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pediatric muscloskel

musculoskeletal pediatric conditions

QuestionAnswer
for what specific conditions are the treatment, dx, nursing care, manifestations and pathophysiology during growth and development for injury or degenerative disease such as osteosarcoma,Ewing’s sarcoma and juvenile idiopathic arthritis? age specific changes, effects of immobilization, differences between soft tissue injuries and fractures, care for a child with a cast or in traction, common congenital musculoskeletal defects, Legg-Calve`-Perthes disease, scoliosis, osteomyelitis,
Age specific changes in birth include: Skeletal system contains more cartilage than ossified bone. Muscular system is almost completely formed. Ballard scoring system is a way to measure neuromuscular maturity at birth.
Dubowitz/Ballard Scoring System matrix of movement capability for infants describing physical maturity
Age specific changes in newborn Muscle tone increases with maturity, ROM. Legs in flexed position. C shaped spine.Spinal curve becomes double S shape. Toddler’s feet appear flat. A delay in neurological development can cause delay motor skill altering skeletal growth.
Musculoskeletal System Assessment Observation. Palpation. ROM. Gait assessment.
Gait assessment. An infant An infant who does not pull to a standing position by 11-12 months should be evaluated. Should be referred if not walking by 18 months.
Gait assessment. An infant An infant who does not pull to a standing position by 11-12 months should be evaluated. Should be referred if not walking by 18 months.
Gait Observation Toddler 12-13 months: Walks along with wide stance for balance. “Toddling” or broad based gait. No arm swing.
Gait Observation Toddler 12-13 months: Walks along with wide stance for balance. “Toddling” or broad based gait. No arm swing.
Toddler 18 months:Gait Observation Base narrows. Walk more stable. Attempts to run but falls easily.
Gait observation 2 to 2.5 years: Can walk up and down stairs. Can jump, using both feet. Can stand on one foot for a second or two. Progresses to tiptoe, climbing stairs with alternating footing.
Gait observation 2 to 2.5 years: Can walk up and down stairs. Can jump, using both feet. Can stand on one foot for a second or two. Progresses to tiptoe, climbing stairs with alternating footing.
Gait Observation Preschooler: 3 year old: Rides a tricycle. Walks on tiptoe. Balances on one foot. Broad jumps. 4 years old: Can hop on one foot. Skips. Catches a ball proficiently. Arms swing with walking.
Gait Observation School-age: 5 years old: Skips on alternate feet. Jumps rope. Begins to skate and swim. Walk similar to adults. 6 years old: Steadier on their feet. Trunk centered over legs. Movement symmetrical and graceful.
Gait Observation, patho Toe walking after age 3 may indicate a muscle problem. Young children bowlegged or knock-kneed between 2 to 7 years of age. Nurse's role to reassure parents that many minor abnormal-appearing alignments will spontaneously resolve with activity.
Observe Muscle Tone Symmetry. Strength and contour. Neurological examination.
Observe Muscle Tone Symmetry. Strength and contour. Neurological examination.
What should be included in your musculoskeletal system assessment of a child? Observation, palpation, ROM and gait assessment.
What should be included in your musculoskeletal system assessment of a child? Observation, palpation, ROM and gait assessment.
Effects of Immobilization immobility and it can have a lasting affect on a child.Inactivity leads to decreased functional capabilities and delayed age-appropriate milestones.
Effects of Immobilization immobility and it can have a lasting affect on a child.Inactivity leads to decreased functional capabilities and delayed age-appropriate milestones.
How is a child's mind affected by immobility? Deprives children of a natural outlet. Can create feelings of helplessness. Even speech and language skills are affected.
How is a child's mind affected by immobility? Deprives children of a natural outlet. Can create feelings of helplessness. Even speech and language skills are affected.
How is communication with the child affected? Monotony can lead to sluggish intellectual and psychomotor responses, decreased communication skills, increased fantasizing and even hallucinations and disorientation.
How is communication with the child affected? Monotony can lead to sluggish intellectual and psychomotor responses, decreased communication skills, increased fantasizing and even hallucinations and disorientation.
what are expected childlike reactions? Children react with protest, anger and aggressive behavior or may become quiet, passive and submissive.
what are expected childlike reactions? Children react with protest, anger and aggressive behavior or may become quiet, passive and submissive.
