chapter 24 muscle skeleton condition Pediatrics

compound fracture

A broken bone that has broken through the skin

strain

A condition resulting from damaging a muscle or tendon

laboratory tests and treatments

CBC ESR erythrocyte sedimentation rate may rule out septic arthritis or osteomyelitis HLA human leukocyte antigen B27 may help diagnose rheumatological disorders are there out history is necessary to determine the basis for muscle skeletal problems which are often Insidious the nurse determines that history of an injury the location of pain when the symptoms started and he weakness numbness or loss of function and any extremity and where are the problem is affecting the daily activities of the child an arthroscopy is commonly performed on adolescents with sports injuries The Physician is able to look inside the joint usually the near shoulder determine the extent of the injury that area is inspected foreign particles of removed or repairs are made to the torn meniscus bone biopsy may show malignancy muscle biopsy May detect muscular dystrophy three types of skin tractions often used for the lower extremities of children are Bryant's traction Buck's extension and Russell's traction nursing interventions focus on maintaining body functions such as range of motion exercises the use of a trapeze to prevent muscle atrophy High roughage diet to stimulate the digestion tract and avoid constipation respiratory exercises to prevent pneumonia

epiphysis

End of a long bone

contusion

a bruise an injury of a part without a break in the skin

neurovascular checks

a priority nursing responsibilities in the care of a child with a fracture who is in traction or who has a cast or ace bandage and places to perform neurovascular assessment or neurovascular checks at regular intervals any abnormality should be reported promptly so that early intervention can prevent complications from developing safety alert the neurovascular check for tissue perfusion is performed on the toes and fingers distal to an injury or cast and includes the following for a fuel pulse rate and quality color capillary refill Time Warmth movement and sensation

slipped femoral capital epiphysis

also known as coxa Vara spontaneous displacement of the epiphysis of the femur often occurs rapid growth of the pre-adolescent is not related to trauma more than 80% of children with slipped femoral Capital epiphysis RVs the epiphysis of the femur widens the femoral head and epiphysis remain in the acetabulum. the head of the femur than rotates in this place symptoms include eye pain and inability to bear weight on the involve legs diagnosis is a confirmed by x-ray treatment placed in traction to minimize future slippage then surgery is scheduled to insert a screw to stabilize the bone serious complications may include disturbance of circulation to the epiphysis resulting in necrosis of the head of the femur nursing care assistant performing orders regarding Ring Of Motion activities guides gradually resumption of weight bearing with help of crutches and encourage referrals to maintain school studies education concerning management of weight is important post-operatively

nursing tip checklist for the patient in traction

body in alignment head of the bed no higher than 20 degrees for countertraction heels of the feet elevated from bed range of motion of unaffected Parts checked at regular intervals anti-embolism stockings of or foot pumps and place as ordered neurovascular checks performed regularly Skin Integrity monitored regularly pain and its Relief by medication recorded measures to prevent constipation use of trapeze for changing a position encouraged

muscle skeletal system differences between child and adult

bone is not completely ossified epiphysis or present and the periosteum is thicker and produces catalase more rapidly than in an adult the lower mineral content content of a child's bone and it's greater porosity increases the bone strength however rotational and angular forces can stress ligaments that insert at the epiphyseal area of the bone and injury to the epiphysis can affect bone growth presence of epiphysis and hyperemia caused by trauma bone overgrowth is common and healing fractures of children less than 10 years of age when a child sits or stands these curves must change to be concave or kyphosis or lordosis will result

genu varum

bow legged

checking circulation of the toes and fingers to check circulation

capillary refill squeezer press 800 or finger to blanch the skin at the circulation is adequate the color should return in less than 3 seconds when the pressure is released if the toes do not blanch congestion may be present and should be reported to the physician it's a blanching persist after pressure is released the circulation is impaired The Physician must be notified report to the physician if extreme pain results from touching or moving of the toes

