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Musculoskeletal Disorders in Children

Musculoskeletal Disorders in Children. Judy Hovelson. Causes. Nonintentional injury School: playground/gym Sports Automobile accidents Child Abuse Congenital syndromes Diseases. * Immobilization*. Inability to move Weakness, injury Casts/Traction Congenital Defects.

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Musculoskeletal Disorders in Children

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  1. Musculoskeletal Disorders in Children Judy Hovelson

  2. Causes • Nonintentional injury • School: playground/gym • Sports • Automobile accidents • Child Abuse • Congenital syndromes • Diseases

  3. *Immobilization* • Inability to move • Weakness, injury • Casts/Traction • Congenital Defects

  4. Physiologic effects • Significant loss of muscle strength, endurance and muscle mass • Bone demineralization leading to osteoporosis • Loss of joint mobility and contractures

  5. Other Organ Effects • Cardiovasular • Orthostatic hypotension, increased workload, thrombus formaiton • Nursing considerations??? • Respiratory • Reduced muscle power, reduced chest expansion • Nursing considerations??

  6. Continued.. • Gastrointestinal System • Risk of aspiration • Slowing of stool • Renal System • Bone demineralization leads to calculi formation • Neurological changes may change bladder sensation and cues • Urine may back up due to horizontal positioning

  7. Continued… • Metabolism • Negative nitrogen balance reltaed to tissue breakdown • Decreased and inappropriate nutrition can occur • Nursing considerations??? • Skin • Poor circulation, mechanical irritation, hygiene issues, prolonged pressure • Nursing Considerations???

  8. Psychological Effects of Immobilization • When sensory deprivation is assoicated: • Restlessness, difficulty problem solving, inability to concentrate, depression, regression, egocentrism • Monotony leads to: • Sluggish intellectual and psychomotor responses, decreased communication skills, hallucinations, disorientaion, dependence and acting out • Many Family Issues!

  9. Immobilization Devices • What are the physiological and psychological concerns for this child?

  10. Fractures • Common in children and elderly • Don’t usually occur in infants • Forearm fractures are common in children • Clavicle is the most frequently broken bone • In children less than 10- Often during birth • Femoral neck fractures happen with automobile accidents (ages 6and 7) • Older children – femur • Teens - knees

  11. Kinds of Casting

  12. What are the physiological and psychological concerns for this child?

  13. Care of the Child with a Fracture • 5 “Ps” • Pain • Pallor • Pulselessness • Parasthesia • Paralysis

  14. Traction • Purpose • To fatigue the involved muscle and reduce spasm so the bone can realign • To position the bone ends • To immobilize the fracture site

  15. Types of Traction • Skin – no pins, usually short term • Example - Buck’s • Skeletal – surgical, pins • Example – 90:90 traction • Nursing Cares?? • Guidelines are on page 1922-1923

  16. Fracture Complications • Circulatory impairment • Nerve compression • Compartment syncrome • Growth plate involvement • Nonunion/Malunion • Infection • Pulmonary Emboli

  17. Osteomyelitis • Occurs between ages 5 and 14 • Infection in the bone • Etiology not always known • Children are very ill • IV antibiotic therapy is prompt and vigorous • Immobilization is usual

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