musculoskeletal disorders revised, summer 2007. talipes equinovarus (clubfoot) adduction and...
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MUSCULOSKELETAL DISORDERS
Revised, summer 2007
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Talipes Equinovarus (Clubfoot)Adduction and supination of forefoot with
an inversion (varis) of the heel and fixed plantar flexion.
Etiology unknown
75% of abnormalities of the foot (1:1000)
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Clinical Manifestations Focus on early detection
Rocker bottom foot Fixed position
Diagnostic tests Ultrasound CT MRI
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Treatment
Corrective casting every 3-14 days
Dennis Browne splints- horizontal bar attached to foot plates
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Nursing Care
Care of Casts
CMS assessment Keep dry/clean Assess placement
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Evaluation:
Regular check-ups
Prognosis
ROM after removal of casts
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?????
An 18 month old is scheduled for application of a plaster cast to correct a clubfoot. The post-op plan should include which of the following measures?a. Elevate the cast above the level of the heartb. Handle cast with fingertipsc. Reposition the child every 2 hoursd. Spray the cast with an acrylic protectant
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Congenital Dislocation of Hip
Malrotation of the hip at birth
Improper formation or function of acetabulum
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Clinical Manifestations
Gluteal folds
Ortolanis sign
Shorter femur
Prominence of femur
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Clinical Manifestations cont…
Limited abduction
Barlow Maneuver
Signs and Symptoms in older child
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Diagnostic Tests:
Ultrasound
CT and MRI
X-ray
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Surgical Treatment:
Release muscles and tendons
Application of body- spica cast
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Treatment with Spica Cast
For complex cases and older children
Dislocated -some closed and open reductions
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Spica cast
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Spica Cast Care
Use palms to handle cast Bar between the legs is not a handle! Use pillows for positioning Keep cast clean & dry
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Nursing Management
Case finding and referral Teach parent application of harness Protect skin Bring environment to child Safety
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Developmental dysplasia of the hip Head of femur is unstable Subluxation of the hip occurs Dislocation of the hip can be in late
stage of development
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Treatment
Splinting of hip- Pavlick harness
Hip maintained in flexion and abduction
Deepen acetabulum from pressure of femur head
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Pavlik harness
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?????
A parent asks why her infant must wear a Pavlik harness. The nurse responds that he purpose of this device is to:
A. Provide comfort and support
B. Shorten the limb on the affected side
C. Maintain the femur within the acetabulum
D. Provide outward displacement of the femoral head.
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Nursing Management
Case finding and referral Teach parent application of harness Protect skin Bring environment to child Safety
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Fractures
Greenstick fracture- most common type in kids < 3 years
MVA -frequent cause of bone injury in 4-7 year olds
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Pathophysiology
Epiphyseal plate
Pliable and porous
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Fractures
Occur as a result of direct or indirect force
Repeated stress on the bone
Pathologic conditions
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Healing
Rapid in children Good rule of thumb:
one week for every year
of life up to 10 yrs
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Assessment
Pain (PROM) Tenderness
Edema
Limited movement
Distortion of limb
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Nursing Care
Casting
Tractionhttp://www.dhmc.org/webpage.cfm?site_id=2&org_
Compartment syndrome
Surgical intervention
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Muscular Dystrophy
Duchennes- 13 types
Onset of symptoms
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Duchenne’s (D M D)
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Duchenne’s characteristics
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Prognosis
Ability to walk lost by age 9-12
Death occurs 9-10 years after diagnosis
1:3500 children effected
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Diagnosis/Treatment
Muscle biopsy **Serum enzyme CK Electromyogram ECG Rehab Corticosteroid therapy
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Nursing Care
Promote optimal health Goal: keep child ambulatory Assess muscle weakness Respiratory function Nutritional status OT, PT
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Scoliosis
Curve greater than 25 degrees Functional
Postural Compensatory
Structural Idiopathic (70-80% of all cases) Congenital Neuromuscular
– Poliomyelitis– Cerebral palsy– Muscular dystrophy
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????
The school nurse would screen an adolescent for scoliosis by instructing him/her to:
A. Bend forward at the waist and allow upper extremities to dangle
B. Lie prone on an examination table
C. Stand with shoulders placed against the wall to check evenness
D. Sit on a chair and raise shoulders
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Manifestations
Progression- 1 degree per month
Observation of curves Texas response to funding issues 6th & 8th grades
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Bracing
Used for skeletally immature http://milwaukee.brace.nu/
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????
An adolescent must wear a Milwaukee brace. Which of the following actions would the nurse take to promote optimal functioning for the teen?
A. Discourage participation in ADL’s.B. Teach appropriate application, removal and
care of skin and brace.C. Discourage sports like golf and tennis
encourage sedentary activities.D. Teach non-weight bearing techniques.
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Rods:
Recommended for curves >40 degrees Goal: fuse spine to prevent progression Why is surgery the recommended
treatment for progressive curvature?
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Post-op Care
Pain management Monitor Neurovascular status Monitor H&H Log Roll, sit, ambulate Dressing changes Report vomiting WHY???
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What would you teach a child to expect in the immediate post-op period?
Frequent neurovascular assessments Need to CT&DB every 2 hours (IS) Possibility of IV, chest tubes Use of post-op analgesia
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Discharge
As sited in text No contact jarring activities for 6-12
months X-rays q 1-2 years until bone solidly
fused Once fused may resume normal activity
levels, skiing, sports, etc…