Transcript Birth Trauma

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Developmental hip dysplasia
Clubfoot
Fractures
Scoliosis
Osteogenesis Imperfecta
Osgood-Schlatter Disease
Osteomyelitis
Muscular Dystrophy
JRA
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Hereditary disorder, more common
in girls
Flat acetabulum of pelvis
Prevents femur from remaining in
the acetabulum and rotating
adequately
Head of femur is dislocated
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May be due to position in utero
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Limited abduction of the affected hip
Asymmetry of the gluteal and thigh fat folds
Affected leg may appear shorter
Positive “Ortolani click”
Uneven gait in older children
 Early
detection is key for success
 Treatment
 Pavlik
depends on age at diagnosis
Harness
 Hip Spica Cast
 ORIF
Pavlik harness
 Keeps hips and knees
flexed, the hips
abducted, and the
femoral head in the
acetabulum
 Worn continuously for
3 to 6 months
 Effective 90% of time
Hip spica cast:
 For child 3-18 months age
 Maintains abduction (froglike position)
 Worn for 1 year
 Must be changed as child
grows
ORIF (surgical insertion of pin)
 For child >18mos
 Successful reduction is
difficult after age 4
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Skin care
Hygiene
Feeding
Handling
Immobility
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Elimination
Growth and
Development
Clothing
Transportation
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Congenital deformity of the foot
Can affect one or both feet
Portions of foot and ankle are twisted out of
normal position
Varying degrees of severity & combinations of
abnormal positions
Can range from mild to severe
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Three areas of
deformity:
◦ The hindfoot turns
inward (varus)
◦ The hindfoot turns
outward (valgus)
◦ The midfoot is directed
downward (equinus)
• Early detection is critical
• Part of newborn assessment
• Move foot to midline
Begins soon after birth, before
discharge
Manipulation with serial casting
for 8-12 weeks (due to rapid
growth)
Cast extends above infant’s
knee to ensure correction
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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
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Break in bone from stress
Frequent in children- bones are not as dense
and more porous
Usually occur from
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Falls
Sports
MVA
Bone disease
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Symptoms:
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Pain
Abnormal limb positioning
Decreased ROM
Edema
Ecchymosis
Crepitus
Refusal to play with extremity, guarding
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Cast
Surgery
Pins and external devices
Traction- used to align bone
◦ Skin
 Pull is applied to the skin and muscle
◦ Skeletal
 Pull is applied to the bone pins
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Inspect skin
◦ observe for swelling, pain, discoloration,
odor
◦ keep cast free of foreign objects
Monitor Neurovascular Status
◦ keep extremity elevated for 1st day
◦ observe for loss of distal pulse,
discoloration, loss of movement
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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 Mobility
 Crutches
 Wheelchair
 Wheeled Carts (hip spica casts)
◦ Promote Growth and Development
promote body image
provide diversional activity
cast becomes part of body, fear removal
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Most common type of spinal deformity
Girls>Boys
Non-painful lateral curvature of spine
begins around pre-pubescent growth spurt
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In NYS all children screened in 5th grade
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Symptoms
◦ Ill fitting clothes
◦ Uneven shoulders, scapulae, hips
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Treatment will not correct the curve, but
prevent it from worsening
Mild Scoliosis
◦ Life Long monitoring
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Moderate Scoliosis
◦ Bracing
◦ Exercises to improve posture and flexibility
◦ Electrical Stimulation to back muscles
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Surgical correction: spinal realignment & straightening
(Harrington Rod), followed by Milwaukee Brace worn 23 hr
day
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Screen and identify children
Refer to orthopedisist for eval and treatment
Assess respiratory, neurological,
cardiovascular as rib cage deformity can
affect
Promote understanding and compliance of
treatment
Promote good body image and self esteem
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Congenital abnormality
Connective tissue disorder, leads to fragile bone
formation
“Brittle Bone Disease”
Causes recurrent pathological fractures
Will not have normal growth in height
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Multiple and frequent fractures
Thin, soft skin
Increased joint flexibility
Weak muscles
Soft, pliable, brittle bones
Short stature
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Goal protect from trauma and reduce the
number of fractures
Early intervention
◦ Splints, Braces, Surgical Rods
◦ Childproof home
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Handle child gently
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Support trunk and extremities as child is moved.