How does immobilization effect their functioning r/t family functioning, and disability? disrupt family function, and catastrophic illness or disability may severely tax their resources and coping abilities.
How does immobilization effect their functioning r/t family functioning, and disability? disrupt family function, and catastrophic illness or disability may severely tax their resources and coping abilities.
Nursing Considerations Physical assessment focusing on entire body. Place on special mattress to prevent skin breakdown. Use anti-embolism stockings. High-protein, high-calorie foods and use supplemental feedings as needed. Encourage child to stay as active as possible.
Nursing Considerations Physical assessment focusing on entire body. Place on special mattress to prevent skin breakdown. Use anti-embolism stockings. High-protein, high-calorie foods and use supplemental feedings as needed. Encourage child to stay as active as possible.
What type of fractures can disrupt the growth of bones? Epiphyseal plate fractures.
What type of fractures can disrupt the growth of bones? Epiphyseal plate fractures.
Soft tissue injuries usually accompany traumatic fractures related to play or sports activities with what types of injuries? Contusions-Tearing of subcutaneous tissue resulting in hemorrhage, edema and pain. Dislocation: The force of stress on a ligament is so great as to displace the normal position of the opposing bone ends. pain increases with movement.
Soft tissue injuries usually accompany traumatic fractures related to play or sports activities with what types of injuries? Contusions-Tearing of subcutaneous tissue resulting in hemorrhage, edema and pain. Dislocation: The force of stress on a ligament is so great as to displace the normal position of the opposing bone ends. pain increases with movement.
What is the difference b/w a sprain and strain? Sprain: Ligament is partially or completely torn or stretched away from the bone causing damage to blood vessels, muscles and nerves. Rapid onset of swelling, immediately disability and pain are involved,
What is the difference b/w a sprain and strain? Sprain: Ligament is partially or completely torn or stretched away from the bone causing damage to blood vessels, muscles and nerves. Rapid onset of swelling, immediately disability and pain are involved,
what r the conditions AEB manifestations, dx, treatment, understanding pathophysiology, nursing considerations during growth and development, with an injury or degenerative disease such as juvenile idiopathic arthritis, Ewing’s sarcoma, & osteosarcoma? differences between soft tissue injuries and fractures, care for a child with a cast or in traction,congenital musculoskeletal defects, Legg-Calve`-Perthes disease, scoliosis, osteomyelitis, osteosarcoma, juvenile idiopathic arthritis,
Age-Specific Changes- Birth Skeletal system contains more cartilage than ossified bone. Muscular system is almost completely formed. Ballard scoring system is a way to measure neuromuscular maturity at birth.
Dubowitz/Ballard Scoring System matrix of illustrated infant movement capabilities with descriptions of physical maturity.
Age-Specific ChangesNewborn Muscle tone increases with maturity, ROM. Legs in flexed position. C shaped spine.
Changes with age: Spinal curve becomes double S shape. Toddler’s feet appear flat. A delay in neurological development can cause delay in mastery of motor skills which can alter skeletal growth.
Musculoskeletal System Assessment Observation. Palpation. ROM. Gait assessment.
An infant Gait assessment. An infant who does not pull to a standing position by 11-12 months should be evaluated. Should be referred if not walking by 18 months.
Gait Observation Toddler 12-13 months: Walks along with wide stance for balance. “Toddling” or broad based gait. No arm swing.
Gait Observation Toddler 18 months: Base narrows. Walk more stable. Attempts to run but falls easily.
Gait observation 2 to 2.5 years: Can walk up and down stairs. Can jump, using both feet. Can stand on one foot for a second or two. Progresses to tiptoe, climbing stairs with alternating footing.
Gait Observation Preschooler Preschooler 3 year old: Rides a tricycle. Walks on tiptoe. Balances on one foot. Broad jumps. 4 years old: Can hop on one foot. Skips. Catches a ball proficiently. Arms swing with walking.
Gait Observation School-age: 5 years old: Skips on alternate feet. Jumps rope. Begins to skate and swim. Walk similar to adults. 6 years old: Steadier on their feet. Trunk centered over legs. Movement symmetrical and graceful
Gait Observation in school age that indicate minor abnormal allignments. Toe walking after age 3 may indicate a muscle problem. Young children bowlegged or knock-kneed between 2 to 7 years of age. Nurse's role to reassure parents that many minor abnormal-appearing alignments will spontaneously resolve with activity.
how does one Observe Muscle Tone Symmetry. Strength and contour. Neurological examination.
