Ch. 28: Developmental Dysplasia of the Hip (DDH) Flashcards
What is acetabular dysplasia?
Delay in acetabular development
What is subluxation ?
Incomplete dislocation of the hip
What is dislocation?
Femoral head does not have contact with the acetabulum
What are signs of DDH in an infant?
- Assymetry of gluteal and thigh folds
- Limited hip abduction
- Shortening of the femur
- Positive ortolani test
- Positive barlow test
What is the ortolani test?
Hip is reduced by abduction (sign of DDH in infant)
What is the barlow test?
Hip is dislocated by adduction (sign of DDH in infant)
What are signs of DDH in the child?
- One leg shorter than the other
- Positive Trendelenburg sign
- Walking on toes on one foot
- Walk with a limp
What is the trendelenbury sign?
While bearing weight on the affected side, the pelvis tilts downward (sign of DDH in child)
In DDH patients, what should be done at 2 weeks of age? Why?
Ultrasound; to determine the cartilaginous head of the femur
What can diagnose DDH in infants older than 4 months of age?
X ray
What do DDH patients newborn-6 months wear?
Pavlik harness
- Maintain harness in place for 12 weeks
- Check straps every 1-2 weeks for adjustment
- Perform neuromuscular skin integrity checks
What is client teaching about the Palvik harness (newborn-6 m)
- Teach fam not to adjust straps
- Teach fam how to place harness if removal is prescribed
- Teach fam about skin care (use an undershirt, knee socks, assess skin, massage skin under straps, avoid lotion and powder, place diaper UNDER straps)
What cast is used when adduction contracture is present?
Bryant traction or hip spica cast
What is the Bryant traction?
-Hips flexed at 90 degree angle with butt raised off bed
What are nursing action for Bryant traction?
- Neurovascular checks
- Maintain traction (ropes, boots, pulleys, and weights)
- Ensure client maintains alignment
- Skin care
What are nursing actions for the hip spica cast?
- Needs to be changed to accommodate growth
- Maintain cast
- Frequent neurovascular check
- ROM with unaffected extremities
- Skin integrity (especially diaper area)
- Assess pain
- Evaluate hydration
- Assess elimination status daily
How should casts be positioned?
On pollows
Keep casts elevated until __
Dry
What helps allow for drying?
Encourage frequent position
How do we handle the cast when it is still wet?
Handle casts with the palm of hand until dry
Use a waterproof barrier around the genital opening of the ____ to prevent soiling with urine or feces
Spica cast
What happens at 6 months-2 years?
Surgical closed reduction with placement of hip spica cast
What are complications of post op?
Atelectasis
Ileus
Infection
What are effects of immobilization complications?
Decreased muscle strength
Bone demineralization
Altered bowel motility
What are effects of casting complications?
Skin breakdown
Neurovascular alterations
Infection: What would be changes in neuromuscular status?
Numbness Tingling Decreased mobility Sensation Cap refill
Infection: What kind of diet helps promote adequate hydration?
High fiber
Infection: Reposition the child ____
Frequently
The nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child’s mother ass the nurse why a Pavlik harness is not being used. Which of the following responses by the nurse appropriately addresses the mothers question?
A. The Pavlik harness is used for children with scoliosis, not hip dysplasia.
B. The Pavlik harness is used for school-age children
C. The Pavlik harness cannot be used for your child b/c her condition is too severe
D. The Pavlik harness is used for infants less than 6 months of age
D
A nurse is caring for a preschool-age child. Which of the following assessments should the nurse use to assess for development dysplasia of the hip?
A. Barlow test
B. Trendelenburg sign
C. Manipulation of foot and ankle
D. Ortolani test
B