Family Violence spousal abuse and child abuse neglect and maltreatment parent should control the time spent watching television and content of programs so the television exposure results in the acquisition of knowledge skills and information that will motivate learning and homes were spouse and and or child abuse occurs children learn the behaviors and will likely practice them and they become adults and the abuse cycle continues

child abuse Kemp a 1962 coin the term battered child syndrome in his Landmark article the journals of the American Media Medical Association refers to a clinical condition in young children who have received serious physical abuse generally from a parent or foster parent sexual abuse involves the activism performed on a child for the sexual gratification of an adult physical neglect the failure to provide for the basic physical needs of the child including food clothing shelter and basic clean the noise physical abuse the deliberate infliction of injury on a child suspected when an injury is not consistent with a history of development level of the child the temperament of the child in the parent can be a causation factor of child abuse emotional abuse intentional verbal Acts that result in in destruction of self-esteem in the child can involve rejection or threat or threatening the child emotional neglect and intentional admission of verbal or behavioral actions that are necessary for development of the healthy self-esteem can include social emotional isolation of a child

assessing for compartment syndrome

compartment syndrome is a progressive loss of tissue perfusion caused by an increase in pressure resulting from edema or swelling that presses on the vessels and tissues circulation is compromised in the neurovascular check is abnormal compartment syndrome can be caused by a cast that is too tight and compromised the circulation or by excessive oedema that causes ischemia often surgical intervention fasciotomy is required to relieve pressure in to restore circulation an important nursing responsibility is to provide frequent neurovascular checks on the distal fingers and toes of an injured limb to an able early intervention

common sports injuries

concussion in a Blow To The Head following by alterations and mental functioning should be treated as possible concussion observe carefully for sequelae Stingers or burners a common neck injury when a player hits another in the head and such Sports as football or soccer caused by brachial plexus trauma feeling like an electrical jolt usually mild and disappear suddenly restrict sports activities until symptoms disappear reassessed protective gear injured knee usually result of stress on the knee ligaments potentially serious should be evaluated by an experienced trainer physician May necessitate Ortho scopic surgery sprained or strained ankle May injure growth plate X-ray films important and Adolescent muscle cramps caused by injury alterations in blood flow or electrolyte deficiency important to warm up before activity and sure fluid intake as adequate shin splints pain and discomfort in lower leg caused by repeated running on a hard surface such as concrete avoid such activity he's well fitted shoes decrease inflammation by rust

Torticollis (wryneck)

condition in which neck motion is limited in cervical spine is rotated because shortening of the stern of sternocleidomastoid muscle can be congenital or acquired acute or chronic congenital normally is which the sternocleidomastoid muscle is injured during birth associated with breech and forceps delivery may be seen in conjunction with other birth defects such as congenital hip dysplasia manifestations symptoms present at birth and that holds the head to the side of the muscle involved chin is tilted in the opposite direction there's a hard palpable mass of dense fibrotic tissues fibroma it's not fixed to the skin resolves by 2 to 6 months of age passive stretching and range of motion exercises and physical therapy may be indicated surgical correction is indicated if the condition persist Beyond two years of age acquired torticollis is seen and older children associated with injury inflammation neurological disorders and other causes nursing interventions is primarily that of detection infant to have limited head movement require further investigation

soft tissue injuries

contusion a tearing of subcutaneous tissue resulting in Hemorrhage edema and pain The Escape of blood into soft tissue is referred to a hematoma or a black and blue mark sprain when the ligament is torn or stretched away from the bone at the point of trauma there maybe resulting damage to the blood vessels muscles and nerves swelling disability and pain or major signs of a sprain strain a microscopic tear of the muscle or tendon that occurs over time and results in edema and pain treatment of soft tissues injuries soft tissue injury should be treated immediately to limit damage from edema and bleeding cold pack and elastic wrap or reduce the demon bleeding and relieve pain I should be applied at altering 30 minute intervals after 30 minute. Is she Mia can occur and impede the tissue perfusion elevating the extremity above Heart level reduces edema when elastic bandages used to compress for compression a priority nursing responsibility is to perform frequent neurovascular checks to ensure adequate tissue perfusion R rest I ice C compression e elevation

cultural sensitive and medical issues

cultural sensitive history is essential nurse should be aware what appears to be a cigarette burn could be a single lesion of infantigo Mongolian spots can be mistaken for bruise a severe diaper rash caused by fungal infection can look like a skull burn some cultural practices can be interpreted as physical abuse at the nurse is not culturally aware of full caring and ethnic practices coining of the body by the Vietnamese to allow disease can cause whelps on the body burning small areas of the skin to treat enuresis is practiced in some Asian cultures Fort Snelling is common in Caribbean discipline techniques yemenite Jews treat infections by placing garlic preparations on wrist which can result in blisters Telugu people of Southern India touch the penis of a child to show respect

diagnosis of osteomyelitis

elevation of white blood cell count and sedimentation rate x-ray examination May initially fell to reveal the infection of microbiology culture of aspirated drainage or a bone scan maybe diagnostic

arthroscopy

endoscopic examination of the interior of a joint

compartment syndrome

external interior internal pressure that seriously restrict circulation to the area

