Transcript The Child With a Musculoskeletal Disorder Chapter 40

The Child With a
Musculoskeletal Disorder
Chapter 40
OBJECTIVES
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1.
Discuss ways the child’s musculoskeletal system differs from the
adult’s system.
2.
Discuss types of fractures seen in children and explain the treatment.
3.
Describe the purpose of doing neurovascular checks in a child with a
musculoskeletal disorder.
4.
List and define the five Ps to observe, record, and report when caring
for a child in a cast.
5.
Identify and explain different types of traction.
6.
Discuss osteomyelitis including the bacterium that usually causes it,
the treatment, and nursing care.
7.
Identify the most common form of muscular dystrophy and describe
its characteristics.
Describe Legg-Calve-Perthes Disease.
9.
Identify the treatment for the child with osteosarcoma and Ewing’s
sarcoma.
10. Discuss juvenile rheumatoid arthritis, including the drugs of choice
used in the treatment.
11. Describe scoliosis and identify methods of correction and nursing
care.
Growth and Development of the
Musculoskeletal System
Provides the structure and framework to support,
protect, and permit movement of the body
 Skeletal system is made up of four types of bone
 During fetal life, cartilage consists of cells implanted
in a gel-like substance which calcifies and becomes
bones
 Bone growth takes place between birth and puberty,
with most growth being complete by age 20
 During childhood, the bones are more sponge-like
and can bend and break more easily than in adults
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Growth and Development of the
Musculoskeletal System (cont.)
Bones of the skull-give shape to the head,
suture lines (fuse within first 2 yrs. of life);
epiphyseal plate
 Spine or vertebral column-develops curves
 As the child grows, the muscles become
stronger and the child has more muscle tone,
strength, and coordination
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Fractures
Children’s fractures differ from those of adults in
that generally they are less complicated, heal
more quickly, and usually occur from different
causes
 Most commonly fractured
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Clavicle
Femur
Tibia
Humerus
Wrist
Fingers
Fractures (cont.)
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Classification of a fracture
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Complete-fragments are separated
Incomplete-fragments are partially joined
Greenstick fractures-incomplete fracture
Compound/open-penetrates the skin
Closed/simple-single break without
penetrating the skin
◦ Spiral fractures-twist around the bone
(associated with child abuse-caused by a
wrenching force)
Fractures (cont.)
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Treatment and Nursing Care
◦ 5 P’s-pain, pulse, parathesia, paralysis, pallor
◦ Casts
 Child and the family should be taught what to expect after
the cast is applied and how to care for the casted area
◦ Traction-skin & skeletal
 Carefully monitored to detect any signs of neurovascular
complications
 Weights must be hanging freely
◦ External fixation devices
 Care for the pin sites
OSTEOMYELITIS
Infection of the bone
-usually caused by Staph aureus
 Clinical manifestations
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◦ Symptoms usually begin abruptly
◦ Joint motion is limited
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Diagnosis-Lab findings (leukocytosis, elevated ESR,
& positive cultures)
Treatment
◦ IV antibiotic therapy-immediately to prevent chronic
osteomyelitis. Why?
◦ Continued for at least 6 weeks
◦ May require I & D
OSTEOMYELITIS (cont.)
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Nursing care
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Reducing pain
Minimizing movement of the limb
Administering medication
Monitor oral nutrition and fluids
Muscular Dystrophy
A hereditary, progressive, degenerative disease
of the muscles
 Most common form of muscular dystrophy is
Duchenne (pseudohypertrophic) muscular
dystrophy
 Clinical manifestations
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◦ First signs are noted in infancy or childhood
◦ Difficulty standing and walking-Gower’s sign
◦ Later trunk muscle weakness develops
Muscular Dystrophy (cont.)
