Infant bones are only 65% ossified

Long bones are porous and less dense and can bend, buckle or break easily

Growth takes place in Epiphyseal plates, and if these are injured, can cause abnormal growth

Growing bones heal quickly and decrease need for treatment

A congenital abnormality in which the foot is twisted out of its normal position.

Muscles, tendons, and bones are involved in the abnormality.◦Adduction and supination of forefoot◦Inversion of the heel◦Fixed plantar flexion

Stretch tightened ligaments and tendons gently to

Return the foot to a maximal anatomic position

Serial manipulation

Corrective casting

Splints

Surgical correction

Cast applied to hold foot in desired position.

Changed every 1-2 weeks until maximum correction is achieved.

Nursing Care:

◦Cast care ◦Skin Care◦Education of parents

Unusual odor beneath the cast Tingling, burning, numbness of toes Drainage through cast Swelling or inability to move toes Toes that are cold, blue or white Sudden unexplained fever Pain that is not relieved by comfort

measures

“Petaling” the edges of the cast

Drying of the cast

Prevention of swelling

Protecting the cast

When to call the doctor

A infant has a cast applied for treatment of club foot. Which of the following symptoms requires immediate attention and should be reported to the health care provider?

A. Capillary refill of 4 seconds in the affected toes. B. Edema in the affected toes that improves with elevation. C. Numbness of the toes on the affected foot. D. Skin distal to the cast is warm

Splinting is used after casts are removed to maintain the correction.

Braces should fit snugly but should not interfere with neurovascular function.

 Before wearing the brace, check the skin for any areas of redness or breakdown.

Give parents guidelines for braces. If redness develops, arrange to have the fit of the brace

evaluated and modified. Bar between legs is not a handle. Teach appropriate positioning for safety to prevent falls,

and allow mobility and "tummy-time“

Parents are trained and become active participants in the physical therapy treatments and child’s stretching program

Nurses need to help the parents understand the time commitment involved

Assess the parents’ ability to monitor the child adequately for complications and confirm they understand the signs and symptoms of the

complications

The parents of an infant with clubfoot ask how it is treated. Which of the following treatments should the nurse discuss with the parents?

A.Weekly cast changes with manipulationB.Probably surgery on the affectedC.Abduction device to keep the extremity in

alignmentD.Use of a Dennis-Browne splint to achieve

correction.

The head of the femur is improperly seated in the acetabulum of the pelvis

1. Limited abduction of the affected hip during Ortolani maneuver. May hear a click upon movement.

2. Asymmetry of gluteal and thigh fat folds when lying with legs extended.

3. Telescoping of thigh

4. Limp and abnormal gait in older

child

Ortolani maneuver

Asymmetry of gluteal folds

Pavlik harness◦ Ensures hip flexion and

abduction and does not allow hip extension or adduction.

◦ It maintains correct position of the femoral head in the acetabulum.

◦ Teach parents/caregivers to remove and apply harness appropriately –only remove for bathing and skin checks.

◦ Teach skin assessment

◦ Encourage cuddling infant to promote cognitive development and infant/caregiver bonding

A parent asks why the infant must wear a Pavlik harness. What is the nurse's best response? This treatment is to:a. provide comfort and support.b. shorten the limb on the affected side.c. maintain the femur within the

acetabulum.d. provide outward displacement of the

femoral head.

Spica cast◦ Covers lower half of

body except perineal area Nursing Care

◦ Elimination/ protection of cast◦ Positioning◦ Neurovascular assessment◦ Skin care◦ Hygiene

Increased mobility and immature motor skills

Trauma

Bone diseases

Pain or tenderness at site

Immobility or decreased ROM

Deformity of extremity

Edema

Other signs – crepitus, ecchymosis, muscle spasm and inability to bear weight

Reduction

Retention

Repositioning of the bone

fragments into normal alignment

Application of a device or mechanism that maintains alignment until healing occurs

Application of Cast

Traction

Pull or force exerted on one part of the body

Which of the following nursing interventions takes highest priority when caring for a child in skeletal traction?

A.Assessing bowel sounds every shiftB.Providing adequate nutritionC.Assessing temperature every 4 hoursD.Providing age-appropriate activities

Fat Embolism◦Particles of fat are carried through

circulation and lodge in lung capillaries causing: Pulmonary edema Respiratory distress with hypoxemia and

respiratory acidosis

◦Treatment Increase in IV fluids Respiratory support and adequate oxygenation

Compartment syndrome (very serious)

All fractures entering the hospital via ER require social service consult for documentation of suspected abuse or neglect.

The nurse must report all suspected abuse to the appropriate authority.

Do not discuss the possibility of abuse with the parents or guardians!! Do not attempt to prove or disprove abuse.

Delayed walking – (first sign) Progressive, symmetric muscle wasting Frequent falls Easily tired when walking, running, or climbing stairs

Hypertrophied calves muscle Waddling wide-based gait Uses Gower’s maneuver to rise from floor Unable to walk independently by age 9 – 12.

Muscle biopsy – reveal fatty fibrous tissue that gradually replaces muscles (the protein dystrophin is low in the muscles of these patients)

Elevated serum enzyme CK (creatine kinase)

Maintain ambulation and independence for as long

as possible.

Coordinate a variety of health care services

Maintain activity and self-care functions Skin care Maintain bladder and bowel functioning Protect from respiratory infections Teach dietary modifications to decrease obesity

Which of the following interventions isINAPPROPRIATE to incorporate in the care for

a child with muscular dystrophy hospitalized

with a respiratory infection?

A.Physical therapyB.Aggressive antibiotic therapyC.Passive range of motion exercisesD.Complete Bedrest

Lateral S curvature of the spine

Assessment findings:◦Lateral curvature of spine◦Truncal asymmetry◦Uneven shoulders◦Prominent scapula – uneven height◦Rib-hump◦uneven hips

What is the priority psychosocial nursing

diagnosis for the adolescent diagnosed with scoliosis?

Pre-operative teaching ◦Demonstrate incentive spirometer and C&DB

◦Discuss all potential equipment (chest tubes, IV, O2 masks & nasal canula, Foley catheter)

◦Teach use of pumps for PCA or epidural block.◦ ◦Demonstrate log rolling and assist out of bed.

Post-operative Care◦Maintain airway

◦Neurovascular Assessment of lower extremities

◦Teach passive and active ROM exercises

◦Encourage independence in ADL’s

◦Provide with resources / information on scoliosis support groups

Post operative care of an adolescent following a

spinal fusion for scoliosis includes: (select ALL

that apply)

A. Oral analgesics for painB. Logrolling every 2 hoursC. Nasogastric intubationD. Bilateral Neurovascular checks of lower

extremitiesE. Use of incentive spirometer q 2 hoursF. Assess skin on bony prominences