Bathing and diapering may cause fractures
Use blanket for additional support when lifting
Never pull legs upward when changing a diaper
Gently slip a hand under the hips to raise
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Encourage well-balanced diet
◦ Additional vitamin C, vitamin D, and calcium to
encourage healing and bone growth.
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Limit calories to maintain weight
◦ Immobility can lead to overweight
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Support normal growth and development
◦ Socialization
◦ Swimming improves muscle tone
◦ Wheelchairs and adaptive equipment
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Thickening & enlargement of tibial tuberosity
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Results from microtrauma (sports-related)
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Bilateral knee pain exacerbated by running,
jumping, climbing stairs
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Self-limiting condition
◦ rest, ice, heat, NSAIDs
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Immobilization of limb may be necessary
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Support other methods of exercise, sports
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Bacterial infection of bone
Common in children age 1-12 years
Can follow open fractures, burns, skin
abscess, foreign body
Infecting organism spreads through the
bloodstream from the penetrating injury to
the bone
 Pain,
warmth, tenderness,
limited ROM localized to the
area of infection
 Usually in the extremities
 In younger child- more subtle
symptoms, irritability
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Increased WBC’s
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Increased sed rate
Increased C-reactive protein
Positive blood culture
MRI shows bone purulence and edema
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4-6 weeks of Antibiotics (PICC line)
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Limit weight bearing on extremity
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Aggressive therapy is needed to prevent
◦ Disruption of the growth plate, interrupt growth
◦ Septic arthritis and joint damage
◦ Recurrent infection
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Administer IV antibiotics
Teach care of PICC line
Strict aseptic technique and transmissionbased precautions during all dressing
changes.
Good hygiene
Teach signs of spread of infection
◦ increasing pain, difficulty breathing, increased
pulse rate, fever
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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
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Inherited disease with progressive
deterioration of muscle cells
Causes progressive muscle weakness and
atrophy
Several different types
All differ by age of onset and severity
The most common form of childhood
muscular dystrophy is Duchenne muscular
dystrophy
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X-linked recessive disorder
Affects boys, symptoms by age 3
Will meet early motor milestones birth to age
3
At age 3 see:
◦ waddling gait, difficulty climbing stairs,
frequent falls; easily tired, when walking
and running
As disease progresses:
◦ toe walking, hypertrophied calves, lordosis
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Speech &
swallowing become
impaired
More pronounced
muscle weakness
(scoliosis)
Wheelchair by
junior high
Tachycardia
Pneumonia
Heart failure age 20
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Maintain ambulation as long as possible
Physical therapy, adaptive equipment
Braces to prevent contractures
Promote independence
Prevention of injury
Prevention of infection
 Chronic
inflammation of
synovium with eventual erosion
of articular cartilage
 Cause is autoimmune
+ ANA (antinuclear antibodies)
+ RF (rheumatoid factor)
 Girls
affected more
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Stiffness in AM
Swelling
Tenderness
Painful to touch
Warm to touch,
seldom red
Loss of motion
Increased WBC’s &
sed rate
Goals of care
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Maintain joint fx (splints, ROM)
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Prevent physical deformities
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Relieve symptoms (pain & inflammation)
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NSAID’s (aspirin, ibuprofen, naproxen)
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SAARD’s Slower Acting Antirheumatic
Drugs(gold, D-penicllamine)
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Facilitate medication compliance
Encourage child to be as independent as
possible
Moist heat (bath or whirlpool) especially in
morning
Prevention of injury
Promote functioning
Most common complication
severe hip involvement with loss of function
A 3-year-old child is suspected of having
Duchenne’s muscular dystrophy. Which of the
following assessment findings by the nurse would
support this diagnosis?
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A history of delayed crawling
Outward rotation of the hips
Difficulty climbing stairs
Wasted 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)
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Positive Blood Cultures
+ ANA
WBC 15,000
Sed Rate 5
Decreased 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?
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Back pain
Skirts that hang unevenly
Unequal shoulder heights
Uneven waist angles
A 4-year-old child with osteogenesis
imperfecta is admitted to the hospital unit.
Which of the child’s nursing diagnosis has
the highest priority?
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Impaired skin integrity related to cast
Pain related to fractures
Risk for injury related to disease state
Disturbed body image related to short
stature
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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?
1. Legos
2. Etch-a-sketch
3. Fireman’s
hat
4. Coloring 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:
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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:
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Osteomyelitis
Osgood-Schlatter Disease
Rheumatoid Arthritis
Fractures