musculoskeletal chapter 31
TRANSCRIPT
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C H A P T E R 3 1
Musculoskeletal
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Pediatric Differences
Ossification nearly complete at birth Posterior fontanel closes 2-3 months of age Anterior fontanel closes approx. 18-24 months of age Most skull growth by 2 years of age
Long bones of children porous and less dense than adults Muscles increase in length and circumference, not in
number Until puberty, ligaments & tendons are stronger than
bone Cartilage replaced by bone & skeletal
maturation by approximately 20 yearsof age
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Who am I?
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Immobilized Child
Once thought to be restorative for patients withillness and injury
We now know that immobilization has serious
consequences Especially on growth & development of the child
Inactivity leads to decrease in functional capacity of the entirebody
Can delay age appropriate milestones
Decreased muscle mass & strength
Decreased metabolism
Decreased bone mineralization
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Immobilization
Muscular system Decreased muscle strength and endurance
Disuse atrophy
Loss of joint mobility
Skeletal system Bone demineralization
Daily stresses on bone by motion & weight
bearing maintain balance between bone
formation (osteoblastic activity) and bone
resorption (osteoclastic activity).During immobil-
ization INCREASED calcium leaves the bone
causing osteopenia (demineralization)
Negative calcium balance
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Immobilizationpsychologically
Movement is critical : immobility deprives child ofnatural outlet for feelings
Physical growth and development depend onmovement
instrument of communication, expression andlearning
Respond to anxiety with
increased activity
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Not Happy!
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Traumatic Injury
Soft Tissue Injury
Muscles
LigamentsTendons
Sports injuries
Mishaps during play
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Contusions
Damage to soft tissue, subcutaneous tissue andmuscle
Escape of blood into tissue-ecchymosis-black and
blue Swelling, pain disability
Crush injuries
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Contusions
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Dislocations
Occur when force of stress on ligament is sufficient todisplace normal position of opposing bone ends or boneends to socket Pain increased with active or passive movement of extremity May be an obvious deformity & inability to move joint
Most common type : Phalanges elbow
Hip dislocation: (< 5 yrs old) potential loss of bloodsupply to head of femur
Shoulder dislocation: (adolescents) sports related Reduce ASAP Unreduced dislocations: increased swelling, reduction is difficult,
increased risk neurovascular problems
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Dislocations
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Sprains
Trauma to a joint fromligament partially orcompletely torn orstretched byforce
May have associated
damage tobloodvessels, muscles,tendons, and nerves
Presence of joint laxity
is indicator of severity Rapid onset of diffuse
swelling withdisability
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Strains
Microscopic tear tomusculotendinousunit
Similar to sprain Swollen, painful to
touch
Generally incurredover time
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Soft Tissue Injury
TherapeuticManagement RICES and ICESRest the injured partIce immediately (max
30 min at a time)Compression with
elastic bandagesElevation of extremity
Immobilize andsupportCrutches (proper
size and height)
f
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Soft Tissue Injurytreatment
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Fractures
Common injury in children (rare in infants, except with aMVA)
Clavicle the most frequently broken bone, especiallyunder 10 years. (Neonates if they are too large for moms
small pelvis) School aged: bicycle/vehicle or skate board injuries
Adolescents: bicycles, ATVs, skateboards, motorcyclesports
Patterns of fractures, problems of diagnosis& methods oftreatment are different in pediatrics than in adultpopulation
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Epiphyseal(physeal) Injuries
Weakest point of long bones: cartilage growth plate(epiphyseal plate)
Frequent site of damage during trauma
May affect future bone growth Treatment may include ORIF to prevent growth
disturbances
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Epiphyseal plate
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Types of Fractures
Simple or closed (no breakin the skin) Compound or open:
fractured bone protrudesthrough the skin
Complicated: bonefragments have damagedother organs or tissue (lungor bladder)
Comminuted: smallfragments of bone are
broken from fracturedshaft and lie insurrounding tissue (rare inchildren)
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Types of fractures in children
Bend: Bone is bent but notbroken Buckle or torus:
Compression of porousbone, bulging projection atfracture site (more
common in young children) Greenstick: compressed
side of bone bends, buttension side of bone
breaks, causing incomplete
fracture Complete: divides the bone
fragments
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Clinical Manifestations of Fractures
Generalized swelling
Pain or tenderness
Deformity
Diminished functional use May have bruising, severe muscular rigidity, crepitus
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Bone healing and remodeling
Typically rapid healing inchildren (femoral shaft)
Neonatal period:2-3weeks
Early childhood:4 weeks Later childhood: 6-8
weeks
Adolescence: 8-12 weeks
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Remember..