Russell traction

femur or lower leg

Erwing sarcoma

first described in 1921 malignant growth occurs in the marrow of the long bones is mainly and older school-age children in early adolescence when metastasis is present on diagnosis the prognosis is poor without metastasis 60% survival rate primary sites for metastasis of the lungs in long bones treatment in nursing care amputation is not generally recommended because tumor is sensitive to radiation therapy and chemotherapy children warned against vigorous weight-bearing to prevent pathological fractures

Legg calve Perthes disease coxa up Plana

group of disorders caught it osteochondrosis in which blood supply to the epiphysis or end of the bone is disrupted tissue death that results from inadequate blood supply is termed avascular necrosis this disease affects the development of the head of the femur approximately 1 + 1250 disease is most commonly seen in boys between ages 5 and 12 more common in caucasians diseases unilateral and about 85% of cases healing occurs spontaneously during two to four years however Mark Distortion of the head of the femur may lead to an imperfect joint or degenerative arthritis of the hip and later life symptoms or painless lump in limited range of motion to confirm the diagnosis X-ray films and Bone scans treatment self-limiting disorder and heal spontaneously the course of two to four years treatment of Vols femoral head deep in the hip socket while heals and prevents weight-bearing use of ambulation abduction cast or braces that prevent subluxation and enable acetabulum Tamil the healing head in such a way that it does not become deformed bed rest and traction May proceed this treatment prognosis Fair may require hip joint replacement procedures as adults nursing care teaching and counseling as directed toward a holistic understanding and the entrance than individual child and family total immobility or partial Mobility is particularly trying for children general principles of traction cast and Brace care used

deschenes muscular dystrophy

group of disorders in which progressive muscle deterioration occurs childhood form is the most common site one in 3,600 live-born male infants it is a sexually linked inherited disorder occurs only in boys disturbing a protein and skeletal muscle is absent occurs between two and six years of age history of delayed motor development during infancy may be evidence Progressive weakness as evidence by frequency falling clumsiness contractures of the ankles and hips and gals maneuver a characteristic of raising from the floor laboratory findings marked increased serum creatinine phosphokinase muscle biopsy shows addenda degeneration of muscle fibers and their replacement by fat and connective tissues a myelogram as a result of Electro stimulation shows decrease in amplitude and duration of motor unit potentials serum blood polymerase Chain Reaction PCR for the gene mutation is a blood serum test death usually results from cardiac failure or respiratory tract infection treatment is the use of prednisone also glutamine and creatine for muscle weakness neurotrophin to replace the missing dystrophin treatment is mainly just supportive to prevent contractures and maintain quality of life some children appear passive and withdrawn

selected recreational activities in the risks

gymnastics common problems associated with children engaging in gymnastics or delayed menstruation and eating disorders trauma and overuse injuries of the large joints and spine are common prevented prevention includes muscle strengthening activities exercises flexibility exercises and wrist brace nutritional planning and education are essential La common problems associated with that include delayed monarchy and eating disorders there is a high risk for stress factor strange shin splints and spinal deviations prevention's include skilled coaching and nutrition planning and education wrestling placement wrestling match is based on weight of binging and purging behavior is commonly found in athletes participating in wrestling concussions next trains and spinal injuries are common skin dermatitis infection occur from contact with floor mats skill coaching and nutrition education and planning are important football improvements and techniques protective equipment in game exercises of decree serious injuries and children participating on football team hockey injuries can occur from both collisions with other athletes and collisions with pucks and sticks proper protective equipment in supporting roles to crease the seriousness of injuries basketball volleyball these are jumping sports that involve injury risk to ankles knees and fingers ankle sprain tendonitis stress fractures and blisters are common complications of these Sports running involves repeated poor absorb foot impact muscle fatigue environmental temperature in running surface contributes to injuries engaging and proper exercises before running he's in good impact absorbing shoes cross training and adequate rest are essential shin splint involve pain over the interior tibia and a result from tearing the ecologist fibers that connect muscle to Bone shoe Orthotics running on soft surface cross training and rice are they priorities of management skiing and snowboarding injuries are usually related to Falls better equipment controlled slope conditions and separation of skiers by skill level contribute to the decreased rate of injury cheerleading includes acrobatics pyramid climbing and tossing Falls related to injury such as Springs fractures dislocations and head injuries save the instruction is important and a certified coach should be present

