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