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Fractures
Diagnostic evaluation: x-rayis most useful tool
Therapeutic managementgoals
Nursing considerations
Nurses make initialevaluation (calm quiet voice)
Calm the child and the parent tobetter assess
Good history of what occurredto see if abuse is possible
Spiral fx in young child mayindicate abuse
Multidisciplinary team tofurther assess
Assess Extent of Fractures
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Assess Extent of FracturesThe 5 Ps
Pain and point oftenderness
Pulse distal to fracturesite
Pallor: capillary refill Paresthesia: sensation
distal to fracture site
Paralysis: movement
distal to the fracture site
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Neurovascular Assessment
PULSES COLOR
MOVEMENT ANDSENSATION
TEMPERATURE
SWELLING
PAIN
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The Child in a Cast
Cast application techniques Plaster of paris: drying fiberglass
Nursing Care management First few hours after application: Elevate extremity
assess sizing and monitor for degree of swelling Assess for hot spots Casts of open fracture has window over wound for assessment First few hours after surgical reduction (casted as closed fracture)
bleeding may soak through the cast. Outline area to monitor Educate parent on time to dry of plaster cast S/S that cast too tight If cast too loose Home environment
Car seats Protecting the cast transparent dressing or diaper
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Nursing Considerations
Swelling may continue thus cast becomes atourniquet, circulation diminished, neurovascularcomplications
Elevate extremity If swelling is severe: casts are bivalved
Permanent tissue damage can occur within 6 to 8 hrs
COMPARTMENT SYNDROME
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Compartment Syndrome
Pain
Swelling
Discoloration
Decreased pulses Decreased temperature
Inability to move distal exposed part
CALL PHYSICIAN IMMEDIETLY
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Compartment Syndrome
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Casting
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Child in Traction
Traction: Extended pulling force
Purposes:
Fatigue muscle involved and reduce muscle spasm so bonescan be realigned
Position distal and proximal bone ends in desired alignment
Immobilize until healing has taken place to permit casting orsplinting
Help prevent or improve contracture deformity
Promote immobilization
Reduce muscle spasms
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Traction: Essential Components
Traction: Forward force Attaching weight to distal bone fragment
Counter traction: backward force
Body weight provides this ( for free)
Frictional force: provided by patients contact withthe bed
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Types of Traction
Manual Traction: applied by the hand distal tofracture site
Skin Traction: Directly to skin surface and indirectly
to skeletal structures Skeletal traction: directly to skeletal structure with a
pin (ouch)
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Skeletal Traction Pins
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Types of Traction
Upper Extremity Traction: Humerus
Overhead suspension: arm bent at elbow andsuspended vertically & traction applied to distal
end of the humerus.Dunlop traction: Lower arm is flexed and
suspended vertically with traction, while upperarm maintains longitudinal direction and pull
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Lower Extremity Traction
Bryant: running traction, pull in 1 direction
Bucks Extension: legs in an extended position
Russell Traction: skin traction with a padded sling
90-90 traction: most common skeletal traction Steinmann pin or Kirschner wire distal in femur at 90 angle
both at hip and knee
Balance suspension traction with
Thomas splint
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Types of Traction
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Cervical Traction
Halo Brace (vest) attached to head with 4 screws inouter skull: bars connected to vest> greater mobilityof rest of the body
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Cervical Traction
Crutchfield tongs (Barton, Gardner-Wells) burr holesin the skull & weights attached to the head
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Nursing Care Management
Know the reason WHY traction is applied Assess patient
Assess pulses bilaterally
Alteration in sensation or increased pain
Assess any change in color of skin or nail bed
Skin breakdown/ massage pressure areas to stimulate circulation
Position changes
Wash and dry skin daily
Any neurovascular changes: record and call MD
Assess traction apparatus
Check line of pull/ weights
Bandages in place/ excessive tightness
Do not remove unless under supervision of physician
Diet
Balanced diet with fruits and vegetables (fiber)
calcium
Encouraging fluids
Offering laxatives
Encourage deep breathing and Incentive Spirometry
Prevent foot drop
Encourage socialization/ discourage isolation
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Nursing Care Management
Pain management: increased initially as traction pullis fatiguing the muscle
Analgesics
Muscle relaxants
Pin care: according to hospital policy or physicianorder
Frequently assessed and cleaned to prevent infection
After first 48 to 72 hours assessment needed less frequently
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Developmental Dysplasia of Hip
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Developmental Dysplasia of HipDDH
Spectrum of disorders describing abnormaldevelopment of hip that can occur
Infancy
childhood
Fetal life
Cause unknown
Gender, birth order, family history,
positioning, delivery type, joint laxity
& post natal positioning
Developmental Dysplasia of Hip
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Developmental Dysplasia of HipDDH
Diagnostic Evaluation Not detected at initial exam after
birth Most often found in pediatrician
office for well baby check up Exhibits as hip joint laxity and
NOT out right dislocation
Shortening of the limb on affectedside
Asymmetric thigh and gluteal fold Broadening of the perineum Ortolani and Barlow tests most
reliable from birth to 3 months Barlow: thighs are adducted
Ortolani: abducting the thighs totest for hip subluxation ordislocation
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DDH
Ortolani Test
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limited hip abduction in flexion
Barlow Test
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thighs adducted
Signs of DDH
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gasymmetry of gluteal and thigh folds
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Therapeutic Management
Treatment initiated as soon as recognized
GOAL: obtain and maintain a safe and congruentposition of hip joint to promote normal development
Early intervention more favorable in restoration of normalbony architecture and function.
