Peds- Musculoskeletal disorders
Barlow test
"when you go to the bar you go OUT" push knees back and down to push hip out HIP OUT
Treat soft tissue injury
1) RICE Rest: Slings, crutches, bedrest Prevent re-injury Ice: 3-5 times per day; 20 minutes/application Compression: Ace-bandage/splint Elevation Above the heart Reduce edema formation 2) Nsaids as ordered 3) Physical therapy
Fractures: Signs and Symptoms
5 PS Inflammation Bruising Pallor Limited ROM Non-weight bearing Displaced/non-displaced
The nurse is providing care to a child with a long-leg hip spica cast. Which of the following would be a priority nursing diagnosis? A) Risk for impaired skin integrity due to cast and location B) Deficient knowledge related to cast care C) Risk for delayed development related to immobility D) Self-care deficit related to immobility
A) Risk for impaired skin integrity due to cast and location
13. A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion? A) Swelling and point tenderness B) Decreased erythrocyte sedimentation rate C) Coolness of the affected site D) Increased range of motion
A) Swelling and point tenderness
A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? A) "We should give this drug before he eats anything." B) "We need to keep a close eye for possible infection." C) "The drug should not be stopped suddenly." D) "He might gain some weight with this drug."
A) "We should give this drug before he eats anything."
An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A) Notifying the doctor immediately B) Applying ice C) Elevating the arm D) Giving additional pain medication as ordered
A) Notifying the doctor immediately
When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A) Skeletal traction B) Physical therapy C) Orthotics D) Occupational therapy
A) Skeletal traction
The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a need for further teaching? A)"I need to monitor his skin at least twice a week." B)"I must monitor skin affected by his adaptive equipment." C)"He must change positions frequently." D)"We must avoid harsh cleaning products."
A)"I need to monitor his skin at least twice a week."
The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A)"I will help you become comfortable in caring for your daughter." B)"You must learn how to care for your daughter at home." C)"You will need to learn to collaborate with all the caregivers." D)"There is a lot to learn, and you need a positive attitude."
A)"I will help you become comfortable in caring for your daughter."
What muscles are affected in Duchenne?
All muscles will be affected, including cardiac and respiratory
A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statement by the parents demonstrates understanding of the instructions? Select all answers that apply. A) "We need to adjust the straps so that they are snug but not too tight." B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." D) "We need to send the harness to the dry cleaners to have it cleaned." E) "We need to call the doctor if she is not able to actively kick her legs."
B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." E) "We need to call the doctor if she is not able to actively kick her legs."
The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which of the following findings would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C) A high-pitched "click" is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.
B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers.
24. When assessing a child for slipped capital femoral epiphysis, which of the following would the nurse identify as a possible risk factor? Select all answers that apply. A) Age younger than 8 years B) African American ethnicity C) History of cystic fibrosis D) Excessive activity E) Obesity
B) African American ethnicity E) Obesity
The nurse is assessing an 11-year-old girl with scoliosis. Which of the following would the nurse expect to find? Select all answers that apply. A) Complaints of severe back pain B) Asymmetric shoulder elevation C) Even curve at the waistline D) Pronounced one-sided hump on bending over E) Diminished motor function F) Hyperactive reflexes
B) Asymmetric shoulder elevation D) Pronounced one-sided hump on bending over
14. Which of the following would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac
B) Covering the sac with saline-soaked nonadhesive gauze
A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, which of the following would the nurse most likely assess? A) Bruising B) Edema C) Limited range of motion D) Absent pulse
B) Edema
15. The nurse is assessing a child with a possible fracture. Which of the following would the nurse identify as the most reliable indicator? A) Lack of spontaneous movement B) Point tenderness C) Bruising D) Inability to bear weight
B) Point tenderness
The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. Which of the following would the nurse use when documenting these observations? A) Spastic B) Athetoid C) Ataxic D) Mixed
B) Athetoid
The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.
B) The process occurs in a head-to-toe fashion.
The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A)Deep-breathing exercises B)Upright positioning C)Coughing D)Chest percussion
B)Upright positioning
cause of cerebral palsy
BIRTH HYPOXIA /HYPOXIA IN UTERO May occur later in life after hypoxic event
How does osteomyelitis happen
Bacteria from the blood invade growth plates Break in skin
Osteomyelitis
Bacterial infection in the bone and tissue around the bone
Treatment for scoliosis
Based on age and curvature Bracing: NOT curative, help prevent worsening
Pathophysiology of Legg- Calve- Perthes
Blood does not go to the head of the femur and sometimes the acetabulum 4-8 years is most common Unknown why
External fixation devices for fractures- what is it? what is a complication?
Bone screwed into external Osteomyelitis is a complication
The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A) "I know it is boring, but you must remain immobile for 2 more weeks." B) "If there are no complications, you only have 2 more weeks here." C) "Let's come up with things to do like books, movies, games, and friends to visit." D) "If you resist your treatment, your condition will only get worse."
