Exam 3: Mobility Flashcards
Causes of alterations in mobility
Neurologic insult (trauma or hypoxia to brain or spinal cord)
Genetic dysfunction or structural abnormality
Can be present at birth but not identified until later
When is myelination complete?
By 2 years old
Why are adolescents at in increased risk for injury?
They have increased muscle growth which leads to increased clumsiness
Common mobility treatments
Goal: Immobilization and reduction; prevent treatment complications (compartment syndrome, osteomyelitis)
RICE
Splinting
Bracing
Casting
Traction (skin vs. skeletal)
Surgery (internal vs. external fixation)
Pain management
Prevent
Developmental Dysplasia of the Hip (DDH)
Improper alignment of the femoral head and the acetabulum creating instability in the hip
Etiology: Genetic predisposition, fetal development, breech positions, oligohydramnios, laxity of ligaments in hip
Patho: Hip instability, subluxation, complete dislocation
If untreated, can lead to osteoarthritis and pain
How does the hip develop normally?
The hip can only develop normally if the femoral head is properly maintained within the acetabulum
Complications of DDH (if continued dislocation or subluxation)
Avascular necrosis of femoral head
Hip instability
Limited ROM
Palsy of femoral nerve
Early onset of osteoarthritis (painful)
Clinical manifestations of DDH
Limited abduction
Asymmetry of gluteal and thigh folds
Diagnostic testing: Allis/Galeazzi sign (limb length discrepancy), Barlow (aDduction = hip instability) and Ortolani (aBduction = hip dislocation) 8-12 weeks, ultrasound <6 months, x-ray > 6 months
What is the goal of DDH treatment?
To maintain the hip joint in reduction allowing the femoral head and acetabulum to develop properly`
Pavlik Harness
Newborn - 6 months
Prevents extension and aDduction
Priority nursing considerations:
Safety: Positioning, no swaddling, car safety, strap adjustments ONLY by specialist
Growth: Move legs and arms freely, encourage developmentally appropriate play, tummy time
Skin integrity: Assess skin under straps, onesie, knee/thigh socks, diaper under harness, assess skin folds, keep skin clean and dry
Perfusion: NV checks
Family education: Keep on for prescribed time, straps adjusted by specialist Q1-2 weeks, adherence and follow up appointments
Bryant Traction
6 months - 2 years
May be used first to stretch soft tissue
Spica Cast
> 2 years or failed previous therapy
Closed reduction (no cutting) and spica cast worn for 12 weeks
Pain control: Acetaminophen (1st day), ibuprofen (> 6 months)
Elimination: Diaper under the cast, change diaper frequently
Perfusion: NV checks
Safety: Car seat, injury prevention
Skin: Cast care: petal/soft edges, handle with palms of hand, nothing in cast, keep skin clean and dry, ensure no skin breakdown especially in perineal area
Developmental: Tummy time, age appropriate play
Family education: Pain control, elimination patterns, cast and skin care
Abductor brace
Worn for approximately 2 months after spica cast removed
Support and ensure healing
Scoliosis
Complex deformity of spine
Lateral S or C curvature >10°
Etiology: Idiopathic (occurs most often during adolescence), congenital (anomalous vertebrae development), neuromuscular (cerebral palsy, muscular atrophy)
Patho: Structural changes occur as a result of curvature, ribs on concave side forced together while ribs on convex side separate, narrowing on vertebral canal
Concern: Over time if not repaired will cause damage to CV and respiratory systems
Clinical manifestations of scoliosis
Uneven shoulder height
Prominent scapula
One-sided rib hump
Truncal asymmetry
Pain not a normal finding for idiopathic scoliosis
Unequal hips - often present with uneven hemline