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Therapeutic Management
Newborn to 6 months Pavlik Harnace
Hip joint in dynamic splint
Proximal femur centered in acetabulum
Worn continuously until proven
stable on exam and with x-ray
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Therapeutic Management
Ages 6 to 18 monthsGradual reduction by traction for 3 weeks
Closed reduction of hip under general
anesthesia
If not successful then open reduction
Then placed in hip spica cast for 2 to 4
monthsOnce hip is stable a flexion abduction brace
is applied
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Hip Spica cast
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Therapeutic Management
Older Child Increasingly difficult after age 4
Impossible or inadvisable > 6 yrs
Contractures of muscles Deformity of femoral and acetabular structures
Correction is challenging as most likely is secondary toarthritis or CP
Operative reduction with or without presurgical traction
Contracted muscles
Osteotomy procedures
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Nursing Management
Nurses can detect DDH on initial assessment
Ambulatory child who displays limp or unusual gateis referred
Primary Nursing Goal: Teaching ParentWHY DEVICE BEING USED!! Application of device
Maintenance of device
Keep in mind rapid growth of the infant/child(check straps)/check for rubbing/ red marks
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Nursing Management
Normalcy is the goal Involve the child in all activities of any other child in
same age group
Maintain active role in family and activities
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Congenital Clubfoot
Deformity of ankle and foot which includesforefoot adduction
Midfoot supination
Hindfoot varusAnkle equinus
Most common talipes equinovarus
Foot is pointed downward and inward invarying degrees
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Congenital Clubfoot
Cause unknown Some attribute to abnormal positioning and
restricted movement in utero
Arrested or abnormal embryonic development Increased risk of hip dysplasia
l l bf
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Congenital Clubfoot
Classification Positional: intrauterine crowding
Responds to simple stretching and casting
Syndromic (teratologic): associated with other congenital
anomalies More severe form/ often resistant to tx
Surgical intervention may or may not be effective
Congenital/idiopathic: can occur in otherwise normal child
Always requires surgical intervention because there is a bonyabnormality
i i l i
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Diagnostic Evaluation
Detectable prenatally through U/S Noted at birth
h i
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Therapeutic Management
Goal: achieve a painless, plantigrade and stable foot Serial casting before discharge
Successive casts encourage gradual stretching and accommodate rapidgrowth
Maximum correction achieved within 8 to 12 weeks
If no positive result after 3 months= surgical intervention
Three stages
Correction of deformity
Maintenance of correction until normal muscle balance is regained
Follow up observation to prevent possible recurrence
P i
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Ponseti
N i C M
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Nursing Care Management
Casted child:observation of skin and circulation
Rapid growth
Educate the parentSigns of skin breakdown
Signs new cast needed
Help the child to live as normally as possible
M Add (V )
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Metatarsus Adductus (Varus)
Most common congenital foot deformity Result of abnormal intrauterine positioning
Type I: foot flexible and corrects easily
Type II: partial flexibility in forefoot Type III: foot rigid and will not stretch
T t t
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Treatment
Type I & IIOften times corrected with gentlemanipulation
Passive stretching of foot
Parent teaching performed
Continue for 6 weeks
Type III
Serial manipulation and casting
N i M t
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Nursing Management
Teaching the parent
hold heal firmly and to stretch ONLY theforefoot
Cast teaching
Signs of skin breakdown
Signs new cast needed
Help the child to live as normally aspossible
Sk l t l Li b D fi i
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Skeletal Limb Deficiency