C) "Let's come up with things to do like books, movies, games, and friends to visit."
A nurse is preparing a program for a group of parents about injury prevention. Which of the following would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization
C) Increased mobility of the spine
The nurse is developing a teaching plan for a child who is to have his cast removed. Which of the following would the nurse most likely include? A) Applying petroleum jelly to the dry skin B) Rubbing the skin vigorously to remove the dead skin C) Soaking the area in warm water every day D) Washing the skin with dilute peroxide and water
C) Soaking the area in warm water every day
An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. Which of the following would the nurse include when teaching the child about the cast? A) The cast will take a day or two to dry completely. B) The edges will be covered with a soft material to prevent irritation. C) The child initially may experience a very warm feeling inside the cast. D) The child will need to keep his arm down at his side for 48 hours.
C) The child initially may experience a very warm feeling inside the cast.
The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which of the following responses from his mother indicates a need for further teaching? A) "He needs to get a medical alert identification." B) "I will need to discuss this with his caregivers." C) "A product's label indicates whether it is latex-free." D) "He must avoid all contact with latex."
C) "A product's label indicates whether it is latex-free."
The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A) "If you wear your brace properly, you may not need surgery." B) "The good news is that you have very minimal curvature of your spine." C) "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." D) "Let's talk to the doctor about your treatment options."
C) "Let's talk to another boy with scoliosis, who is winning trophies for his swim team."
A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A) "Would you like me to bring you a blanket and pillow?" B) "You are doing such a wonderful job with your son." C)"He's in good hands; consider going home to get some sleep." D)"Are you planning to spend the night or to go home?"
C)"He's in good hands; consider going home to get some sleep."
A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which of the following would the nurse include when teaching the parents about caring for their child? A) Waiting 48 hours before allowing the child to take a tub bath B) Not allowing the child to sleep on his side for about 4 weeks C) Calling the physician if the child's temperature is over 100.5°F D) Discouraging the child from stretching or bending forward for 4 weeks
D) Discouraging the child from stretching or bending forward for 4 weeks
After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A) Limb-girdle B) Myotonic C) Distal D) Duchenne
D) Duchenne
The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A) Recommend the bed's side rails be raised throughout the day and night. B) Suggest a caregiver be present continuously to prevent falls from bed. C) Encourage a loose restraint to be used when he is in bed. D) Recommend raising the bed's side rails when a caregiver is not present.
D) Recommend raising the bed's side rails when a caregiver is not present.
DO NOT DO with Slipped Capital Femoral Epiphysis?
DO NOT ASSESS ROM
Osteomyelitis: Nursing Interventions
Draw labs Hang antibiotics as ordered STAT Prep for surgery PRN Prep for x-rays/MRI/CT scans/bone scans
Soft Tissue Injury: Signs and Symptoms (4)
Edema Pain Ecchymosis Inflammation
Osteomyelitis: Signs and Symptoms
Fever Crying a lot Redness Warmth Swelling Pain Limping
Pavlik harness- how many times do you go for checkups?
Frequent clinic visits for adjustments (1-2 weeks)
Gower's sign
Get themselves in a crawling position to stand up Cant just pop up!
The child with Duchenne's muscular dystrophy must push on his legs and "walk up the leg" in order to rise to a standing position. The nurse recognizes this characteristic behavior as _______________ maneuver.
Gower's
Slipped Capital Femoral Epiphysis
Head of the femur separated from the rest of the femur at the growth plate
Slipped Capital Femoral Epiphysis: Signs and Symptoms
Hip tenderness Painful ROM Limp Decreased hip flexion Pain increases with toes turned inward Position of comfort with external rotation of the affected leg Inability to bear weight Trendelenburg gait
Cerebral Palsy: Signs and Symptoms how do they walk?? (2 things)
Hyperreflexia Hypertonia Muscle spasticity Toe walking! Scissoring- legs going over one another when walking Neonatal reflexes Writhing movement Trouble speaking Uncoordinated movements
Teaching for cast?
Itching weeks later Do not stick anything in the cast Callus formation to hold bone together Check for cap refill Younger the kid, the quicker the healing
Scoliosis
Lateral curvature and rotation of the spine >10 degrees
Club foot definition:
Mal-alignment of feet which resists being moved into proper alignment
Life long issues of spina bifida (4) what allergy?
Mobility GU function Hydrocephalus Latex allergy
Treatment for Legg- Calve- Perthes (3)
NSAIDS & rest Non-weight bearing Brace
Legg-Calve-Perthes
Necrosis of femur head Blood supply returns, but damage to bone is done
Signs and symptoms of spina bifida? (4)
Neural tube abnormalities DIMPLING NEAR BUTTOCKS ABNORMAL PATCHES OF HAIR HYDROCEPHALUS
Casting for fractures how does it feel when forming? may take time to?