checking for nerve damage

humeral fracture breaking the humerus can damage the radial nerve check for sensation over the dorsum of the index finger to check motor function as the patient to hyperextend the thumb radial fracture a break in the radius can damage the medial as well as the radial nerve besides checking sensory and motor function of the radial nerve evaluate medial nerve function check for sensation in the Palmar surface of the fingers and the thumb half of the Palm to check motor function as the patient to touch the thumb to the tip of the little finger ulnar fracture breaking the ulna can damage the ulnar nerve check sensation on the older border of the hand from the little finger to the ring finger to check motor function ask the patient to abduct or spread his or her fingers femoral fracture a break in the femur can damage the peroneal nerve check for sensation over the top of the foot between the first and second toes to check motor function ask the patient to dorsiflex the foot pointing his or her toes toward the head fibular fracture breaking the fibula can also can damage the peroneal nerve lack of sensation between the first and second toes and the top of the foot or an inability to dorsiflex the foot is a sine of perineal nerve damage tibial fracture a break in the tibia can damage the tibial nerve to check for sensory damage ask the patient if the medial side of the sole of his foot feels warm to evaluate motor function ask this patient to plantar Flex the foot point the toes downward

Legg calve Perthes disease

idiopathic avascular necrosis of the femoral capital epiphysis. mc in boys 4-10 yo.

osteomyelitis

inflammation of bone and bone marrow

sprain

injury to a ligament caused by joint trauma but without joint dislocation or fracture

neurological examination

neurological assessment is a vital part of the comprehensive muscle skeletal examination assessment of reflexes as sensory assessment in the presence or absence of spasm should be noted

osteomyelitis

is an infection of the bone that generally occurs in children younger than 1 years of age and in those between 5 and 14 years of age long bones containing few phagocytic cells white blood cells to fight bacteria that may come to the bone from another part o of the body the inflammation produces and excavate that collects under the marrow and cortex of the bone staphylococcus aureus is the organism responsible for osteomyelitis and 75 to 80% of cases and children more than five years of age influenza is the most common cause in younger children salmonella and pizzuto Mones or organisms often found in adolescents who are intervening as drug users osteomyelitis may be preceded by local injury to the Bone such as an open fracture burn or contaminated during surgery it may also follow a furnico infantigo and abscessed tooth in neonates a heel puncture or scalp vein monitor can be predisposing site of infection ineffective emboli May travel to small arteries of the bone setting up local destruction and abscess for this reason a careful search for infection and other bones and soft tissues may be necessary the vessels is affected area are compressed and thrombosis occurs producing ischemia and pain the collection of pus under the periosteum of the bone can Elevate the periosteum which can result in necrosis of that part of the bone if the post reaches the previous of the bone and infants infection can travel to the joint space causing septic arthritis of that joint local inflammation and increase pressure from the distended periosteum can cause pain older children can localize the pain and Main lamp younger children and infants will show decrease voluntary movement of that extremity Associated muscle spasms can cause limited active range of motion the child May refuse to stand or walk sounds of local inflammation may be present a detailed history of May Show possible sources of primary infection blood cultures to identify the organism may be valuable the child has not been given antibiotics for primary infection a urine test for the presence of bacterial antigens and the tissue biopsy may be helpful to establish the diagnosis

juvenile idiopathic arthritis also known as juvenile rheumatoid arthritis

it is systemic autoimmune disease involves joints connective tissues and viscera differ somewhat from adult rheumatoid arthritis approximately 1 and 1000 children and the United States have juvenile idiopathic arthritis exact causes unknown but autoimmune response is believed to be the cause manifestations and types oligo arthritis involves four or fewer joints and the uveitis inflammation of the eyes comment about 30% of children polyarthritis involves five or more joints and they you uveitis occurs in about 10% of children systemic arthritis characterized by fever rash and Joint inflammation uveitis occurs in about 10% of these children systemic form is manifested by intermittent spiking fever above 103 persisting for more than 10 days Anon purity macular rash abdominal pain elevated ESR C-reactive protein and lab test presence of antinuclear antibodies and possible enlarged liver and spleen often and children ages 1 to 3 and 8 to 10 years of age treatment goals of therapy are to accomplish the following reduce joint pain and swelling promote mobility and preserved joint function promote growth and development promote independent functioning help the child and family to adjust to the living with a chronic disease medications such as NSAIDs and Methotrexate may be provided patient should have frequent CBC test to monitor closely for side effects steroids are administered for incapacitating arthritis uveitis or life-threatening complications and Enbrel is a tumor necrosis Factor inhibitors used in children unresponsive to methotrexate administered subcutaneously weekly and may have serious side effects slow-acting antibiotic drugs such as sulfasalazine hydroxychloroquine gold and D penicillamine can be used with NSAIDs but are not as popular today as in the past. nursing care multidisciplinary Healthcare team includes pediatrician rheumatologist social worker physical therapist occupational therapist psychologist ophthalmologist in school and Community nurse occupational therapy helps with activities of daily living resting in a bed with the support of flat mattresses helpful resting splints during sleep can prevent Flex eight flexion contractures moist heat and exercise are advised and Whirlpool baths and hot packs relieve pain and stiffness school nurse can be contacted to help promote normal growth juvenile idiopathic arthritis can interfere with development of positive self concept long-term disease is characterized by periods of remission and exacerbation nurses can serve as advocates of the child and can help alleviate stress by recommending the impact of the disease and openly communicating with a child the family and other members nurses support the family members and instill hope

