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Chapter 24 The Child with a Musculoskeletal Condition Pediatric Trauma • Prevention • Proper use of pedestrian safety – Contusion • Car seat restraints – Sprain • Bicycle helmets and other – Strain protective athletic gear • Injuries should be • Pool fences treated immediately to • Window bars limit damage from • Deadbolt locks edema and bleeding • Locks on cabinet door • Soft-tissue injuries include 2 Bryant’s Traction • Used for the young child(under 2 yo; 2030LBS.) who has a fractured femur • Note that the buttocks are slightly off the bed to facilitate countertraction • Active infants may require a jacket restraint to maintain body alignment Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3 4 Spica Cast • Seen with child with hip dysplasia • Immobilize hips & thighs • Care – Keep dry – Cleanse with damp cloth – Assess for tightness – Neurovascular checks – Reposition q 2-4 hrs – Sponge bath 5 Duchenne’s or Becker’s Muscular Dystrophy (MD) • Group of disorders in which progressive muscle degeneration occurs – Duchenne’s MD is most common – Sex linked inherited- affects males only – Lack of dystrophin – protein in skeletal muscle • Onset is generally between 2 and 6 years of age • A history of delayed motor development during infancy may be evidenced • Increase in calf size – muscle replaced by fat 6 Duchenne’s or Becker’s Muscular Dystrophy (MD) (cont.) • Additional signs and symptoms – Progressive weakness as evidenced by • • • • Frequent falling Clumsiness Contractures of the ankles and hips Gower’s maneuver to rise from the floor – Intellectual impairment is common 7 8 Duchenne’s or Becker’s Muscular Dystrophy (MD) (cont.) • Diagnostics – Marked increase in blood creatine phosphokinase level – Muscle biopsy reveals a degeneration of muscle fibers replaced by fat and connective tissue – ECG abnormalities are also common 9 Legg-Calvé-Perthes Disease (Coxa Plana) • One of a group of disorders called the osteochondroses in which the blood supply to the epiphysis, or end of the bone, is disrupted – Tissue death that results from inadequate blood supply is termed avascular necrosis – Affects the development of the head of the femur 10 Legg-Calvé-Perthes Disease (Coxa Plana) (cont.) • Symptoms include – Painless limp – Limitation of motion • X-ray films and bone scans confirm the diagnosis – Some may require hip joint replacement 11 Osteosarcoma • Primary malignant tumor of the long bones – Mean age of onset is 10 to 15 years of age – Children who have had radiation therapy for other types of cancer and children with retinoblastoma have a higher incidence of this disease • Metastasis occurs quickly because of the high vascularity of bone tissue – Lungs are primary site of metastasis 12 Osteosarcoma (cont.) • Manifestations – Experiences pain and swelling at the site – Pathologic fractures can occur • Diagnosis – Confirmed by biopsy – Radiological studies help to confirm • Treatment – Radical resection or amputation surgery – Phantom limb pain can occur because nerve tracts continue to “report” pain 13 Ewing’s Sarcoma • Malignant growth that occurs in the marrow of the long bones • Mainly occurs in older school-age children and early adolescents • When metastasis is present, prognosis is poor • Primary sites for metastasis are lungs and long bones • Treatment – Radiation therapy and chemotherapy – Amputation is not recommended due to effectiveness of chemo and radiation to tumors 14 Juvenile Idiopathic Arthritis (JIA) • Formerly known as juvenile rheumatoid arthritis (JRA) • Most common arthritic condition of childhood • Systemic inflammatory disease involving joints, connective tissues, and viscera 15 Juvenile Idiopathic Arthritis (JIA) (cont.) • Systemic – Intermittent spiking fever (above 103° F) persisting for over 10 days – Nonpruritic macular rash – Abdominal pain – Elevated ESR and C-reactive protein 16 Juvenile Idiopathic Arthritis (JIA) (cont.) • Treatment – Goals of therapy • • • • • Reduce joint pain and swelling Promote mobility and preserve joint function Promote growth and development Promote independent functioning Help the child and family to adjust to living with a chronic disease • Moist heat packs before getting OOB • NSAIDS, steroids, methotrexate 17 Scoliosis 18 Scoliosis (cont.) • More common in girls • Two types – Functional—caused by poor posture – Structural—caused by changes in the shape of the vertebrae or thorax • Usually accompanied by rotation of the spine • Hips and shoulders may appear to be uneven 19 Scoliosis (cont.) • Treatment – Aimed at correcting curvature and preventing severe scoliosis • Curves up to 20 degree- no treatment • Curves 20 degrees to 40 degrees require Milwakee brace • Curves greater than 40 degrees – Spinal fusion is performed 20 Family Violence • Affects children of all social classes • Includes – Spousal and child abuse – Neglect – Maltreatment 21 Assessing for Child Abuse 22 23 24