Diagnosis-S&S during first 2 yrs., highly
increased serum CPK, muscle biopsy
 Treatment-no effective treatment
 Nursing care
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◦ Research is rapidly closing in on genetic
identification
◦ Breathing exercises
◦ Keep the child’s life as normal as possible
◦ Keep child active as possible (delay atrophy)
Legg-Calvé-Perthes Disease (Coxa Plana)
Legg-Calvé-Perthes disease is an aseptic necrosis
of the head of the femur
 Occurs 4 to 5 times more often in boys than in
girls, and 10 times more often in whites than in
other ethnic groups, can be caused by trauma to
the hip, but generally cause is unknown
 Clinical manifestations-pain in the hip or
groin and a limb, muscle spasm and limitation of
motion
 Diagnosis-difficult, mimics synovitis, xray
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Legg-Calvé-Perthes Disease (Coxa Plana)
(cont.)
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Treatment
◦ Treatment focuses on containing the femoral head
within the acetabulum during the revascularization
process so that the new femoral head will form to
make a smoothly functioning joint, prognosis depends
on the child’s age at the time of onset, the amount of
involvement, and the cooperation of child and
caregivers
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Nursing care
◦ Nursing care focuses on helping the child and
caregivers to manage the corrective device and the
importance of compliance to promote healing and to
avoid long-term disability
Question
In what disease does the nursing care focus on
helping the child and caregivers understand the
importance of compliance to promote healing and
avoid long-term disability?
a. Osteosarcoma
b. Legg-Calvé-Perthes disease
c. Osteomyelitis
d. Muscular dystrophy
Answer
b. Legg-Calvé-Perthes disease
Rationale: Nursing care focuses on helping the child
and caregivers to manage the corrective device, and
the importance of compliance to promote healing
and to avoid long-term disability.
Osteosarcoma
Malignant tumor seen in the long bones
 Children who have had exposure to radiation
or retinoblastoma are more prone to the
malignancy
 Clinical manifestations
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◦ Pain and swelling at the sight of the tumor
◦ Pathologic fractures of the bone can occur
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Diagnosis-biopsy, xray, bone scan, MRI, CT;
metastasis to lungs can occur
Osteosarcoma (cont.)
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Treatment
◦ Surgical removal of the bone or the limb followed
by chemotherapy is the treatment for the tumor
◦ Fitted for a prosthesis soon after surgery
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Nursing care
◦ Honest answers and support are helpful
◦ Support groups with other children
◦ Early diagnosis and treatment increase survival
Ewing’s Sarcoma
A malignant tumor found in the bone marrow of
the long bones
 Clinical manifestations
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◦ Pain at the site of the tumor
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Diagnosis
◦ Pain becomes severe enough to keep the child awake
at night
◦ Metastasis to the lungs and other bones may already
have taken place by the time of diagnosis
◦ Biopsy, bone scan and bone marrow aspiration
Ewing’s Sarcoma (cont.)
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Treatment
◦ Tumor is removed
◦ Radiation
◦ Chemotherapy
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Nursing care
◦ 50% achieve 5 year survival rate
◦ Support and encouragement
Juvenile Rheumatoid Arthritis
Clinical manifestations-joint inflammation
occurs first; if untreated, irreversible changes to
joint cartilage, ligaments, and menisci eventually
causing complete immobility
 Treatment-drugs, PT, and surgery
 Nursing care
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◦ Drug therapy-enteric coated ASA, NSAIDS,
◦ Physical therapy-exercise, splints, and heat, prevention
of ankylosis
Scoliosis
Diagnosis-screenings
 Treatment
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◦ Electrical stimulation-applied at night
◦ Braces or traction
◦ Surgical treatment
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Nursing process
◦ Assessment-page 903
◦ Nursing diagnosis-page 904
◦ Outcome identification and planning-page 904-905
Scoliosis (cont.)
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Nursing process (cont.)
◦ Implementation
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Promoting mobility
Preventing injury
Preventing skin irritation
Promoting positive body image
Promoting compliance with therapy
◦ Evaluation: goals and expected outcomes
Question
In what disease is electrical stimulation
used in treatment?
a. Juvenile rheumatoid arthritis
b. Muscular dystrophy
c. Scoliosis
d. Osteomyelitis
Answer
c. Scoliosis
Rationale: Treatment occurs at night while the child is
asleep. The leads are placed to stimulate muscles on the
convex side of the curvature to contract as impulses are
transmitted. This causes the spine to straighten.