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Skin ◦ Pull applied to skin ◦ Causes traction on bones and muscles Skeletal surgically placed Pins, wires or tongs through distal end of bone Progressive degeneration of symmetric skeletal muscles Gene mutation results in absence of dystrophin (protein in skeletal muscles) X-linked recessive trait ◦ Affects boys almost exclusively Onset between 3-6 years Muscle weaknesses Difficulty rising from sitting/lying position Difficulties running, riding bikes, climbing stairs **Gower maneuver/sign Waddling gait Muscle hypertrophy (pseudo hypertrophy) Calf muscle hypertrophy Mental delay w/ 30% of children Scoliosis & lumbar lordosis Profound muscle atrophy Contractures & joint deformities Heart & respiratory muscle weakness in terminal stages Clinical symptoms **Polymerase Chain Reaction (PCR) for the dystrophin gene mutation Serum Enzyme assay Muscle biopsy EMG Creatine kinase levels Goals of treatment: Maintain optimal function Prevent contractures No effective treatment exists Corticosteroids used Research on gene & stem cell therapy Multidisciplinary Approach Care PT, OT, Neurologist, Orthopedist Assist family with care & coping Prevent & treat respiratory infections Cardiac Evaluation Genetic Counseling Physical NANDA’s Activity Intolerance Ineffective Breathing Pattern Impaired Skin Integrity Risk for infection Risk of Constipation Risk for Falls Imbalanced Nutrition Psychosocial NANDA’s Caregiver Role Strain Anxiety, Hopelessness Compromised family coping Anticipatory Grievance Abnormal development of the hip caused by spectrum of disorders Cause Unknown: May be hereditary Predisposing factors More common in girls Caucasian > other cultures Intrauterine/postnatal positioning + Ortolani test + Barlow test + Galeazzi test ◦ Asymmetry of gluteal & thigh folds w/ shortening of thigh ◦ Unequal leg length Limited abduction of leg + Trendelenburg sign ◦ In wt bearing child Waddling gait (bilateral) Marked Lordosis (bilateral) Clinical signs Ultrasound 0-4mo X-ray after 4mo CT after closed reduction & casting Newborn – 6mo 6mo – 18mo Older child Pavlik harness Skin traction Closed reduction surgery Spica cast Open or closed reduction Spica cast Bracing Assessment Musculoskeletal Gait Skin Circulation Interventions Education Encourage parents to hold & cuddle infant Administer medications Neurovascular & skin integrity checks Cast care Teach parents how to use/apply/care for devices Proper seatbelt & carseat use Diapering with spica cast Congenital malformation of bones, muscles, tendons of foot, ankle and lower leg leading to plantar flexion, inverted heel and an adducted forefoot. Statistics: ◦ 1-2 per 1000 births ◦ More common in Boys ◦ Bilateral in 50% Cause: Unknown Diagnosis: ◦ Visual inspection ◦ X-ray Anterior half foot adducted, inverted Medial border of foot concave Heel drawn up Underdeveloped calf muscle Small foot Atrophy of joint capsule Correction of deformity ◦ Stretching and manipulation exercises ◦ Denis Browne Splint ◦ https://www.bing.com/videos/search?q=club+foot +denis+browne+splint+video&&view=detail&mid= 13F519297FF8B79863BA13F519297FF8B79863BA& rvsmid=B8C5545144EA73CFE627B8C55 ◦ Serial casting: long leg casts changed q 1-2 weeks for 8-12 weeks ◦ Surgery 3-12 months last resort ◦ Cast care education Genetic defect in the production of collagen resulting in faulty bone mineralization, abnormal bone architecture & increased susceptibility to fracture 1 : 30,000 births 6 types with varying severity Diagnosis Therapeutic Management Multiple fx in various stages of healing Blue sclerae DEXA & Elevated Alk Phos Supportive care Pamidronate infusions Braces & splints PT Surgery High Calcium & vitamin D diet Nursing Management Assessment Education Support Infection of bone (usually long leg bones) Affects ages 1 to 12 yrs Clinical Manifestations: Etiology: Exogenous or endogenous cause Staphylococcus most common organism Diagnosis: Cultures X-ray/CT/MRI Elevated WBC & ESR Therapeutic Management: IV antibiotics Assessment ◦ Pain ◦ Mobility ◦ Affected site Interventions ◦ ◦ ◦ ◦ Administer medications Isolation if open wounds Possibly cast care NWB Education Aseptic necrosis of femoral head Ages 2-12yrs ◦ Boys 4-8yrs Cause unknown 4 stages: ◦ Avascular stage ◦ Revascularization stage ◦ Reparative stage ◦ Regenerative stage Clinical Manifestations: ◦ Pain ◦ Limp ◦ Decreased ROM Diagnostic Evaluation: ◦ X-ray ◦ MRI Therapeutic Management: ◦ Initial: Rest & NWB ◦ Abduction braces, leg casts, traction ◦ Surgical reconstruction Nursing Management: ◦ Assessment ◦ Education ◦ Support Spontaneous or gradual displacement of femoral epiphysis in a posterior or inferior direction Surgical/Medical Emergency Increased incidence: During accelerated growth (10-16 yrs) Boys > girls Obese children Endocrine disorders Clinical Manifestations: Limp on affected side Pain Restricted ROM Shortening of LE Diagnosis: Anteriorposterior & frog-leg x-rays Therapeutic Management: ◦ Completely NWB ◦ Surgical pinning ◦ Post-surgical care Nursing Management: ◦ Assessment ◦ Education Complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry and thoracic hypokyphosis Curvature >10º Usually presents at preadolescent growth spurt History of poorly fitting skirts/pants Observation: View standing child (in underwear) from the back View child bend at waist w/ arms hanging down Clinical manifestations: Asymmetry of shoulders, scapula, ribs, flank &/or hips X-ray: Cobb technique Risser Scale Observation Regular clinical & radiographic evaluation Bracing & Exercise Not curative: slows progression Boston/Milwaukie Braces Thoracolumbosacral orthotic (TLSO) Surgical Spinal Fusion Anterior approach Posterior approach Screening & Early Detection School Nurse screens adolescents Assessment of Complications Respiratory, Cardiac, Neurologic, Pain Education about Brace/Exercise Compliance Risk for Injury Risk for Impaired Skin Integrity Support Disturbed Body Image Assessment: Neurologic!! Circulation Pain Incision Respiratory Interventions: Log rolling Skin care Early OOB Education: Home mgmt A. Urinary Output B. Bowel Elimination C. Infection D. Sensation and movement of extremities Rationale? A. B. C. D. Attempt to dry the cast using a hairdryer Refrain from placing pillows under the cast Avoid using the palms of the hands on the cast when positioning the child Turn the child q 2 hours A. B. C. D. Circle and note the date and time of any drainage on the cast. Note any rough edges on the cast. Assess the cast for areas of dampness. Check circulation to the toes. A. Wash the cast if it becomes soiled. B Allow the cast to remain uncovered until it dries completely. C. Support the wet cast carefully and avoid denting it. D. Make sure nothing is placed inside the cast. E. Check the child’s leg frequently for signs of swelling. A 10 year old child fell from the gym bars onto her right arm. The school nurse is called to the scene. The child points to her right forearm and states. “It really hurts here.” Which of the following actions should the nurse perform at this time? Select all that apply. 1. Apply pressure at the point of tenderness. 2. Ask the child to move the fingers of her right hand 3. Compare the radial pulses on the right wrist to those on the left wrist. 4.Compare the range of motion of the right wrist to that of the left wrist 5. Ask the child whether her right hand and arm feel differently from the left hand/arm