genu valgum

knock knees

gait

manner of walking

observation assessment of the muscle skeletal system in The Growing Child

newborn hip has limited internal rotation range of motion the legs are maintained in a flex position and the lower leg has an internal rotation internal tibial torsion caused by the effects of uterine positioning this can last four to six months the newborn's feet normally turn inward virus or outward valgus but the turning in self corrects when the soles of the feet is stroked toddlers feet appear flat because of presents of Flat Pad of the arch any delay in neurological development can cause a delay in the Mastery of motor skills which can result in Altered altered skeletal growth to assess includes observation palpation and range of motion and gait assessment of children who can walk children by the age of 18 months if they are not walking should be referred to the health care provider for a follow-up it's considered a serious delay

prevention of pediatric trauma

nurses are responsible for educating parents and school teachers about how to prevent accidental injury and maintaining a safe environment proper use of pedestrian safety practices car seat restraints bicycle helmets and other athletic protective gear pool fences window bars deadbolt locks and locks on cabinets can prevent many injuries to children pediatric trauma can cause permanent disability or premature death

treatment of fractures with a cast

nursing care of a child in a cast the cast of the device used to immobilize a fracture site usually including the joint above and below the fracture cast or construction to plaster Paris or synthetic materials such as fiberglass fiberglass cast or lighter than plaster cast and come and various bright colors that cannot be written on as easily as plaster-cast can the prop if the proper lining is used under the fiberglass cast the cast in is water resistant and can be washed and dried whereas plaster cast will deteriorate if it becomes wet fiberglass cast drives within a half an hour plaster cast take 10 to 72 hours to dry must be handled carefully with open palms and extended fingers to prevent indents that can create pressure areas on the skin during the drying time nursing responsibilities include elevating the affected extremity on a pillow and Performing frequent neurovascular checks on the digital digits before discharge the nurse teaches the child and the parents how to care for the cast and to support the cast to prevent the extremity from assuming a dependent position that could compromise circulation the child is taught safe transfer from bed to wheelchair and save crutch watching walking techniques parents are also taught how to check whether the cast is too loose or too tight and went to return to the clinic or health care provider safety alert pain and relieved by medication swelling cyanosis or paler of digits or decrease pulse and skin temperature should be immediately reported because they may be signs of compartment syndrome the child should be prepared of the experience of cast removal because the cast cutter can't appear in sound threatening after cast removal the skin can experience to be dry and Kate lotion and soothing bats are advised care of a child in a spica cast as discussed in chapter 14

nursing responsibilities for traction

observe the traction ribs to be sure that they are intact and in the wheel grooves of the pulleys and that the child's body is in good position in Bryant's traction leg should be at a right angles to the body with the buttocks raise significantly to clear the bed and all types of traction elastic bandages should be neither too loose nor too tight a jacket restraint may be used to prevent a child from turning from side to side the weights are not removed after they are applied continuous traction is necessary the weights must be hang free in room Furnishings such as a chair must not obstruct the pool of the weights the weights are not lifted or supported when the bed is moved the nurse performs frequent neurovascular checks to toes to see if they're warm and that their color is good observations of conditions such as cyanosis numbness or irritation from attachments tight bandages severe pain hypoxia or absence of pulse rates and extremities are reported immediately to the nurse in charge volkmann's ischemia to hold back and hey Mia blood which occurs when the circulation is obstructed when the legs are elevated over the head is as in Bryant's traction there is a gravitational vascular drainage arterial occlusion can be can cause anoxia of the muscles and reflex vasospasm which win unnoticed could result in contractures and paralysis the child is bathed in back and buttocks care are given sheepskin padding may also be used the sheets are pulled taut and are kept free of crumbs the jacket restraint is changed when it is soiled the child is encouraged to drink plenty of fluids and eat foods that are high in methods to prevent constipation caused by lack of exercise because the child is unable to sit upright when eating special precautions to prevent choking and aspiration during mealtime or priority nursing responsibilities stool softeners may be necessary a fracture pan is used for bowel movements and careful record is kept of eliminations deep breathing exercises are encouraged to prevent the collection of fluid in the lungs caused by the child's in Mobility these exercise may be done by blowing bubbles or by blowing in a pinwheel diverse therapy is important because hospitalization may be lengthy toys may be securely suspended over the child's head so they are with an ease of reach child's crib is taken to the playroom and possible so the child can experience the excitement of these activities their DVD CD MP3 players video game stories and other forms of entertainment are important aspects of the total nursing care plan pain control is essential parents are encouraged to visit the child as often as possible with proper treatment the prognosis for the child within this condition is good

