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Child with musculoskeletal Disorder
MSN.Khetam moh’d
Assessment the child for possible S&S of
musculoskeletal Disorder
1 .potsis
2. malaise ,fever, irritability.
3. poor sucking
4. muscle weakness
5 .spinal curvature
6 .pain ( in hip joint )
7. stiffness & swelling.
8. repeated fracture
9. waddling gait
10. flat feet & pigeon toe
11. heel pain & tenderness
* Nursing diagnosis :
1. pain R/T chronic inflammation joints
2. impaired physical mobility R/T cast on leg
3. situational low self esteem R/T continuous
of body brace
* implementation:
1. care of a child in a cast or traction
2. teaching a bout common concerns such as
posture or child shoes .
3. teach child & family to cope with new
changes
4. referral to appropriate organization
( www.arthritis.org ,www.osteo.org
,www.oif.org)
*Diagnostic Test :
1. X-ray study
2. bone scan ( give IV.contrase )
3. Electromyogrophy EMG
4.muscle or bone biopsy
5. Arthroscopy
(direct visualization of joint ,knee, wrist,
hip, shoulder , & elbow)
management:
1. Casting
2 . Traction ( skin ,& skeletal traction )
3 . Distraction
4. Open reduction
Scoliosis:
* permanent curvature of spine –Idiopathic
accompanied by damage to the vertebrae
(30% has family history )
* 5 time more common in girls than boys
* ( 8-15 y/d ) peak incidence of age
* Two type :
1. functional unequal leg ( C-shaped curve )
2. structural - ( S-shape curve )
* Assessment :
1. all child 10 y/d should be assess for scoliosis
2. X-ray to the back and shoulder.
*management:
1. if spinal curve less than 20 degree --until 18y/d should be correct
2 .if the curve (20- 40) degree --- used body
brace or traction
3 .if more may need to surgical
correction
*NDx:
1. situational low self-esteem R/T brace
Juvenal Arthritis ( JRA)OR ( JA):
Age group ( 16y/d ) lasted for 3 month
* Peak incidence ( 1-3 y/d & 8-12 y/d )
it can occur as young as 6 month of age
*case : is unknown --autoimmune
process
child developed antibodies against his
or her own body cell
*Assessment :
1. fever
2. rashes
3. pain in joint ( lead to limited motion )
4. need help in ( eating ,dressing
,ambulating or toileting )
5.Rheumotoid factor +ve & ANA titer +ve
6. increased in WBC
MANAGEMENT :
* ( LONG TERM ILNESS)
1. exercise
2. medication administration to relived pain
3. restore function
4. maintain joint mobility
NDx:
Deficite knowledge R/T care necessary to
control disease symptoms
So need ongoing follow up
1. Exercise :
dance routine or games ( swimming ,tricycle riding )
* avoid this type of exercise:
( running ,jumping ,prolong walking & kicking )
child should attend school but short school day
• 2. medication
• give NSAIDs ( Tolectin ,Naproxen ,Ibuprofen ,if still
sever pain used Celebrix ,or Vioxx) this medication
used ( 6-8 weeks )
but : it case GI upset and bleeding .
* Heat application to decrease the pain and some time
need to splinting
* Nutrition ( they usually reduce intake because of pain
& fatigue )
Myasthenia graves
Is an interference ( muscle problem which have
progressive muscle weakness. )
For muscle to contract effectively must release
neurotransmitter ,acetylcholine)
In that case decrease also in receptors of
acetylcholine ,it's autoimmune process.
*occurs in 3 forms in childhood:
1. Neonatal transient MYSTHEMIA.
2. Congenital MYSTHEMIA
3. Juvenile MYSTHEMIA.
*assessment :
* Neonatal :
1. poor sucking
2. weak respiratory effort
3. ptosis ( drooping eyelids )
* Congenital
( inherited -autoimmune , 10-13 y/d ) common
in girls more than boys
1. Have thymus hypotrophy
2. develop double vision
( diplopia )
3. ptosis ( weak in extrocular muscle )
:assessment *
4.facial ,neck ,jaw ,swallowing, intercostals
muscle weakness,& general fatigue then all
muscle become tired specially respiratory
muscle )
( all S&S increased in emotional stress, fatigue ,
menstruation, respiratory infection ,alcohol
used )
* assessment:
1. child perform repetitive movement
2. child look upward * hold that position
* Diagnostic test :
1. X-ray and CT for thymus gland
2. physical exam
* management
1. Give prostigmin OR mestinon
2. Neostigmin ( prostigmin ))
( dosage 2mg/kg/daily given 3-4 hr )
(0.01 - 0.04mg /kg/dosage if given IM,IV,SC
( 2-3time /hr )
* Nursing Implication:
1. if given IV should give infusion
2. standby PREPARE ( Atropine sulfate )
as antidote if any crisis or overdose.
3. if given orally ( should administered
with milk and food to prevent GI upset
,and it should given before meal time
4. Side effect increased salivation
,emesis ,frequent urination
* Nursing Implication:
5. if all this not effective as a medication
may we need ( Plasmaphersis
to remove immune complexes from blood
stream so it reduce S&S ).
6. excision of the thymus gland
7. If respiratory involve we need to put
patient on ventilator.