Non-displaced=non-painful Help keep calm/distracting Explain that it gets warm when forming May take time to dry Stabilizes so extremity cannot move Comfort measures Sedation Traction Pulling
Slipped Capital Femoral Epiphysis- what is the cause?
OVERWEIGHT TEENAGER (at growth spurt)
Signs and Symptoms Legg- Calve- Perthes
Often painless Limp- worsens with activity
2 tests we use for DDH:
Ortlani & Barlow +x-ray and ultrasound
Treatment of DDH- what kind of harness? how long is it worn? what is not allowed?
Pavlik harness Continuously warn!!! Less than 6 months Keeps legs abducted to keep trochanter in the acetabulum No lotions/powder; monitor skin
Duchenne Muscular Dystrophy
Progressive loss of function due to muscular loss
Assessment of scoliosis
Screening Bend over at the hips and touch toes Monitor physical appearance during exam
Treatment of club foot? what kind of casting how many applications
Serial casting Constant reapplication due to rapid growth Every 2 weeks Surgery Physical Therapy
Developmental Dysplasia of the Hip (DDH)
Subluxation or complete dislocation of hip
Treatment for Slipped Capital Femoral Epiphysis?
Surgery immediatley Immobilization of the joint
If Pavlik harness fails or >6 month?
Surgery+Spica casting
Family and patient teaching for cerebral palsy
There is NO cure Encourage participation with classmates; adapt as necessary
If kid with DDH does not get treated, what gait will they have?
Trendelenburg gait:Unequal hip height
Scoliosis: Signs and Symptoms
Uneven posture One scapula/clavicle higher than the other Hip/rib asymmetry Back pain
Assessment of Fractures
X-ray Ultrasound 5 P's Pulses Pallor Pain Paralysis Parasthesia
The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching? a. "Apply warm compresses to the ankle for the first 24 hours." b. "Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off." c. "Wrap the ankle in an Ace bandage for support." d. "Keep the leg elevated when sitting."
a. "Apply warm compresses to the ankle for the first 24 hours." Heat is not a treatment for soft tissue injuries. The principles of managing soft tissue injuries are rest, ice, compression, and elevation.
What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis? a. Ask the child to bend forward at the waist and observe the child's back for asymmetry. b. Observe the gait while the child is walking forward heel to toe. c. Have the child flex the knees and look for uneven knee height. d. Look at the child's shoulders and hips while fully clothed.
a. Ask the child to bend forward at the waist and observe the child's back for asymmetry.
The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb f. Lordosis
a. Positive Ortolani click b. Unequal gluteal folds A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Unequal gluteal folds, negative Babinski sign, and Trendelenburg sign are signs that appear in older infants and children. Telescoping of the affected limb and lordosis are not clinical manifestations of developmental dysplasia of the hip.
Which nursing diagnosis would be a priority when preparing a plan of care for a child in a leg cast? a. Risk for altered peripheral tissue perfusion b. Risk for altered urine elimination c. Knowledge deficit d. Risk for infection
a. Risk for altered peripheral tissue perfusion
A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate, immediate action by the school nurse is to: a. apply ice. b. observe for edema and discoloration. c. encourage child to assume a position of comfort. d. obtain parental permission for administration of acetaminophen or aspirin.
a. apply ice. Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.
Fracture definition:
any break to the bone
The nurse is caring for a 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? a. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." b. "I know it will be important for me to catheterize my child for the rest of her life." c. "I will make sure that I always use latex-free catheters." d. "I will wash the catheter with warm soapy water after each use."
b. "I know it will be important for me to catheterize my child for the rest of her life." Children with adequate upper extremity function and normal intelligence usually learn to catheterize themselves around age 6.
The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis? a. "Pressure of inelastic bone" b. "Purulent drainage in the bone marrow" c. "The cast applied on the extremity" d. "Circulatory congestion of the skin"
b. "Purulent drainage in the bone marrow" Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain.
A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. How long will the nurse indicate that antibiotic therapy will probably last? a. 2 weeks b. 6 weeks c. 2 months d. 3 months
b. 6 weeks
The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones
b. Decreased metabolic rate Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.
A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect? a. Juvenile rheumatoid arthritis b. Poor posture c. Heredity d. Myelomeningocele
b. Poor posture
What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child? a. Has inward-turned knees while standing b. Walks on the toes c. Appears to have flat feet d. Swings his arms when walking
b. Walks on the toes
What would the nurse include in planning teaching to parents of a child with Legg-Calvé-Perthes disease about the long-term effects of this disease? a. There are no long-term effects. b. The disease is self-limited and requires no long-term treatment. c. Degenerative arthritis may develop later in life. d. There is risk of osteogenic sarcoma in adulthood.
c. Degenerative arthritis may develop later in life.