Underdevelopment of skeletal elements ofextremities
Can range from minor defects (missing digit) toserious abnormalities
Amelia: loss of entire extremity
Meromelia: partial absence of an extremity
Phocomelia: seal limbs
Most are primary defects of development of limb Prenatal destruction can occur due to constriction of
amniotic band
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Meromeliati l b f t it
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partial absence of extremity
Sk l t l Li b D fi i
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Skeletal Limb Deficiency
Therapeutic Management Prosthetic devices
Applied at earliest possible stage
Nursing Care Management
Teaching parent about prosthetic application
Occupational therapist
Encourage parent to assist the child in making age appropriateadvancements
Do not OVERPROTECT child
L C l P th Di
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Legg- Calve-Perthes Disease
Self limiting disorder withfemoral head aseptic
necrosis
Affects ages 2 to 12
Most commonly in boysages 4 to 8
Cause unknown
Can take place over 18
monthsor as long as several years
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Camerons Personal Story
Legg Calve Perthes Disease
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Legg- Calve-Perthes Disease
Insidious onset History may reveal intermittent limp or persistent
ache or stiffness
Diagnosed with x-ray and confirmed with MRI Revealing osteonecrosis
Legg Calve Perthes Disease
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Legg- Calve-Perthes Disease
Therapeutic Management Goal: Keep head of femur in acetabulum Treatment varies based on: Age
Appearance of femoral head vasculature and position within acetabulum Rest and non weight bearing
At times traction applied to stretch tight adductor muscles
Non weight bearing devices:
Abduction brace Leg casts
Leather harness sling
Surgery in some cases
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Legg Calve Perthes Disease
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Legg- Calve-Perthes Disease
Self limiting Younger children have better prognosis for complete
recovery Epiphysis are more cartilaginous
Children 10 and older have high risk for degenerativearthritis
The later the diagnosis, the more damage to femoral
head
Legg Calve Perthes Disease
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Legg- Calve-Perthes Disease
Nursing Care Management Identify the affected child and refer
Educate the parent
Why device being orderedManagement and application of corrective
device
Signs of skin breakdownSigns that a new size needed
Help the child to live as normally as possible
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Skeletal deformity
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Skeletal deformity
Kyphosis: increased convex angulation in curvatureof the thoracic spine
Secondary to
TB
Arthritis Osteodystrophy
Compression fractures of thoracic spine
Lordosis: accentuation of cervical or lumbar
curvature Trauma
idiopathic
Idiopathic Scoliosis
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Idiopathic Scoliosis
Complex spinal deformity in three plains Lateral curve
Spinal rotation causing rib asymmetry
Thoracic kyphosis
Most common spinal deformity Classified according to age of onset Infantile: birth to 3 yrs
Juvenile: develops during childhood
Adolescent: develops during the growthspurt of early adolescents.
Most noticeable during the pre adolescent growth spurt
Idiopathic Scoliosisdiagnostic evaluation
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diagnostic evaluation
Observation: behind standing child Symmetry of shoulder height
Scapular or flank shape
Hip height and alignment
As child bends forward at the waist (Adams test)with hanging arms
Assymetry of ribs and flanks may be noted
Scoliometer used to measure truncal rotation
Definitive diagnosis made by radiograph
of child in standing position
Idiopathic ScoliosisTherapeutic Management
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Therapeutic Management
Observation with clinical and radiographic evaluation Curve < 10 degrees is postural variation
Curve < 20 degrees is mild
Orthotic intervention (bracing) Boston, Wilmington, TLSO (thoracolumbosacral
orthosis),Milwaukee, Charleston Nighttime Bending Brace
Surgical spinal fusion: realignment and straighteningwith internal fixation and instrumentation combinedwith bony fusion of the realigned spine.
