Presented by Marlene Meador RN, MSN, CNE
Newborn Musculoskeletal SystemFlexibility prevents injuryLong bones porousEpiphyseal plates cartilaginousMuscular system complete at birth
Clubfoot: Talipes EquinovarusAdduction and supination of forefoot with an inversion (varus) of the heel and fixed plantar flexion and the midfoot directs downward (equinus).
Clinical ManifestationsFocus on early detectionAssessmentDiagnostic tests
TreatmentPonseti method - Serial manipulation with corrective casting
Dennis Browne splints - horizontal bar attached to foot plates Surgical correction
Nursing Care & EvaluationProvide Emotional SupportPromote bondingCast CareReferrals
Regular check-upsPrognosisROM after removal of casts
Clinical Judgment:An 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
Developmental Dysplasiaof the HipMalrotation of the hip at birthImproper formation or function of acetabulum
Clinical ManifestationsInfantGluteal folds+ Ortolani s - Barlows Maneuver ChildrenLimited ROMShort femurGait
Diagnostic Tests:UltrasoundCT and MRIX-ray
Treatment: Splinting of hip - Pavlik harnessHip maintained in flexion and abductionDeepens acetabulum from pressure of femur head
Treatment contd.Skin TractionRelocates femoral head while stretching restrictive soft tissue
Surgical Treatment & Spica Cast: Release muscles and tendonsApplication of body spica cast
Promoting Developmental NeedsBondingEnvironmentActivity
?????A parent asks why her infant must wear a Pavlik harness. The nurse responds that the purpose of this device is to:provide comfort and support.shorten the limb on the affected side.maintain the femur within the acetabulum .provide outward displacement of the femoral head.
Cast Care & AssessmentUse palms to handle wet castElevate extremity & change position Keep cast clean & dryPetal castBar between the legs is not a handle!Assess CMS (circulation, movement, sensory); bleeding, temperature, skin integrity.
Complications Associated with CastsCompromise to circulation and innervation
Compartment SyndromeParathesiaPainPressurePallor **Paralysis **Pulselessness **
Nursing Management for the Casted Child Encourage cuddlingTeach parent application of harnessDevelopmental needsBring environment to childProtect skinDietSafety
?????An 18 month old is scheduled for application of a plaster cast to correct a clubfoot. The post-op plan should include which of the following measures?a. Elevate the cast above the level of the heartb. Handle cast with fingertipsc. Reposition the child every 2 hoursd. Spray the cast with an acrylic protectant
FracturesOccur as a result of direct forceGreenstick fractureMVA Repeated stress on the bone
Patho-physiologyEpiphyseal platePliable and porousHealing is Rapid in childrenApproximately 1 week for every year of life up to 10 years of age
AssessmentPain TendernessEdemaLimited movementDistortion of limb
Complications associated with orthopedic trauma:Fat EmbolismParticles of fat are carried through circulation and lodge in lung capillaries causing:Pulmonary edemaRespiratory distress with hypoxemia and respiratory acidosisTreatmentIncrease in IV fluidsRespiratory support and adequate oxygenation
Legal & Ethical implications when caring for a child with a fracture: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.
ScoliosisLateral S or C curvature of the spine > 10Structural Idiopathic (70-80% of all cases)Congenital NeuromuscularPoliomyelitisCerebral palsyMuscular dystrophy
ManifestationsScreening 5th & 7th gradesClassic Signs:Truncal asymmetryUneven shoulders and hipsA one-sided rib bumpProminent scapula
Treatment of ScoliosisMild 10-20Exercises improve postureModerate 20-40Bracing maintains existing curvatureSevere 40 or >Spinal fusion(> 80% = compromised respiratory function)
Goal: limit or stop progression of curvature
????The school nurse would screen an adolescent for scoliosis by instructing him/her to:Bend forward at the waist, holding hands togetherLie prone on an examination tableStand with shoulders placed against the wallSit on a chair and raise shoulders
BracingUsed for skeletally immature http://milwaukee.brace.nu/
An adolescent must wear a Milwaukee brace. Which of the following actions would the nurse take to promote optimal functioning for the teen?Discourage participation in ADLs.Teach appropriate application, removal and care of skin and brace.Discourage sports like golf and tennis encourage sedentary activities.Teach non-weight bearing techniques.
Recommended for curves > 40 degreesGoal: fuse spine to prevent progression
Surgical CarePre-opMentally prepareDemonstrate incentive spirometer, TCDB, log rollPCA pumpPost opPain managementMonitor neurovascular statusMonitor H&HLog Roll, sit, ambulateROMDressing changes
What would you teach a child to expect in the immediate post-op period?a. Frequent neurovascular assessmentsb. Need to CT&DB every 2 hours (IS)c. Possibility of IV, chest tubesd. Use of post-op analgesia
Discharge TeachingNo heavy lifting, bending or twisting at the waist. Brace applicationFollow-up X-rays Once fused may resume normal activity levels, skiing, sports, etc
Muscular DystrophyMuscle fiber degeneration and muscle wasting.Duchennes Onset of symptoms 3-4 years of lifeTerminal disorder
Clinical Manifestations & DiagnosisS/SDelayed walking, frequent falls, tire easily, toe walking, hypertrophied calves, waddling gait, lardosis, + Gowers maneuver, mental retardationDx:Muscle biopsy ( distrophin) Serum enzyme CKElectromyogramEEG (75% are abnormal)
Prognosis: 1:3500 children effected
Ability to walk lost by age 9-12
Death occurs 9-10 years after diagnosis
Nursing Care:Promote optimal healthGoal: keep child ambulatory Assess muscle weaknessRespiratory functionNutritional statusOT, PT, RT
Psychological ImpactWhat are some psychological issues that may affect a family caring for a child with muscular dystrophy?
Family Centered Care:Financial resourcesCommunity resourcesCultural influences Support groups
Please contact me if you have any questions or concerns regarding this presentation.Marlene Meador RN, MSN, CNEmmeador@austincc.edu