Peds Exam 5 DDH( HIps)

1

A 1 month old infant is seen in a clinic and is diagnosed with DDH. on assessment the nurse understands that which finding should be noted in this condition? 1. limited ROM in the affected hip 2. Apparent lengthened femur on the affected side 3. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4. Symmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table saunders pg 517 number 450

C

A 2 day old infant in the newborn nursery is diagnosed with DDH and treatment is started by the orthopedist. the nurse assist the parents by providing home care instructions that include: A> return to the ortho office in 2 weeks to remove the hip spica cast B- the infants bilateral foot cast should be elevated on pillows as much as possible C- remove the Pavlik harness once a day for no more than 2 hours and inspect skin D- remove the Pavlik harness while the infant is awake to allow tummy time Wong page 977number 5

3

A pediatric nurse interprets that which infant is least likely to be diagnosed with devlopmental dysplaisa of the hip( DDH)? 1. an infant with a family history with DDH 2. an infant with a birth weight of 10 pounds 3. an infant carried on the mothers hip 4. the infant who had frank breech position in the utero. hogan page 1157 number 23

4

In infants older than ___ months of age, xrays are useful in diagnosing this

ortolani

Thighs are ABDUCTED( out like a frog) you hear a click or clunk as the femoral head passes back into the socket( this test pushes a dislocated hip back into the hip socket) only done by experienced DR

1,2,3

Which can occur in untreated DDH. Selct all that apply: 1. Duck gait 2. pain 3. osteoarthritis in adulthood 4. osteoporosis in adulthood 5. increased flexibility of the hip joint in adulthood peds success page 220 number 3

Left hip

Which hip is most often involved?

4

Which should the nurse stress to the parents of a infant in a Pavlik Harness for treatment of DDH? 1. put socks on over the foot pieces ti help stablize the harness 2. use lotions or powder on the skin to prevent rubbing of straps 3. remove harness during diaper changes for ease of cleaning diaper ares 4. check under the straps at least 2-3 times daily for areas. peds success pg 219 number 2

3

Which would the nurse asses in a 4 week old infant who has DDH and is wearing a Pavlik harness? 1. diaper dermatitis 2. talipes equinovarus 3. leg shortening and limited abductio 4. pain peds success page 288 number 46

3

Which would the nurse expect to asses on a 3 week old infant with DDH? 1. excessive hip abduction 2. femoral lengthening of an affected leg 3. asymmetry of gluteal and thigh folds 4. pain when lying prone peds success pg 219 number 1

Subluxation

accounts for the largest percentage of DDH Head of femur remains in contact with the acetabulum but a stretched capsule and ligamentum teres causes the head of the femur to be partially displaced ( stretched ligament)page 960 picture

first

all infants are monitored for ddh at follow up visits throughout the ____ year of life

girls

80% of the cases of developmental hip dysplasisa are girls or boys?

4 weeks

Barlow and ortolanis are most reliable until ____ and must be done by an experienced clinician?

Acetabular dysplasia( preluxation)

Preluxation( shallow) mildest form neither subluxation nor dislocation femoral head remains in the acetabulum delay in the development of the acetabulum

3

The nurse is assisting a HCP examining a 3-week old infant with DDH. What test or sign should the nurse expect the HCP to assess. 1. babinskis sign 2. moro reflex 3. ortolanis maneuver 4. palmar/plantar grasp saunders pg 517 number 449

posititve barlow positive ortalani uneaqual or asymmetry of the gluteal and thigh folds restricted abduction of the hip on the affected side positive Galeazzi sign( apparent short femur on the affected side)

clinical manifestations of infants: page 961

lurching forward( causes by the femoral head losing its place inside the acetabulum) minimal to pronounced variations in gait and lurching toward the affected side affected leg appears shorter than other head of femur can be felt to move up and down trendelenburg sign- pelvis tilts downward on the normal side instead of upward

clinical manifestations of walking child:

true

extra thigh folds, the side that has the extra roll is the affected side true/false

Ours(American)

highest incidence of hip dysplasias occur when cultures use swaddling- tightly wrapped with the hips adducted and extended in blankets what culture is this

carry infants on mothers back with hips in abducted position

hip dysplasia is less common when cultures do what?

shallow acetabulum, subluxation, or dislocation

may include a ______, ______, or ______

dislocation

most severe form THE FEMORAL HEAD LOSES CONTACT WITH THE ACETABULUM the head of the femur lies outside of the acetabulum ligametum teres is elongated and taut pg960

ortolani and barlow

subluxation and the tendency to dislocate can be demonstrated by____ and _____

worn continuously until hip is proved stable on clinical and ultrasound exam usually in 6-12 weeks straps should be checked every 1-2 weeks for adjustment which would be done by the practitioner PARENTS DO NOT ADJUST STRAPS Prevent skin breakdown check frequently 2-3 times a day for red areas on skin irritation in skin folds and under straps gently massage healthy skin under the straps once a day to stimulate circulation ALWAYS PLACE A DIAPER UNDER THE STRAPS Can be removed for bathing if the parents learn how to adjust the straps

teaching with Pavlik Harness page 1070

Physiologic: intrauterine positioning-maternal hormone secretion Mechanical Factors: breech presentation, multiple fetus, oligohydraminos( low amt of amniotic fluid), continued maintenance of the hips in adduction Genetic factors: positive family history( if a parent had it, kids may have it)

what are some predisposing factors to hip dysplasias?

Pavlik Harness

what is the treatment from newborns to 6 months of age

ossification of the femoral head is usually not done until 4-6 months of age

why are x-rays not done until after 4 months of age?

barlow

with this test the thighs are ADDucted( adding it to the body) a snap is felt as the femur leaves the hip socket( the___ test pushes a dislocated hip out of the hip socket)