Curve >40 degrees Paralytic and Congenital curves generally
-progress
Idiopathic ScoliosisNursing Care Management
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Nursing Care Management
Treatments extends over years Childs identity (physical and psychological) is
formed in adolescents
Nursing care must take into consideration the
adolescents perspective Positive reinforcement
Encouragement
Independence
Selection of clothing Participation of activities
Socialization with peers
Idiopathic ScoliosisNursing Care Management
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Nursing Care Management
Preoperative Care Educate on complexity of surgery
Teach patient to manage own PCA
How to Log Roll
Prepare for foley catheter Possibility of a chest tube
Possibility of NG tube
Have a favorite toy, stuffed animal, iPad
Meeting with a peer who has undergone similar surgery as well
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Idiopathic ScoliosisNursing Care Management
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Nursing Care Management
Postoperative care Monitored in an acute care setting
Neurological assessments of extremities critical
Delayed paralysis may develop
Most common post op issues Neurological injury
Spinal cord injury
Hypotension from blood loss
Wound infection
Log rolled
Skin care Risk for pressure ulcers
Pain management
Scoliosis
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Scoliosis
Ambulation begins 2 or 3 P.O.D. Discharged after 1 week Adequate urine output Fluid and electrolyte balance ileus
Skin integrity Start PT as soon as patient able Self care always encouraged Teaching of family Body image
Refer family to resources American Association Orthopedic Surgeons Scoliosis Research Society
Osteomyelitis
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Osteomyelitis
Inflammation and infection of bony tissue May be caused by exogenous reasons ( trauma/
puncture wound/ or surgery)
Or hematogenous sources (pre existing infection/tonsillitis/ impetigo where the organism travels)
Osteomyelitis
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Osteomyelitis
Exogenous: infectious agent invades the bone following penetrating
wound, open fracture, contamination in surgery or secondaryextension from abscess or burn.
Hematogenous: Existing infection spreads to bone
Sources may be furuncles, skin infection, URI, abscessed teeth,pyelonephritis
Any organism can cause osteomyelitis
Infective emboli travel to arteries in bone metaphysis, causingabscess formation and bone destruction
Anna
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Anna
Osteomyelitis
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Osteomyelitis
Staphylococcus aureus is most common causativeorganism
Signs and symptoms begin abruptly, resemblesymptoms of arthritis and leukemia
Marked leukocytosis and elevated Sed rate
Early x-ray may appear normal
CT, Bone scan , MRI
Bone culture obtained from biopsy
or aspirate
Osteomyelitistherapeutic management
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therapeutic management
May have sub-acute presentation with walled offabscess rather than spreading infection
Prompt, vigorous IV ABT for extended period (3-4weeks or up to several months)
Monitor hematologic, renal, hepatic
responses to treatment
OsteomyelitisNursing Considerations
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Nursing Considerations
Complete bed rest and immobility of limb Casting at time necessary
Pain management: position and medicate Surgery may be necessary Long term IV access (for ABT administration) Nutritional considerations Child may have vomiting and poor appetite As infection controlled appetite returns
Long term hospitalization/ Physical Therapy to
ensure restoration of optimum functioning Psychosocial needs Diversional and constructive activities
Juvenile Idiopathic Arthritis(juvenile rheumatoid arthritis)
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(juvenile rheumatoid arthritis)
Chronic Autoimmune inflammatory disease causinginflammation of joints and other tissue
Starts before age 16 with peak onset between ages 1 and 3 years
Twice as many girls are affected
13.9 per 100,000 children per year in caucasian children 113 per 100,000 children overall
Unknown cause
Immunogenic susceptibility
Environmental or external trigger such as a virus
Pathophysiology of JIA
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Pathophysiology of JIA
Chronic inflammation of synovium with joint effusioneventual erosion
destruction
fibrosis of the articular cartilageIf inflammatory process continues
adhesions between joint surfaces
ankylosis of joints
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JIA
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Clinical Manifestations
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Variable and unpredictable Not life threatening but can
cause significant disability 70% of cases eventually
becomes inactive However child may have severe
or minimal joint damage bytime disease process abates
30% have progressive diseaseinto adulthood Significant joint deformity and
functional disability Medical evaluations PT
Possible joint replacements Chronic or acute uveitis may
occur
Diagnosis
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g
Diagnosis of exclusion Clinical criteria at age of onset before 16 years
Swelling and pain
Lab tests may or may not provide evidence
Sedimentation rate may or may not be elevated
Leukocytosis usually present with acute exacerbationAntinuclear antibodies common but not specific
Radiology studies
Show soft tissue swelling and joint space widening with increasedsynovial fluid
Uveitis Inflammation of anterior chamber of the eye
Can be sight threatening
Therapeutic Management
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p g
Control pain NSAIDS
Preserve Joint ROM and function
PT: active range of motion
Minimize effects of inflammation/ Joint deformity NSAIDs/PT/OT
Promote normal growth and development
Pool therapy Nighttime splinting reduce flexion deformity
Medications
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NSAIDS
Naproxen, ibuprofen and tolmetin
Take with food
Hydrate
bruising
Methotrexate
Second line tx for children who have failed NSAIDs alone
Used in combination with NSAID
CBC and LFTs
Corticosteroids
Potent immunosuppressives
Incapacitating arthritis/ uveitis/life threatening complications
Etanercept (TNFI) (Enbrel)
Tumor necrosis factor receptor blocker SAARDS
Slow acting anti rheumatic drugs
Work in combination with NSAIDS
Sulfasalazine
Hydroxychloraquine, gold, D-penicillamine.
