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Developmental hip dysplasia Clubfoot Fractures Scoliosis Osteogenesis Imperfecta Osgood-Schlatter Disease Osteomyelitis Muscular Dystrophy JRA
• Hereditary disorder, more common in girls
• Flat acetabulum of pelvis• Prevents femur from remaining in
the acetabulum and rotating adequately
• Head of femur is dislocated
• May be due to position in utero
Limited abduction of the affected hip Asymmetry of the gluteal and thigh fat folds Affected leg may appear shorter Positive “Ortolani click” Uneven gait in older children
Early detection is key for success
Treatment depends on age at diagnosis Pavlik Harness Hip Spica Cast ORIF
Pavlik harness Keeps hips and knees
flexed, the hips abducted, and the femoral head in the acetabulum
Worn continuously for 3 to 6 months
Effective 90% of time
Hip spica cast:For child 3-18 months ageMaintains abduction (frog-like position) Worn for 1 yearMust be changed as child grows
ORIF (surgical insertion of pin)For child >18mos Successful reduction is difficult after age 4
Skin care Hygiene Feeding Handling Immobility
Elimination Growth and
Development Clothing Transportation
Congenital deformity of the foot Can affect one or both feet Portions of foot and ankle are twisted out of
normal position Varying degrees of severity & combinations of
abnormal positions Can range from mild to severe
Three areas of deformity: ◦ The hindfoot turns
inward (varus)◦ The hindfoot turns
outward (valgus)◦ The midfoot is directed
downward (equinus)
• Early detection is critical• Part of newborn assessment•Move foot to midline
Begins soon after birth, before discharge
Manipulation with serial casting for 8-12 weeks (due to rapid growth)
Cast extends above infant’s knee to ensure correction
Surgical correction btw 4-12 mos, realignment of bones, pin insertion, cast for 6-12 weeks
Denis Browne Splints shoes attached to metal bar to maintain correction
Break in bone from stress Frequent in children- bones are not as
dense and more porous Usually occur from
◦ Falls◦ Sports◦ MVA◦ Bone disease
Symptoms:◦ Pain◦ Abnormal limb positioning◦ Decreased ROM◦ Edema◦ Ecchymosis◦ Crepitus◦ Refusal to play with extremity, guarding
Cast Surgery Pins and external devices Traction- used to align bone
◦ Skin Pull is applied to the skin and muscle
◦ Skeletal Pull is applied to the bone pins
Inspect skin◦observe for swelling, pain, discoloration,
odor◦keep cast free of foreign objects
Monitor Neurovascular Status◦keep extremity elevated for 1st day◦observe for loss of distal pulse,
discoloration, loss of movement
Clinical manifestations begin about 30 minutes after tissue ischemia starts.
Paresthesia (tingling, burning, loss of two-point discrimination)
Pain (unrelieved by medication, characterized by crying in the young child)
Pressure (skin is tense or discolored, cast appears tight) Pallor distal to cast (pale, gray, or white skin tone) Paralysis (weakness or inability to move extremity) Pulselessness distal to cast (weak or absent pulse)
◦ Promote Mobility Crutches Wheelchair Wheeled Carts (hip spica casts)
◦ Promote Growth and Development promote body image provide diversional activity cast becomes part of body, fear removal
Most common type of spinal deformity Girls>Boys Non-painful lateral curvature of spine
begins around pre-pubescent growth spurt
In NYS all children screened in 5th grade
Symptoms◦ Ill fitting clothes◦ Uneven shoulders, scapulae, hips
Treatment will not correct the curve, but prevent it from worsening
Mild Scoliosis◦ Life Long monitoring
Moderate Scoliosis◦ Bracing◦ Exercises to improve posture and flexibility◦ Electrical Stimulation to back muscles
Surgical correction: spinal realignment & straightening (Harrington Rod), followed by Milwaukee Brace worn 23 hr day
Screen and identify children Refer to orthopedisist for eval and
treatment Assess respiratory, neurological,
cardiovascular as rib cage deformity can affect
Promote understanding and compliance of treatment
Promote good body image and self esteem
Congenital abnormality Connective tissue disorder, leads to fragile
bone formation “Brittle Bone Disease” Causes recurrent pathological fractures Will not have normal growth in height
Multiple and frequent fractures Thin, soft skin Increased joint flexibility Weak muscles Soft, pliable, brittle bones Short stature
Goal protect from trauma and reduce the number of fractures
Early intervention◦ Splints, Braces, Surgical Rods◦ Childproof home
Handle child gently◦ Support trunk and extremities as child is moved.◦ Bathing and diapering may cause fractures◦ Use blanket for additional support when lifting ◦ Never pull legs upward when changing a diaper◦ Gently slip a hand under the hips to raise
Encourage well-balanced diet ◦ Additional vitamin C, vitamin D, and calcium to
encourage healing and bone growth.