greenstick fracture

one in which the bone is bent and only partially broken

traumatic fractures

pathophysiology of fracture is a break in the bone and is usually caused by accident it's characterized by pain tenderness on movement and swelling discoloration limited movement and numbness may also occur simple fracture the bone is broken but the skin over the area is not compound fracture a wound in the skin accompanies the broken bone and there is an added danger of infection greenstick fracture is an incomplete fracture in which one side of the bone is broken and the other is bent this type of fracture is common in children because their bones are soft flexible and more likely to splinter complete fracture the bone is entirely broken across the width spiral fracture a forceful twisting motion of the femur when an x-ray film shows multiple fractures at various stages of healing child abuse should be suspected a fracture heal heals more rapidly in a child then it doesn't end up the child's periosteum is stronger and thicker and there is less stiffness of mobilization injury to the car to langa's epiphysis the growth plate which is found at the ends of the long bones is a serious if it happens during childhood because it may interfere with the longitudinal growth a fat embolism can occur within a few hours after fractures of the long bones are multiple fractures when that particles escape from the site into the circulation and Lodge into the lawn although it is more common in adults than children the nurse must observe for signs of hypoxia following traumatic fractures

osteosarcoma

primary malignant tumor of the long bones two most common types of tumors in children are osteosarcoma in Irwin sarcoma mean age onset is between 10 and 15 years of age children who have had radiation therapy for other types of cancer in children with retinoblastoma have a higher incidence of this disease metastasis occurs quickly because of the high vascularity of the bone tissue lungs are primary site of metastasis the brain and other bone tissue also sites of metastasis manifestations experiences pain swelling at the site often attributed to injury or growing pains flexing the extremity May lessen the pain later a pathological fracture may occur diagnosis is confirmed by biopsy complete physical examination including CT and bone scan is performed treatment of Nursing Care treatment of osteosarcoma consist of radio radical resection or amputation surgery internal prosthesis are available for most sites long-term survival as possible with early diagnosis and treatment nursing care similar to other types of cancer problems of body image of particularly important to the self-conscious adolescent nurse anticipates anger fear and grief from patient immediately after surgery the stump dressing is observed frequently for signs of bleeding bannon's vital signs or monitor child as position as ordered by the surgeon Phantom limb pain is likely to be experienced and should be treated with an analgesic may be necessary Rehabilitation measures follow surgical repair

overcoming the effects of traction on a child

prolong treatment requires absence from school request to home tutor maintain written or email contact with friends blood perfusion decreases cause and risk for thumb thrombi by use anti embolic stockings or foot pumps as ordered pressure can cause tissue breakdown inspect skin and provide skin care decreased lung expansion use Inspira meter techniques an activity decreases appetite attractive food preparation battery changer in risk of cystitis maintain strict intake and output muscle wasting occurs from decreased activity encourage range of motion exercises decreased appetite and activity causes constipation and courage Lewis and fiber in diet

treatment and nursing care of osteomyelitis

prompton vigorous treatment is essential to ensure of a favorable prognosis intravenous antibiotics are prescribed for four to six weeks. The high doses required indicator nursing responsibility to monitor the infant or child for toxic responses into Insurance long-term compliance The Joint may be drained of pus arthroscopically or surgically to reduce pressure and to prevent bone necrosis a complication should be suspected if fever lasts Beyond five days the use of appropriate pain-relieving medications and gentle handling to minimize pain or essential the child should be positioned comfortably with the limb supported by pillows or blanket rolls bed rest is followed by will show access that weight bearing should be avoided