: What should be included in your musculoskeletal system assessment of a child? Observation, palpation, ROM and gait assessment.
what are the Most difficult aspects of illness in children ? immobility and it can have a lasting affect on a child.
what does inactivity lead to in children? decreased functional capabilities and delayed age-appropriate milestones.
How does inactivity of immobilization effect child behavior? Deprives children of a natural outlet. Can create feelings of helplessness.Children react with protest, anger and aggressive behavior or may become quiet, passive and submissive.
How does it affect child's communication? Even speech and language skills are affected. Monotony can lead to sluggish intellectual and psychomotor responses, decreased communication skills, increased fantasizing and even hallucinations and disorientation.
what care is done for risk of skin breakdown, clot development, and nutrition? Physical assessment focusing on entire body. Place on special mattress to prevent skin breakdown. Use anti-embolism stockings. High-protein, high-calorie foods and use supplemental feedings as needed.
How is the child's behavior modified? Encourage child to stay as active as possible. Transport outside room when possible. Consult a play therapist or child-life specialist.
What type of fractures can disrupt the growth of bones? Epiphyseal plate fractures
Soft tissue injuries usually accompany traumatic fractures related to play or sports activities are usually what type of injuries? contusions and dislocations
what is the difference b/w sprain and strain? Sprain: Ligament is partially or completely torn or stretched away from the bone causing damage to blood vessels, muscles and nerves. Rapid onset of swelling, immediately disability and pain are involved. Strain is microscopic muscle/tendon tear.
treatment of injuries means RICE... to limit damage from edema and bleeding Rest. Ice immediately. Compression (elastic bandage): with ice to reduce edema and bleeding and relieve pain, applied at alternating 30 minute intervals to prevent ischemia. Elevation: several inches above heart to reduce edema.PMS checks
Immobilize torn ligaments, but how is mobility cared for? Crutches are used for mobility to rest the affected extremity.
What is the nurses' role in most diagnostic procedures for musculoskeletal conditions? Preparation of the child/family and escort the child.
what causes a fracture and how does it heal? Occurs when the resistance of bone against the stress being exerted yields to the stress force.Fractures in children heal faster.Most are related to traumatic incidents. True injuries that cause fractures rarely occur in infants.
Transverse vs Oblique Transverse fractures are crosswise at right angles to the long bone. Oblique fractures are slanting but straight, between a horizontal and perpendicular direction.
Open vs closed If the fracture does not produce a break in the skin, it is a simple or closed fracture. Open or compound fractures are those which the bone protrudes.
complete vs incomplete When fracture fragments are separated, the fracture is complete; when they remain attached, the fracture is incomplete.
Spiral fracture Spiral fractures are slanting and circular, twisting around the bone shaft. This type of fracture in children may indicate child abuse, and further assessment of the family situation should involve a multidisciplinary team.
manifestations in DX Eval Generalized swelling. Pain or tenderness. Diminished functional use. Bruising. Severe muscular rigidity. Crepitus.
Goals in therapeutic mgm Regain alignment and length of bony fragments through reduction. Regain alignment and length through immobilization. Restore function to the injured parts. Prevent further injury.
how long are fx's normally casted? Most fractures are managed by closed reduction and casted for 7 to 10 days. Children are hospitalized for fractures of the femur and distal humerus.Children are hospitalized for fractures of the femur and distal humerus.
what are the five P's in assessing the fx limb? Pain and point of tenderness. Pulse distal to fracture. Pallor. Paresthesia distal to fracture. Paralysis distal to fracture.
nursing concerns for fx's Move the injured part as little as possible. Calm the parents. Have the child wiggle his or her fingers and toes. Communicate with parents and child.
: Explain the acronym RICE. Rest, ice, compression and elevation to reduce edema, bleeding and pain.