Nursing Care Management
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g g
Assessment of all aspects of the child General health
Status of involved joints
Emotional response
Support of the parents Parental concerns of prognosis
Financial concerns
Spouse and sibling relationships
Job and schedule conflicts
Referral to social worker, counselors and support groups
Nursing Care Management
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g g
Relieve Pain Provide as much relief as possible Medications
Opioids avoided Non pharmacologic
Behavior therapy
Relaxation techniques Promote general health Well balanced diet with sufficient caloric intake Sufficient rest Communication between family/PCP/rheumatology team is critical
Normalcy Encourage independence!!! Attending school important
Communicate with school and school nurse
Nursing Care Management
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Educate the patient and family on Medications Therapeutic levels r/t schedules Signs and symptoms of toxicity
splints and appliances Proper placement and reason for device
available resources
Benefits of heat application Moist heat Bathtub Electric blankets
Exercise Pools : range of motion
Prevent isolation and foster independence Encourage child to perform ADLs independently Encourage family to pursue normal activities
Osteosarcoma
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Most common bonecancer in children
Peak incidence between10 and 25 years of age
Primary tumor sites inmetaphysis of long bones(most likely in lowerextremities)
>50% femur
Humerus, tibia pelvis, jawand phalanges
Therapeutic Management
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Surgery and chemotherapy Biopsy followed by limb salvage or amputation
Nursing Care Management
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Education for family and child Salvage vs amputation
Prosthesis fitting promotes early functioning
Chemotherapy and side effects
Anger and depression are normal and expected
Honesty and straightforward answers Be in the room when physician explains
Everyone grieves and learns differently
Phantom limb pain Sensations such as tingling itching and pain in amputated limb
Elavil
Nursing Care Management
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Promote normalcy and resumption of preamputation activities
Pick clothing that does not draw attention to amputation
Body image critical to adolescents
Ewing Sarcoma
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Primitive neuroectodermal tumor Second most common malignant bone tumor in
childhood
Under age 30 majority being between ages 4 and 25
Originates in the shaft of long and trunk bones
Femur tibia fibula humerus ulna vertebrae scapula ribs pelvicbone and skull
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Therapeutic Management
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Intensive irradiation of the bone combined withchemotherapy
Amputation last resort
Nursing Care Management
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Less traumatic for family related to likelihood that noamputation will be necessary Need education r/t Diagnostic testing (BMT, biopsy) Radiation and chemotherapy
Intense radiotherapy causes skin reaction Dry or moist desquamation then hyperpigmentation
Increased sensitivity of area Child should wear loose fitted clothing over the area to minimize
additional skin irritation
Chemotherapy
Hair loss, n/v, peripheral neuropathy and possible cardiotoxicity
Encourage resumption of normal lifestyle and activities
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Systemic Lupus Erythematosus(SLE)
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Autoimmune disease of connective tissues and bloodvessels
Chronic
Multisystem Result of genetics as well as a trigger
Exposure to ultraviolet light
Estrogen/pregnancy
Infections
drugs
Multisystem
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SLE
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Clinical Manifestations
Malar rash
Discoid rash
Photosensitivity
Oro nasal ulcers
Arthritis
Serositis
Renal disorder
Neurological disorders
Hematologic disorders
Therapeutic Management
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Balance medications needed to avoid exacerbation andcomplications
While preventing or minimizing treatment associatedmorbidity Corticosteroids
Antimalarial: rash and arthritis
NSAIDS
Immunosuppressive: cyclophosphamide
Nutrition
Sleep Exercise
Limited exposure to sun & UV light
Nursing Care Management
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Goal: assist family to positively adjust to disease & therapy Recognize exacerbation Recognize complications of medications Discuss with health care provider
Body Image Problems Rash/hair loss/ steroid therapy
Support Groups Lupus Foundation of America Arthritis Foundation
Teaching Regular medical supervision Seek attention QUICKLY during illness or prior to elective surgical procedures
Avoid sun and AVB exposure Wear sunscreen and sun resistant clothing Limiting outdoor activities
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