumbar & lumbosacral areas most common

• Location & magnitude of defect determine nature and extent of impairment

Initial management of myelomeningocele

• Prevent infection

• Assessment of neurologic and associated anomalies

• Early closure in 12 – 72 hours after birth– Prevent stretching of other nerve roots &

further damage.

Meningocele

• Defect contain meninges and CSF, no neural elements

• No neurologic deficits

Strategies for nursing care

• Prevent initial infection

• Prophylactic antibiotics

• Observe for s/sx of meningitis

• Prone position or side-lying to reduce pressure on sac

• Temperature control

Hydrocephalus

• Caused by an imbalance in the production & absorption of CSF

• Dx: increased head circumference & associated neurological signs, CT & MRI

• Tx: relief of hydrocephalus, shunt placement, management of problems

Strategies for nursing care

• Assess FOC• Elevate HOB > 30 degrees• Assess for complications of VP shunt (i.e.,

infection & malfunctioning)• Post-operative

– Routine assessment– Do not place on operative side– Watch for increased ICP, seizure activities– Family support

Ventriculoperitoneal shunt

Charlie’s story