What things need to be included in the assessment of a child with a suspected fracture? The 5 P’s: pain, pallor, pulselessness, paresthesia, paralysis.
what are fun interesting facts about casts? Made of plaster, fiberglass and/or polyurethane resin. All types of casts produce heat after application. Plaster casts take up to 72 hours to completely dry. Synthetic casts dry in about 30 mins.
what are nursing considerations for casts? The cast must remain uncovered initially. A child in a body cast must be turned every 2 hours initially. Hot spots should be reported. Elevate the casted extremity and observe for signs of complications and neurovascular compromise.
Report what signs immediately Unrelieved pain. Swelling with discoloration. Decreased pulses. Inability to move the distal exposed parts.
Provide education to parents: Cast care. Checking for signs that cast is too tight. Maintaining hygiene.
If child is in a hip spica cast, teach the parents: Feeding the child with head elevated or prone. Small bedpans or other containers may be necessary for using the bathroom.
care for cast removal When cast is removed, children feel vibration. Allow parents to keep cast if desired. Soak the extremity in the bathtub. Do not pull off or forcibly remove caked skin.
what are the effects of traction? Reduce or realign the fracture site. Body weight provides counter-traction. Contact with the bed constitutes frictional force.
describe traction Most balanced skeletal traction is applied on children after a severe or complex injury to allow physiologic stability, align bone fragments and permit closer evaluation of the injured site.
describe the healing process Combined forces are used to align the bone fragments. Gradual process.
Traction types Overhead suspension: Dunlop:Bucks extension Russell’s traction90-degree traction: Balance suspension traction: Cervical traction:
nursing concerns Regular assessments. Ensure traction is maintained as set by the orthopedist. Routine skin observation and pin care are needed. A pressure reduction device on the bed with help reduce skin breakdown. Pain medication.
Traction apparatus do's Weight’s hanging freely & out of reach. Ropes on pulleys. Knots not resting on pulleys. Linens not on traction ropes. Counter traction in place. Apparatus not touching foot of bed.
Checklist of do's for the pt care Regular neuro checks. Monitor skin integrity. Pain relief. Prevent constipation. Encourage trapeze.Proper alignment. HOB 20 degrees or less. Heels elevated. ROM unaffected parts. Antiembolism stockings.
What are you looking for when checking the functionality of the weights on a child in Dunlop’s traction? The weights must be the correct weight, hanging freely and in a safe location.
QUESTION: What are three things that can be done to prevent skin breakdown in a child in traction? Provide alternating pressure mattress under the hips and back, Inspect pressure points daily or more often if breakdown is observed, Change position at least every 2 hours to relieve pressure.
Certain fractures are believed to affect the risk of DDH such as: Gender. Birth order. Family history. Intrauterine position. Delivery type. Joint laxity. Postnatal position.
what is the mildest form of hip dysplasia Acetabular dysphasia is the mildest form of DDH in which there is a delay in the development of the acetabulum.
what is the difference b/w subluxation and dislocation? Subluxation is where there is an incomplete dislocation of the hip. Dislocation is where the femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over the rim.
DX Eval Attention to deficits. X-rays after 6 months. Ultrasound.
therapeutic mgm Began as soon as recognized and varies according to age and extent of dysplasia. Goal: obtain and maintain a safe position to promote normal hip joint development.
6-18 mos. therapeutic mgm 6 to 18 months: Gradual reduction of traction. Open or closed reduction.
older child therapeutic mgm Older child: More difficult. Operative reduction.
nursing considerations Assess for deviations. Teach parents to apply and maintain reduction devices. Keep child involved in developmentally appropriate activities.
how is clubfoot classified? Classification: Positional. Syndromic or teratologic. Congenital or idiopathic.
describe clubfoot Congenital clubfoot is a complex deformity of the ankle and food where there is an inversion and the foot is pointed downward and inward in varying degrees of severity.
what causes clubfoot? Positional clubfoot which is believed to occur primarily from intrauterine crowding and responds to simple stretching and casting.
what type of clubfoot is resistant to treatment Syndromic or teratologic clubfoot which is associated with congenital anomalies such as myelomeningocele and is a more severe form of clubfoot that is often resistant to treatment.
how is therapy managed? Goal: painless, plantigrade and stable foot. 3 stages: Correction. Maintenance. Follow up observation.Serial casting. X-rays and ultrasound as needed. Surgery if casting is not effective.
