musculoskeletal dysfunction

S/S of cerebral palsy

spastic: persistent primitive reflexes ankle clonus development of contractures dyskinetic: athetoid: chorea dystonic/dysarthria ataxic: wide based gait disintegration of movement

treatment for duchess MD

steroids calcium Supp braces aids PT

management for osteogenesis imperfecta

supportive care no contact sports lift by the hip gently and place down gently PT mobility aids hydrotherapy

osteogenesis imperfecta

affects collagen that results in fragile bones that break easily

ewing sarcoma

affects leg bones

osteogenic sarcoma

affects primarily the femur S/S: pain, swelling, limp treatment: surgery, chemo, amputation or limb salvage

treatment for DDH

baby- pavlik harness on back to sleep monitor for skin breakdown sponge bath long socks teach parents about signs of decreased circulation

treatment of CP

based on child and severity

diagnosis of JIA

based on symptoms

s/s of osteogenesis imperfecta

blue sclera hearing loss discolored teeth bone fractures

spica cast fro DDH

cast all the way up to hip down to feet -give them toys they can't stick down cast -neurovascular checks Q4H -reposition Q2H could become constipated so high fiber diet -parents involved with deep breathing to prevent PNA

juvenile idiopathic arthritis

characterized by chronic inflammation of the synovium with joint effusion and eventual erosion, deconstruction and fibrosis of the articular cartilage

pediatric differences

-all muscles, tendons and ligaments present -bones are not fully ossified -growth occurs at epiphyseal plate closure in late adolescence -300 bones are birth and ossify and end up with 206 total bones in body

S/S of DDH

1 short leg on the affected side wide perineum decreased abduction of affected hip uneven skin folds hip click (ortolani test) mild, waddling gait

cerebral palsy

condition characterized by abnormal motor function prenatal, perinatal and postnatal causes usually accompanied by disabilities

neural tube defects

congenital defect that develops during first 27 days of conception - moms need to take folic acid

talipes equinovarus (clubfoot)

congenital malformation of the lower leg, ankle and foot diagnostic tests- X-rays and US management- serial casting

while assessing a 3 year old child who has has an injury to the leg, has pain , and refuses to walk, the nurse notes that the childs left thigh is swollen. what should the nurse do next? a. assess the neurologic status fo the toes b. notify the HCP immediately c. determine the circulatory status of the upper thigh d. obtain VS

A

problems associated with MMC

CNS infection hydrocephalus possible retardation orthopedic anomalies, paralysis lack of sensation neurogenic bladder, frequent UTIs flaccid bowel, incontinence higher incidence rate of latex allergy

developmental dysplasia o the hip

DDH degrees -shallow, partial, complete

soft tissue injury

contusions (bruise) dislocations( joint comes out of socket) sprains(ligaments tear) strains(tear tendon) REST, ICE, COMPRESSION, ELEVATION

Gower's sign

Duchenne's muscular dystrophy

diagnosis of duchenne MD

EMG muscle biopsy increased CPK levels genetic analysis

treatment for osteogenesis imperfecta

NO CURE

when examining school age and adolescent children, the nurse routinely screens for scoliosis. which statement accurately summarizes how to perform this screening? a. listen for clicking sound as child abducts the hips b. have the child run the heel of one foot down the skin of the other leg while standing c. have the child shrug the shoulders as the nurse applies mild pressure to the shoulders d. have the child stand firmly on both feet and bend forward at the hips

d

which child most needs a screening for scoliosis? a. a preschooler entering kindergarten b. infant of a mother with no prenatal care c. toddler with a diet low in Ca and Vitamin D d. a preadolescent at the beginning of a growth spurt

d

management of CP

early diagnosis by MRI and history multidisciplinary team approach to maximize quality of life -family support, financial support

S/S of juvenile idiopathic arthritis

fever rash joint pain or stiffness in morning or after sitting for awhile

meningocele spina bifida

form of spina bifida in which the spinal cord develops properly but the meninges protrude through the spine

management of scoliosis

goals braces -worn between 16 to 23 hours a day -clean brace daily -no cream, lotion or powder under brace if braces dont work, will do rods

muscular dystrophy

group of hereditary, genetic disorders that cause progressive degeneration of muscle fibers leading to weakness, disability and premature death

scoliosis

history assessment diagnosis- observation, xray to see degree goals- prevent resp complications, prevent pain/disc dx, + body image

diagnosis for osteogenesis imperfecta

history skin biopsy to detect collagen genetic testing bone scans

acquired MS disorders

kyphosis lordosis scoliosis

treatment for JIA

manage pain maintain joint mobility promote normalcy drug therapy- NSAIDS, antirheumatics, steroids in severe cases nutrition- well balanced diet adequate rest give longer in the morning PT/OT- swimming, splints possible

immobilization

may have lasting consequences -physiologic effects inactivity leads to decrease in functional capabilities of the whole body -psychological effects removal of power, natural way o learning about the world, quiet, depressed, angry, can disrupt family

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges

duchenne muscular dystrophy

most common, most severe Xlinked recessive fat replaces atrophied muscle -mom carrier -> son affected

Myelomeningocele (spina bifida)

most severe form of spina bifida in which the spinal cord and meninges protrude through the spine -dont lay on back -sterile soaked gauze, keep moist, keep from rupturing

nursing care for MMC

observe sac for leakage of CSF assess for S/S of infection skin breakdown KEEP SAC MOIST special mattress passive ROM monitor I&O measure head circumference prone position support parents to be involved in care

history

pain? limp/non-weight bearing? recent trauma/strenuous use? assessment posture/symmetry/gait/skin/swelling palpate for tenderness, deformity diagnostic testing -XR common or MRI for ligamentous injury

management of MMC

possible fetal surgery possible csection birth surgical skin closure over defect 24-36 hours after timing of surgery- done ASAP as child may need skin graft -surgery doesn't fix problem but lessens risk of infection, prevents damage to the spin al cord and makes handling easier

management of duchenne MD

promote mobility maintain cardiopulmonary function maximize quality of life -can meet developmental milestones just later

nursing care for child with CP

promote motor function promote self care within limitations promote speech and swallowing proctor development provide support and education

treatment for ewing sarcoma

radiation chemo surgical incision

fractures

reduce, realign fractures open reduction closed reduction

management:

serial casting to correct leg keep cast dry sponge bath monitor for tightness/circulation neurovascular checks COMPLIANCE

pavlik harness

used for DDH