talipes new

8/7/2019 talipes new

1/14

ADULT NURSING V(OBSTETRIC NURSING)

TALIPES


2/14

OVERVIEW

Talipes is a congenital

deformity that develops in the

womb during the first

trimester (between 8 to 12weeks)

Causes an abnormal twisting

of the ankles, heels, toes and

feet .

these incidences are known

as congenital talipes equinov

arus (CTEV) or clubfoot.


3/14

ETIOLOGY

Cause is unknown.

Genetic or hereditary

element

Positioning of the foot

when it is in the womb

If there is too little amniotic fluidsurrounding the baby in the womb (a

condition called oligohydramnios),

there is a higher rate of talipes,

possibly due to increased pressure on

the foot


4/14

TYPES OF TALIPES

Talipes equinovarus - the most

common form

Talipes equinovalgus - where

the foot points outwards anddown

Talipes calcaneovarus - where

the foot points inwards and up

Talipes calcaneovalgus-

where the foot points inwards

and down


5/14

PATHOPHYSIOLOGY

The pathophysiology of the more commonisolated form is not known and is the subjectof controversy .

Possible contributing factors:

too little amniotic fluid surrounding

the baby un the womb ( a calledoligohydramnios)

increased pressure on the foot.

The heel is turned inwards and the whole foot

plantar fiexed.

The foot is turned outwards and upwards.

The affected foot is shorter and the calfmuscles are thinner than normal. Theposition of the foot is fixed and can't beeasily corrected.


6/14

SIGNS & SYMPTOMS

heel is turned inwards and the whole foot plantar flexed

(bent downwards).

The foot turns inward and downward at birth (resisting

realignment)

The calf muscle may be smaller than normal andunderdeveloped

Clubfoot is painless, except in elderly, arthritic patients.

In older children, clubfoot may be secondary to paralysis,

polio-myelitis, or cerebral palsy, in which case treatmentmust include management of the underlying disease

Deformity may be so extreme that the toes touch the

inside of the ankle, or it may be only vaguely apparent.


7/14

DIAGNOSTIC PROCEDURE

An EKG and chest x-ray will identify the most

common causes of clubbing

A sedimentation rate, and chemistry panel

should also be done routinely. x-ray - a diagnostic test which uses invisible

electromagnetic energy beams to produce

images of internal tissues, bones, and organs

onto film. computerized tomography scan


8/14

TREATMENTS

Treatment is often started in the weeks following birth.

Strapping and physiotherapy Strips of adhesive strapping are

passed around the foot, up the sides of the leg, and over the top of the

knee, to hold the foot in a corrected position.

Plaster fixation The surgeon manipulates the foot into position, and

holds it in place with plaster.

Surgery aims to loosen and lengthen tightened ligaments and

tendons in the medial and posterior parts of the feet

GOAL: to restore the feet to their normal position to enable properfunction as well as eliminate pain and deformity.


9/14

CONTS

NON SURGICAL METHOD:

The Ponseti method

begins with a series of gentle manipulations

and toe-to-thigh cast placements for the first

five to seven weeks .

The heel-cord is cut to complete the

correction of the foot before the last cast isapplied .

Then, the last cast is placed for three weeks,

by which time the heel-cord has healed

properly

The French method

consists of gentle stretching of the feet,

followed by taping to maintain their

improved position.

SPLINTING

CAST


10/14

NURSING MANAGEMENT

` Nursing Diagnosis: Impaired physical mobility

related to cast wear.

` Goal: A client can maintain of movement and can

perform ADL normally.

Nursing intervention:

` Assess the level of physical mobility

R-to know the level of physical mobility of the client

` Assist the client to perform ADL

R-to maintain the ADL


11/14

Elevate the leg with pillow

R-to reduce the pain and pressure at the leg

Encourage client on bed rest

R-to minimize the mobility and reduce anxiety

E: pt free from pain


12/14

CONTS

Nursing diagnosis :Parents knowledge deficit

regarding condition, prognosis, treatment,

selfcare and discharge needs

Goal :Parents will acknowledge feelings andidentify health ways to deal with them

Nursing intervention :

1) assess for the level of knowledge of parents

R:to know the level of knowledge to educate the

parents.


13/14

2) review pathology,prognosis and future

expectations R : provides knowledge base from which parents

can make informed choices.

3) discuss the deformity and expected treatment

in terms the parents can understands

R : to rule out misconceptions and to provide

accurate information about the deformity

Evaluation : the pt was able to acknowledge

feelings and identfy health ways to deal with

them


14/14

Documents

talipes new