1 / 61

Musculoskeletal

Musculoskeletal. Common MS disorders in Children. Developmental hip dysplasia Clubfoot Fractures Scoliosis Osteogenesis Imperfecta Osgood-Schlatter Disease Osteomyelitis Muscular Dystrophy JRA. Disorders of the lower extremities. Developmental hip dysplasia.

Audrey
Download Presentation

Musculoskeletal

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Musculoskeletal

  2. Common MS disorders in Children • Developmental hip dysplasia • Clubfoot • Fractures • Scoliosis • Osteogenesis Imperfecta • Osgood-Schlatter Disease • Osteomyelitis • Muscular Dystrophy • JRA

  3. Disorders of the lower extremities

  4. Developmental hip dysplasia • Hereditary disorder, more common in girls, unilateral • Improper formation and function of hip socket • Head of femur is dislocated • Flat acetabulum of pelvis (prevents femur from remaining in the acetabulum and rotating adequately)

  5. Congenital hip dysplasia

  6. Symptoms • 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

  7. Diagnosis • Early detection is key for success • Treatment depends on age at diagnosis

  8. Management for infants under 3 months of age 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

  9. Managementfor infants >3 months age Hip spica cast: maintains abduction (frog-like position) 3-18 months age Worn for 1 year Must be changed as child grows ORIF (surgical insertion of pin) • For child >18mos Successful reduction is difficult after age 4

  10. Nursing Considerations • Skin care • Hygiene • Feeding • Handling • Immobility • Elimination • Growth and Development • Clothing • Transportation

  11. Clubfoot (equinusvarus) • Congenital deformity of the foot • Three areas of deformity: • The midfoot is directed downward (equinus), • the hindfoot turns inward (varus), • the forefoot curls toward the heel (adduction) and turns upward in partial supination.

  12. Clubfoot • 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

  13. Assessment: • Early detection is critical • Part of newborn assessment • Move foot to midline • Can range from mild to severe

  14. Treatment: • 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

  15. 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

  16. Fractures • Break in bone from stress • Frequent in children- bones are not as dense and more porous • Usually occur from • Falls • Sports • MVA • Bone disease

  17. Fractures • Symptoms: • Pain • Abnormal limb positioning • Decreased ROM • Edema • Ecchymosis • Crepitus • Refusal to play with extremity, guarding

  18. Management • 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

  19. Nursing Considerations: New Cast • 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

  20. Watch for Compartment Syndrome • 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)

  21. Cast Care in Children • 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

  22. Disorders of the Spine

  23. Scoliosis • Most common type of spinal deformity, girls 5:1 ratio • Lateral curvature of spine • Can be congenital or develop in infancy or childhood Dx: by observation, non painful at first • All children screened in 5th grade • Ill fitting clothes • Uneven shoulders, scapulae, hips • Scoliometer: degree of curvature

  24. Treatment • 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

  25. Treatment for Severe Scoliosis • Surgical correction: spinal realignment & straightening (Harrington Rod) • Followed by Milwaukee Brace . Worn 23 hr day

  26. Nursing Considerations • Screen and identify children • Refer to ortho 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

  27. Disorders of the bones

  28. Osteogenesis Imperfecta • Connective tissue disorder, leads to fragile bone formation • “Brittle Bone Disease” • Causes recurrent pathological fractures • Will not have normal growth in height

  29. Clinical manifestations • Multiple and frequent fractures • Thin, soft skin • Increased joint flexibility • Weak muscles • Soft, pliable, brittle bones • Short stature

  30. Nursing Management • Goal: protect from trauma and reduce the number of fractures • Early intervention • Splints, Braces, Surgical Rods • Childproof home

  31. Nursing Management • 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

  32. Nursing Management • 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

  33. Nursing Management • Support normal growth and development • Socialization • Swimming improves muscle tone • Wheelchairs and adaptive equipment

  34. Osgood-Schlatter Disease • Thickening & enlargement of tibial tuberosity • Results from microtrauma (sports-related) • Bilateral knee pain exacerbated by running, jumping, climbing stairs

  35. Nursing Management • Self-limiting condition • rest, ice, heat, NSAIDs • Immobilization of limb may be necessary • Support other methods of exercise, sports

  36. Osteomyelitis • 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

  37. Signs and Symptoms • Pain, warmth, tenderness, limited ROM localized to the area of infection • Usually in the extremities • In younger child- more subtle symptoms, irritability

  38. Osteomyelitis • Diagnosis: • Increased WBC’s • Increased sed rate • Increased C-reactive protein • Positive blood culture • MRI shows bone purulence and edema

  39. Treatment • 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

  40. Nursing Considerations • 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

  41. Nursing Considerations • Promote Development • Provide suggestions for the family if the child will be immobilized at home. • Assistthe family in planning for completion of school tasks

  42. Disorders of the Muscle

  43. Muscular Dystrophy • 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

  44. Duchenne’s Muscular Dystrophy • X-linked recessive disorder • Affects boys, symptoms by age 3 • Will meet early motor milestones, but later at age 3 see: • waddling gait, difficulty climbing stairs, frequent falls; easily tired, when walking and running • toe walking, hypertrophied calves, lordosis

  45. Gower’s Sign: press hands against ankles, knees & thighs to stand up

  46. Duchenne’s Muscular Dystrophy • Speech & swallowing become impaired • More pronounced muscle weakness (scoliosis) • Wheelchair by junior high • Tachycardia • Pneumonia • Heart failure age 20

  47. Nursing Considerations • Maintain ambulation as long as possible • Physical Therapy, Adaptive equipment • Braces to prevent contractures • Promote independence • Prevention of injury • Prevention of infection

  48. Disorders of the soft tissue

  49. Juvenile Rheumatoid Arthritis • Chronic inflammation of synovium with eventual erosion of articular cartilage • Cause is autoimmune + ANA (antinuclear antibodies) + RF (rheumatoid factor) • Peak: 1-3 years or 8-12 years, girls affected more

  50. Follows one of three clinical courses • Systemic: elevated temperature, rash, any # of joints affected • Pauciarticular: involves 4 or less joints, usually large joints • Polyarticular: involves 5 or more joints, smaller joints or weight bearing joints

More Related