Transcript Care OF THE pediatric patient with movement and coordination

Elizabeth Allen RN, MSN
 Describe
Pediatric Variations in the
Musculoskeletal System
 Recognize Signs and Symptoms of Infectious
Musculoskeletal Disorders
 Collaborate with Families to Plan Care for
Child with Chronic or Long-Term Disorders
 Plan Nursing Interventions to Promote Safety
and Developmental Progression for Children
with Braces, Casts, Traction, and Surgery
 Provide Nursing Care Regarding Prevention
and Treatment of Fractures in a Child
 Child’s


More porous and pliable
Less dense
 Infant


Bones
Skull
Fontanel closure: 18 months
Overall growth completion: 2 yrs
 Child
Bone Growth from Epiphyseal Plate
 Muscles


Number same as adult
Only length and circumference grow
 Ligaments

and Tendons
Stronger than bone until puberty
 Talipes
equinovarus (Club Foot)
Figure 28–5 Parents of a child with clubfoot will have many questions. Can the
condition be treated? Will the child be able to walk normally after surgery? Will parents
need help caring for the infant? How much will surgery and other care cost? Will any
subsequent children have a clubfoot? Modified from Staheli, L. T. (1992). Fundamentals
of pediatric orthopedics (p. 5.10). New York: Raven Press.
“varus”
means inward

Genu valgum (knockknees)

Genu varum (bowlegs)
Figure 28–9 A, Genu valgum or knock-knees. Note that the ankles are far apart when the knees
are together. B, Genu varum or bowlegs. The legs are bowed so that the knees are far apart as the
child stands.
 Hip



Dysplasia
Legg-Calve-Perthes
Slipped Capital Femoral Epiphysis (SCFE)

Pathophysiology
Femoral head and the acetabulum are improperly aligned
 Hip instability
 Dislocation
 Subluxation



Asymmetry of gluteal folds
Girls 4x’s more than Boys

Allis’ sign
One knee lower than the other when the knees
are flexed

Ortolani-Barlow
maneuver positive


Treatment
Pavlik harness
 Bryant’s traction
 >6 months: closed
reduction & spica cast

Most common treatment for
DDH in a child <3 months is the
Pavlik harness
 Pavlik
 Spica
Harness
Cast
(London et al., 2014)
Spica Cast after surgery
for hip dysplasia
 Pathophysiology:



Spontaneous Displacement of the proximal
femoral epiphysis
Adolescent
Very tall, obese – boys more than girls
 Diagnosis


Referred pain – groin, hip or knee
X-ray, bone scan, ultrasound, MRI
 Treatment


Surgery to pin and fixation of epiphysis, possible
traction
Weight reduction
Figure 28–14 In slipped capital femoral epiphysis, the femoral head is displaced from
the femoral neck at the proximal epiphyseal plate.

Pathophysiology



Necrosis of femoral head
Boys 4x more than girls (4-10 yrs.)
Stages:






Diagnosis


I – Initial
II – Avascular
III – Revascularization
IV – Bone healing
V – Remodeling
X-ray, bone scan, MRI
Treatment

Assess




CSM, pain
Bed rest – traction
Toronto Brace
Surgery
 Scoliosis


More common in girls than boys
Assessment
Trunk asymmetry, 1 sided rib
hump, uneven shoulder or
hip height




Exercises
Braces (moderate curve)
Spinal surgery (Curves >40 degrees)
 No bending or twisting
of the torso
 Restricted from some
sports
 6-8 months recovery
Figure 28–15 A child may have varying degrees of scoliosis. For mild forms, treatment will focus on
strengthening and stretching. Moderate forms will require bracing. Severe forms may necessitate surgery
and fusion. Clothes that fit at an angle, such as this teenage girl’s shorts, and anatomic asymmetry of the
back provide clues for early detection.
 Prevention


Greater risk for children
Teach use of protective equipment, safe play
 Types

Closed Fracture


Open Fracture


Casting
Surgery and casting
Epiphyseal Plate

ORIF if displaced
(London et al., 2014)
 Care
of the
Patient with Cast

Immobilize Joint
and/or Bone




of the
Patient with
Traction

Perform frequent
neurovascular
assessment


 Care

More frequent when
applied, fewer after
stable
Compartment Syndrome
Elevate limb
Manage itching
Teach cast care
Force and/or
Positioning to Joints
and Bones




Maintain positioning and
force
Protect skin from
pressure, wetness
Skin Traction

Assess skin


Pin care
Prevent infection
Skeletal Traction
Respiratory
Assessments
Figure 28–12 For infants older than 3 months of age, skin traction
is commonly used for treatment of DDH
Figure 28–16 In severe scoliosis, the child may wear a halo
brace, shown here, to hold the body in position after surgery.
 Bone
Infection
 Etiology: Idiopathic or Nosocomial

Due to trauma, pins, unknown
 Symptoms




Bone pain
Edema
Joint pain
Fever
 Treatment


IV Antibiotics
Surgical debridement
 Osteogenesis


Imperfecta
Brittle-bone disease, collagen defect
Thin soft skin, increased flexibility, short stature,
weak muscles, hearing loss
 Achondroplasia

Short stature, prominent forehead
 Marfan



Syndrome
Connective tissue disorder
Skeletal changes
Cardiac, respiratory, vision changes
 Most
common Juvenile Idiopathic Arthritis
 Diagnosis

younger than 16 and have initial swelling in one
or more joints for at least six weeks.
 Treatment



Goals
Relieve pain
Reduce inflammation
Optimize child’s quality of life
 Muscular
 Inherited






Dystrophies
Most common is Duchene Muscular Dystrophy (xlinked)
Progressive muscle fiber degeneration and
muscle wasting
Some forms with intellectual disability
Early signs: weakness and hypotonia
Later signs: Gower’s Maneuver
Become immobile
 Muscular
Dystrophies
 Diagnosis
Symptoms, muscle biopsy, EMG
 Treatment






No effective treatment
Steroids and deflazacort (glucocorticoid) may
preserve muscle function, walking for a time
Promote independence and mobility
Mental health support
Respiratory, GI, GU system support with
progression
 Progressive
weakness and muscle deformity
result in disabilities
Figure 28–20 This young boy with muscular dystrophy needs to
receive tube feedings and home nursing care. He attends school
when possible and is able to use an adapted computer.