Pediatric Musculoskeletal Disorders NUR 2310 Flashcards
Unilateral or bilateral (41%)
Affected foot points downward, toes turn inward, and bottom of foot twisted inward
May affect bones and ankle joints, as well as tendon and ligaments.
Clubfoot, a congenital disorder. (3:1) in males Cause is unknown
Increased incidence if 1st degree relative had clubfoot
Seen with other anomalies like cerebral palsy
the parents of a new born son with clubfoot asks about how they can get their son to live a normal life without surgery. what does the nurse say
Treatment includes serial casting, Denis-Browne Bar or braces and in extreme cases surgical intervention may be required
clubfoot diagnose
Diagnosis
Visual inspection
X-ray and MRI
the nurse hears the infant crying. the nurse assesses the cast feet and notice capillary refill is 1, and cooler than usual, what should the nurse do
the child’s foot circulation is being cut off therefore increASING THE RISK FOR AMPUTATION. call doctor. Remember the 5 P’s for cast care[pain, paralysis, paresthesia, pallor,]
upon new born examination the nurse notice the female infant has Unequal gluteal folds when prone what disorder does the nurse speculate
Developmental Dysplasia of The Hip-
Shortened limb on affected side
Restricted abduction of hip on affected side
Unequal gluteal folds when infant prone
Positive Ortolani test
Positive Barlow test
If Developmental Dysplasia of The Hip
(DDH) goes uncorrected, what manifestations will develop
Affected leg shorter than the other
Telescoping or piston mobility of joint
Marked lordosis if bilateral dislocations
Waddling gait if bilateral dislocations
the parent ask if there is a way to treat their child nonsurgical, what will the nurse say
The Pavlik harness (shown on the slide) is a commonly used abduction device that allows for the head of the femur to sit in the acetabulum. It should be worn 24 hours a day for 3-4 months. For children greater than 6 months skin traction or surgery may be required if the abduction device doesn’t work. A significant risk factor for both surgical and non-surgical treatments for DDH is avascular necrosis of the femoral head.
is a Pavlik harness a good recommendation for a toddler of 2 yrs
spica casting is a better option since 2 yr old are constantly moving but excess movement is contraindicated for DDH
this is is a group of progressive, degenerative, inherited diseases causing wasting of the muscles.
Muscular Dystrophy; The absence of dystrophin results in degeneration of skeletal or voluntary muscles that control movement. Fat & connective tissue replace degenerated muscle.
Nursing Management and Family Teaching
DDH
Assessment of child
Child will learn maximum mobility in harness, cast, or brace
Skin evaluation for pressure points/ulcers
Cast care for family
Harness application or when to return to Dr. for adjustment
during a health check-up the nurse notice the 4 yr old has a waddling gait, lordosis, and have very big calf muscles for his age. what condition the nurse suspects the child to have
Muscular Dystrophy (MD)
Clinical Manifestations
Onset between ages 2 & 4 years
Progressive muscle weakness, wasting, and contractures
Waddling gait, frequent falls
Lordosis
the doctor orders a diagnostic test, what test is most likely to be ordered
muscle biopsy will reveal that fatty and connective tissue has replaced normal muscle tissue.
electromyogram (EMG)
nerve conduction velocity (NCV) , blood enzyme test
Serum creatine kinase (CK)
the mother ask how her son has Muscular Dystrophy (MD)
when her other two daughters are fine. she said she was very healthy when carrying her son. what is the nurse’s respones
this disease is X-linked recessive disease, meaning that she has/ carries this gene and her son got it. it only affects boys
the mother feels guilty about his MD and ask is there any treatment for him. what does the nurse say
ROM, Bracing, Performance of ADLs, Surgical release of contractures (as needed), Physical therapy and Occupational therapy can slow down the progression but this is a lifelong disease
MD things to know
There is no cure for muscular dystrophy. As the nurse it is important to ensure that supportive care is provided and complications are prevented. The primary goal is to maintain function in the unaffected muscles as long as possible and keep the child as active as possible. Survival may be prolonged through the use of cough augmentation, non-invasive ventilator support and steroid use.