what are the nursing considerations Care is the same as for any child in a cast. Conscientious observation of skin and circulation is important. Educate parents on overall plan and the importance of complying with plan.
clinical features of osteogenesis imperfecta Bone fragility, deformity and fractures. Blue sclerae. Hearing loss. Dentinogenesis imperfecta.
describe osteogenesis imperfecta Most common osteoporosis syndrome in children. It is an inherited syndrome characterized by excessive fractures and bone deformity.
describe the therapy management Supportive. Goals: Prevent contractures and deformities. Prevent muscle weakness and osteoporosis. Prevent Malalignment of lower extremities.
what are the nursing considerations for osteogenesis imperfecta Careful handling. Educate regarding the child’s limitations and guidelines when planning activities. Refer to support group.
Why would a Pavlik harness be used on a newborn? The Pavlik harness is used on newborns to help splint their hips in a safe position with the femur centered in the acetabulum. The harness is worn continuously until the hip is proved stable on examination.
What things should a nurse do to help prevent fractures while caring for a child with Osteogenesis Imperfecta? These children require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved and held.
Legg-Calve’-Perthes Disease One of the osteochondroses disorders. A self-limiting juvenile idiopathic vascular necrosis of the femoral head.
Incidence of Legg-Calve’-Perthes Disease Cause & incidence unknown. More common in boys 2-12 years old. Most common in 4 to 8 year age group. More common in Caucasians. 90% cases unilateral.
pathophysiology of legg--calve'perthes disease Affects development of head of femur. May lead to imperfect joint of degenerative arthritis. Spontaneous healing in 2-4 years
Manifestations of legg--calve'perthes disease: Painless limp. Limited movement.
dx of legg-calve'-perthes disease Signs and symptoms. Bone imaging and x-ray.
therapy mgm of legg-calve'-perthes disease Goals: Keep head of femur in hip pocket. Avoid weight bearing. Bed rest & traction. Ambulation-abduction casts or braces. Prognosis is excellent. May require hip replacement as adults.
nursing considerations for legg-calve'-perthes disease Support parents & include in planning. Depends on age & prescribed treatment. Holistic teaching of child & family. Pre-op & post-op for surgery. General principles of traction, cast & brace care.
What two major factors are considered when planning nursing care? The age of the child and the type of treatment.
define scoliosis a complex spinal deformity in three plans, usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis.
Etiology and Incidence More common in adolescent girls. Functional is caused by poor posture and is easily correctable. Structural is due to changes in the shape of the vertebrae or thorax. Neuromuscular is caused by muscle weakness. Idiopathic.
Scoliosis Manifestations S-shaped spine. One shoulder higher than the other. One hip more prominent. Back pain. Clothes do not fit right
scoliosis treatment halo traction, boston brace, milwaukee brace, spinal fusion,
nursing implications screening Pre/post operative care: Explain brace. Prevent complications of immobility. Exercise, physical therapy and promote developmentally appropriate activities.
Which type of scoliosis is easily correctable and why? Functional, because it's just a matter of correcting poor posture.
define osteomyelitis infection of the bone
Etiology and Incidence osteomyelitis Most common in children < 1yr and between 5 to 14 yrs. Staphylococcus aureus is causative organism in 74-80%. Sometimes preceded by some type of local injury to the bone.
Pathophysiology osteomyelitis Infectious emboli may travel to small arteries of the bone. Local destruction and abscesses set up.
Manifestations osteomyelitis Pain. Decreased movement & limited ROM. Signs of local inflammation. May limp.
Osteomyelitis Diagnosis Increased WBC & ESR. Bone scan. Detailed history. Blood culture. Urine for bacterial antigens. Tissue biopsy.
Osteomyelitis Treatment IV antibiotics x 4-6 weeks. Bed rest initially. Immobilization. Surgical drainage.
Osteomyelitis Nursing Implications Monitor for toxic reaction. Diversional activities, PT & tutoring. Work with home care providers. Routine cast/splint care. Pain management. Position comfortably.
How long is the course of antibiotics for osteomyelitis? 4-6 weeks, IV.
Osteosarcoma Definition: primary malignant tumor of the long bones.
Incidence of Osteosarcoma Mean age is 10 – 15 years. Children who had radiation therapy or retinoblastoma are at highest risk.