The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? a. Encourage follow-through with physical therapy exercises. b. Restrict the child to a special needs classroom. c. Encourage after-school activities within the limits of the child's abilities. d. Ensure the school is aware of the child's capabilities.
c. Encourage after-school activities within the limits of the child's abilities.
What characteristic manifestation does the nurse caring for a child with Duchenne's muscular dystrophy document? a. Ambulates by holding onto furniture b. Exhibits atrophy of the calf muscles c. Falls frequently and is clumsy d. Has delayed fine-motor development
c. Falls frequently and is clumsy
A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.
c. Frequent, serial casting is tried first. Serial casting is begun shortly after birth before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.
A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? a. Age that the child learned to walk b. Parents' expectations of the child's development c. Functional status related to eating and mobility d. Birth history to identify cause of cerebral palsy
c. Functional status related to eating and mobility Each child with cerebral palsy has individual strengths. The nurse must know this child's functional status, as mobility and feeding may both be affected in the child with cerebral palsy.
The nurse is taking care of a 10-year-old child who has osteomyelitis. Which treatment plan is considered the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy
c. Intravenous antibiotic therapy Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.
A school nurse is conducting a staff in-service to other school nurses on idiopathic scoliosis. During which period of child development does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. Preadolescent growth spurt d. Adolescence
c. Preadolescent growth spurt
The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove harness several times a day to prevent contractures. c. Return to clinic every 1 to 2 weeks. d. Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.
c. Return to clinic every 1 to 2 weeks.
If scoliosis is severe?
cardiac and respiratory compromise
The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel? a. Ambulate the children twice daily to promote mobility. b. Encourage commode use to promote bowel function. c. Provide diversionary activities, as the children must stay flat on their backs. d. Assist with log-rolling the children every 2 hours.
d. Assist with log-rolling the children every 2 hours.
The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.
d. Elevate casted arm when resting and when sitting up.
A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention? a. Apply supplemental oxygen. b. Notify the respiratory therapist. c. Monitor pulse oximetry. d. Position for adequate airway clearance.
d. Position for adequate airway clearance. Positioning for airway clearance is the priority intervention, although suctioning may also be required. Interventions for airway maintenance take priority over other issues.
A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance
d. Teaching the family the care and management of the corrective appliance The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.
Club foot cause: (3) more common in what gender
fetal positioning Intrauterine restriction Myelomeningocele more common in boys
cause of DDH? more common in
fetal positioning more common in girls
How do you get Duchenne? WHO GETS IT?
hereditary ONLY BOYS GET IT
2 things you want to prep for spina bifida
infection control surgical prep get everyone on board to advocate for pt: Neurology Neurosurgery Urology Orthopedics Therapy Rehab
Duchenne Muscular Dystrophy: When do signs and Symptoms and symptoms start to show?
initially growth/development are NORMAL signs and symptoms start to show around 3 years old!
When does scoliosis occur? in boys or girls?
more common in girls in pre-adolescent growth spurt
Spina bifida is a developmental birth defect in which the
neural tube fails to close as a fetus
Around 3-years-old, what is seen in Duchenne muscular dystrophy? what sign develops?
not walking as well, taking the easy way out of things Initially small functions, then becomes gross motor Gowers sign develops
How do you asses for Slipped Capital Femoral Epiphysis?
obese pre-teen X-ray
when is cerebral palsy diagnosed?
often diagnosed in first year of life
Cerebral Palsy
paralysis caused by damage to the area of the brain responsible for movement Non-progressive, permanent disability Affects movement and speech Affects voluntary and involuntary muscles
Diagnosis of spina bifida (2)
prenatal MRI
Ortalani Test
put knees opposite AND pushing back IN
Spina bifida results in 3 things
spina bifida occulta meningocele meninomyelocele
Soft Tissue Injury
strains and sprains Sprains Twisting of a joint Damage to the tendons and ligaments Overuse ("Strain") Tearing or breakdown of tissue
prevention of spina bifida
take folic acid at child bearing age
Treatment for Duchenne muscular dystrophy (3)
there is NO CURE Deep breathing exercises/chest PT Preserve ambulation, vital organ function, and independence for as long as possible Monitoring/treatment for depression
Physical Appearance of DDH (3 things)
uneven thigh folds uneven femur length/unequal knee height
Spina bifida cause?
unknown cause LACK OF FOLIC ACID
Nursing interventions for cerebral palsy
we want to recognize this early!! Promote mobility Promote optimal development using multidisciplinary opportunities Physical therapy Occupational therapy Early intervention
Duchenne muscular dystrophy- by teenage years?
wheel chair bound
Assessment of Soft tissue injury
x-ray to rule out fracture
How do you assess club foot?
x/ray ultrasound