Limit calories to maintain weight ◦ Immobility can lead to overweight
Support normal growth and development◦ Socialization◦ Swimming improves muscle tone◦ Wheelchairs and adaptive equipment
Thickening & enlargement of tibial tuberosity
Results from microtrauma (sports-related)
Bilateral knee pain exacerbated by running, jumping, climbing stairs
Self-limiting condition◦ rest, ice, heat, NSAIDs
Immobilization of limb may be necessary
Support other methods of exercise, sports
Bacterial infection of bone Common in children age 1-12 years Can follow open fractures, burns, skin
abscess, foreign body Infecting organism spreads through the
bloodstream from the penetrating injury to the bone
Pain, warmth, tenderness, limited ROM localized to the area of infection
Usually in the extremitiesIn younger child- more subtle symptoms, irritability
Increased WBC’s◦ Increased sed rate◦ Increased C-reactive protein◦ Positive blood culture◦ MRI shows bone purulence and edema
4-6 weeks of Antibiotics (PICC line)
Limit weight bearing on extremity
Aggressive therapy is needed to prevent◦ Disruption of the growth plate, interrupt growth ◦ Septic arthritis and joint damage◦ Recurrent infection
Administer IV antibiotics Teach care of PICC line Strict aseptic technique and transmission-
based precautions during all dressing changes.
Good hygiene Teach signs of spread of infection
◦ increasing pain, difficulty breathing, increased pulse rate, fever
Promote Development
◦ Provide suggestions for the family if the child will be immobilized at home.
◦ Assist the family in planning for completion of school tasks
Inherited disease with progressive deterioration of muscle cells
Causes progressive muscle weakness and atrophy
Several different types All differ by age of onset and severity The most common form of childhood
muscular dystrophy is Duchenne muscular dystrophy
X-linked recessive disorder Affects boys, symptoms by age 3 Will meet early motor milestones birth to age
3 At age 3 see:
◦waddling gait, difficulty climbing stairs, frequent falls; easily tired, when walking and running
As disease progresses:◦toe walking, hypertrophied calves, lordosis
Speech & swallowing become impaired
More pronounced muscle weakness (scoliosis)
Wheelchair by junior high
Tachycardia Pneumonia Heart failure age 20
Maintain ambulation as long as possible Physical therapy, adaptive equipment Braces to prevent contractures Promote independence Prevention of injury Prevention of infection
Chronic inflammation of synovium with eventual erosion of articular cartilage
Cause is autoimmune+ ANA (antinuclear antibodies) + RF (rheumatoid factor)
Girls affected more
Stiffness in AM Swelling Tenderness Painful to touch Warm to touch,
seldom red Loss of motion Increased WBC’s &
sed rate
Goals of care1. Maintain joint fx (splints, ROM)2. Prevent physical deformities3. Relieve symptoms (pain &
inflammation) NSAID’s (aspirin, ibuprofen,
naproxen) SAARD’s Slower Acting
Antirheumatic Drugs(gold, D-penicllamine)
Facilitate medication compliance Encourage child to be as independent as
possible Moist heat (bath or whirlpool) especially
in morning Prevention of injury Promote functioning Most common complication
severe hip involvement with loss of function
A 3-year-old child is suspected of having Duchenne’s muscular dystrophy. Which of the following assessment findings by the nurse would support this diagnosis?
1. A history of delayed crawling2. Outward rotation of the hips3. Difficulty climbing stairs4. Wasted muscle appearance
A child is admitted to the hospital suspecting osteomyelitis. Which of the following serum laboratory values noted by the nurse supports this diagnosis? (Select all that apply)
1. Positive Blood Cultures2. + ANA3. WBC 15,0004. Sed Rate 55. Decreased C-Reactive Protein
An adolescent diagnosed with moderate scoliosis describes all of the following symptoms. Which one would the nurse conclude is not associated with the initial diagnosis?
1. Back pain2. Skirts that hang unevenly3. Unequal shoulder heights4. Uneven waist angles
A 4-year-old child with osteogenesis imperfecta is admitted to the hospital unit. Which of the child’s nursing diagnosis has the highest priority?
1. Impaired skin integrity related to cast2. Pain related to fractures3. Risk for injury related to disease state4. Disturbed body image related to short
stature
Which item should the nurse remove from the bedside table of a 4-year-old child who has just been placed in bilateral long leg casts?
1.Legos2.Etch-a-sketch3.Fireman’s hat4.Coloring book
The nurse is assessing a child in a newly applied cast to the lower leg for a tibia fracture. The nurse medicates the child for pain, which is ineffective. The nurse should further assess:
1.Color of toes.2.Apical pulse.3.Skin temperature.4.Blood pressure
A 14-year-old states her fingers and wrists are stiff in the morning, hurt, and are swollen. The nurse suspects this adolescent will be tested for:
1.Osteomyelitis2.Osgood-Schlatter Disease3.Rheumatoid Arthritis4.Fractures