diagnostic tests and treatments

radiographic studies X-ray films take him to confirm suspected pathological condition and affected area is compared with an affected area bone scans are helpful in identifying pathological conditions and may not clearly be seen on a routine x-ray study such a septic arthritis or tumors computed tomography CT scans provide a cross-sectional picture of the bone and its relationship to other structures within the area that of examination magnetic resonance imaging MRI does not involve harmful radiation produce detailed pictures of the brain spinal cord and soft tissue lesions including a slipped femoral epiphysis ultrasound does not involve harmful radiation is used to rule out foreign bodies and soft tissues joint effusions and development dysplasia of the hip

spiral fracture

ragged break occurs when excessive twisting forces are applied to a bone

observation of muscle tone

should have said symmetry of movement and the strength and Contour the body's extremities having the child push away the examiner's hand with his or her foot or hand can test the strength of the extremities

muscle skeletal

skeletal growth is the most rapid during infancy and Adolescence assessing growth and development is an integral part of the physical examination for children the bones of children are most resilient tend to bend and maybe form before breaking the blood supply to the Bone and children is Rich there for healing occurs more quickly there. periosteum thick and osteogenic activity is high epiphyseal plate fractures in children can disrupt the growth of the bones muscle skeletal problems maybe growth related rapid growth of the skeletal frame of children can cause deformities to become more severe

nursing interventions for abused and neglected children and adolescents

teach child anxiety-reducing techniques such as teach the child gradual relaxation relaxation the music visual imagery how to use exercise to reduce anxiety how to talk to Safe appropriate people about Billings to choose build and maintain positive support systems to ensure personal safety to set boundaries to establish a safe supportive relationship to clarify expectations and rules to self soothing techniques used assist child in managing his or her feelings such as teach child to identify feelings to express feelings appropriately to modulate and control feelings to identify events that elicit strong positive and negative feelings to express feelings verbally instead of physically to normalize feelings resulting from abuse to share feelings appropriately with peer group to find commonality and support within a group from fillings result from abuse teach child assertiveness skills such as to identify difference between assertiveness passivity and aggression to practice assertiveness skills to identify boundaries to understand when someone violates boundaries to practice responses when someone violates boundaries assist Child and Development problem solving skills by provide simple problem solving model increase awareness of child's control and decision-making teach child to generate a list of possible solutions to problems that relations help child look at consequences of each solution make the best choice give positive in general negative feedback to self coach problem solving with actual situations as much as possible teach about good touch and Bad Touch teach refusal skills and age-appropriate sexual expression and the effects of substance abuse assist child in value building in clarification Define values identify role of values assist child and identifying and verbalizing values help link children child values to child's actions assist Child and Development of values help child practice value-based decision-making assist child and enhancing his or her coping mechanisms by teaching child to practice positive self-talk help child set realistic expectations for self assist child in learning to nurture self teach child to practice relaxation to practice assertiveness and appropriate expression of feelings assist child in learning to accept defeat and failure help child identify the building skills and hobbies and courage child to identify and focus on strength help child set and accomplish goals assists Child and Development in developing organizational skills

key points

the age neurological development and motor milestones and she will influence the nursing assessment of the muscle skeletal system and a growing child the normal gain of a toddler is wide and unstable by 6 years of age the gait resembles an adult walk immobility causes a declaration of body metabolism injury to the Vizio play at the end of the long bones is a serious during childhood because it may interfere with longitudinal growth in a compound fracture of wound in the skin accompanies the broken bone and there is an added danger of infection any delay in neurological development can cause a delay in Mastery of the motor skills which can result in Altered skeletal growth children who do not walk by 18 months of age should be referred for a follow-up care rest ice compression and elevation of the principles of managing soft tissue injuries remember rice pain over a muscle area that does not respond to medication May indicate a complication known as compartment syndrome a neurovascular check includes color warrants capillary refill time movement pulse sensation and pain frequent neurovascular checks should be performed on a distal digits of a patient with a cast to determine adequate tissue perfusion tutorial assistant should be provided to school age children who are hospitalized or immobilized for long periods of time a complication of any traction is a arterial occlusion turn volkmann's ischemia Legg calve Perthes disease affects the blood supply to the head of the femur juvenile idiopathic arthritis is the most common arthritis condition of childhood juvenile idiopathic arthritis can inhibit social interaction in the development of a positive self-image treatment of scoliosis includes bracing exercise and surgery spinal fusion adolescent to participate in sports or subject to injury such as concussions and ligament injuries activities must be selected carefully according to the physical maturity size and skill required a spiral fracture of the femur humerus may be a sign of child abuse child abuse may be physical emotional or sexual or may involve neglect