Pathophysiology Osteosarcoma Metastasis occurs quickly because of high vascularity of bone. Lungs primary site of metastasis, brain and other bone tissue also.
Manifestations Osteosarcoma Pain & swelling. Pain may be lessened by flexed position. Pathologic fracture may occur.
Osteosarcoma Diagnosis CT scan. Bone scan. Bone biopsy. Complete physical.
Osteosarcoma Treatment Radical resection or amputation. Internal prostheses. Long term survival with early diagnosis & treatment.
Support patient & family. Anticipate grief process, especially with amputation. Post-op care: Vital signs. Stump dressing. Body image change. Positioning. Phantom limb pain (may need to treat). Rehabilitation. Osteosarcoma Nursing Implications
What conditions increase a child's risk for osteosarcoma? Children who had radiation therapy or retinoblastoma.
Ewing’s Sarcoma Definition: malignant growth that occurs from the marrow, usually of long bones but can develop in the skull or flat bones of the trunk.
Ewing’s Sarcoma Incidence Occurs during puberty. 60% survival rate if no metastasis.
Pathophysiology Ewing’s Sarcoma Mets to lungs and other bones. Mets in about 1/3 children at time of diagnosis.
Manifestations Ewing’s Sarcoma : Pain. Swelling. Fever.
Ewing’s Sarcoma Diagnosis Skeletal x-ray. Chest x-ray. CT scan of chest. Bone scan. Tumor biopsy.
Ewing’s Sarcoma Treatment: Chemotherapy and radiation therapy. Surgical removal. Nursing Implications: Warn against vigorous weight-bearing. Prepare for effects of treatment. Support patient and family.
When is Ewing's sarcoma most likely to occur? During puberty.
Juvenile Idiopathic Arthritis an autoimmune inflammatory disease causing inflammation of joints and other tissue.
Etiology and Incidence Cause unknown: may be infection or an auto immune response. Affects 4.08 per 100,000 children. Most common arthritic condition of childhood.
Juvenile Idiopathic Arthritis Manifestations General signs include: Swollen, tender and stiff joints. Joints warm to touch. 3 Forms: Systemic (10%). Polyarticular (40%). Pauciarticular (50%).
Systemic High fevers. Transient rash. Elevated sed rate. Enlarged liver and spleen. Ages range from 1-3 years and 8-10 years.
Polyarticular Can involve four or more joints. Often joints of hands and feet. Joints are swollen, warm and tender. Occurs throughout childhood mostly in girls.
Pauciarticular Limited to four or less joints. Usually large joints of hips, knees, ankles and elbows. Occurs in children under 16 years. At risk for iridocyclitis.
Iridocyclitis Symptoms: Redness. Pain. Photophobia. Decreased visual acuity. Nonreactive pupils. Need periodic slit-lamp eye examination.
Juvenile Idiopathic Arthritis Diagnosis X-ray studies. Clinical manifestations. Laboratory results. Other disorders ruled out.
Juvenile Idiopathic Arthritis Treatment Goals: Reduce pain and swelling. Promote mobility & preserve joint function. Promote growth & development. Promote independent functioning. Help child & family adjust. There is NO cure; treatment is supportive.
Juvenile Idiopathic Arthritis Treatment Con’t Medical: NSAIDS. Methotrexate. Immunosuppressant. Gold. Slow-acting anti-rheumatic drugs. Physical and occupational therapy.
Nursing Care for JIA Nurse member of multidisciplinary team. Physical therapist oversees amount & type of exercise. ROM exercises. Pool exercises. Avoid traumatizing inflamed joints. Warm bath and moist hot packs. Resting splints. Using a very low pillow. body allign
Nursing Care for JIA Administer meds. Ensure rest. Measures to alleviate boredom. Home care: Use a firm mattress. Age appropriate activities. Modify daily living: Elevate toilet seats. Install handrails. Velcro fasteners. Regular eye exams.
Nursing Care Con’t for JIA Meal planning. Avoid unnecessary physical restrictions. Attend school. Set limits but do not overindulge. Child advocate. Open communication.
Which form of JIA involves 4 or less joints? Pauciarticular.
Who is responsible for determining the type and amount of activity the child should perform? The physical therapist.
Created by: redhawk101