fracture of the femur in early childhood

the femur thigh bone is largest and strongest bone of the body is the one of the most prevalent serious breaks that occur during early childhood child complains of pain and tenderness when the leg is moved or and he or she cannot bear weight on it close are gently remove starting at the end injured side to proceed to the injured side and may not be necessary to cut the clothes X-ray films will confirm the diagnosis skin traction is used to reduce the fracture and keep the bones and proper alignment a spica cast may be applied safety alert a spinal femur fracture in a young child May indicate child abuse and must be referred to an assessment team

observational gait

toddler who begins to walk has a wide and Stable Gate the arms do not swing with The Walking motion by 18 months the age The wide-base Narrows in the walk is more stable by 4 years of age the child can hop on one foot in the arm swings occur with walking 6 years of age the game resembles adult walk with equal stride length in Associated arm swing walk is more symmetrical toe walking after three years of age Canada's ate indicate a muscle problem most cases excessive in towing or toes pointing inward will resolve by the Age 4 teaching proper sitting and body mechanics is the treatment of choice participation in ballet classes and inline skating will enhance hip flexibility if problem does not resolve a brace may be prescribed failure to treat can result in Hip knee or back problems in adulthood younger children appeared bow-legged or known as Junu varam or not need Junu valgum which the knees turn inward until five years of age bowing is seldom pathological the ligaments that support the arch are not mature before 6 years of age and therefore the child may appear to have flat feet Orthotics Appliance can be prescribed for a child wearing inside the shoes when the flat foot is painful a referral for follow-up examination should be initiated

signs and symptoms of abuse and neglect

too many clothes make covering up signs of child abuse retinal Hemorrhage blood spots and infants one year may indicate shaken baby syndrome in the eyes failure to thrive May indicate neglect irritation in genital area should be considered suspicious do not criticize parent or caretaker in front of the child child Alton loves abusive parent support self-esteem of the child believe it child he describes abusive experiences dirty clothes and skin rashes May indicate neglect look for and list location and color of bruises scars and wounds look for and friends are outlines of objects on a child skin such as a red and area in the shape of a hand divide the body into four planes front back right side and left side injuries occurring in greater than one plane should be considered suspicious

treatment of fractures with traction

traction with the young child Bryant's traction is used to treat fractures for femur and children less than 2 years of age or lighter than 20 to 30 lb weights and pulleys extend the limb as in a Buck's extension Hauer of the legs are suspended vertically the weight of the child supplies that counteraction Bryant's traction is used for the young child who has a fractured femur note that the buttocks is slightly off of bed to facilitate counter react counter traction active infants may require jacket restraint to maintain body alignment Traction in the older child is used when the cats cannot maintain alignment of the two bone fragments skeletal muscles act as a splint for the fracture traction aligns the injured bone by the use of weights and counter traction immobilization is maintained until the bone fuse Buckskin traction Buck's extension is a type of skin traction used in fractures of the femur and in the hip and knee contractures it pulls the hip in the leg into extension the child body supplies countertraction therefore is essential that the child does not slip down in the bed and that the bed is not placed in high Fowler's position Buck's extension is sometimes use preoperatively either unilateral or bilateral e to reduce pain and muscle spasms associated with a slipped capital femoral epiphysis Russell traction is similar to books extension and Russell traction however the sling is positioned under the knee which spins the distal thigh above the bed skin traction is applied to the lower extremity pulling into directions vertically from the knee sling and longitude of Lee from The footplate this prevents posterior so black scene of the tibia on the femur which can occur in children who are in traction split Russell traction uses two sets of Weights one suspending the thigh and the other exerting a pool on the leg and the weights at the head of the foot of the bed balanced suspension using the Thomas splint and piercing attachments is used to treat disease of hip as well as fractures and older children and adolescents and maybe use both before and after surgery skeletal traction a steinmann pin or kitcher wire is inserted into the bone and traction is applied to the pin daily cleansing of the pin sight is essential 99 or 90 degrees 90 degrees traction with a boot cast or sling on the lower leg may be used correction field for Barton tongs may be used in the school to provide cervical traction skeletal traction carries the added risk of infection from the skin bacteria that may cause osteomyelitis the child and traction experience is certain effects as a result of in mobilization nursing tip checklist for traction apparatus wait hang freely weights Out Of Reach of the child ropes on the police not not resting against pulleys bed linens not on traction ropes counter traction and place apparatus does not touch foot of the bed safety alert the nurse should never lift or move weights from the traction apparatus during the delivery of patient care

Bryant's traction

type of skin Traction in apparatus commonly used for toddlers with this fractured femur vertical suspension is used