infant bones are only 65% ossified long bones are porous and less dense and can bend, buckle or...
TRANSCRIPT
Infant bones are only 65% ossified
Long bones are porous and less dense and can bend, buckle or break easily
Growth takes place in Epiphyseal plates, and if these are injured, can cause abnormal growth
Growing bones heal quickly and decrease need for treatment
A congenital abnormality in which the foot is twisted out of its normal position.
Muscles, tendons, and bones are involved in the abnormality.◦Adduction and supination of forefoot◦Inversion of the heel◦Fixed plantar flexion
Stretch tightened ligaments and tendons gently to
Return the foot to a maximal anatomic position
Serial manipulation
Corrective casting
Splints
Surgical correction
Cast applied to hold foot in desired position.
Changed every 1-2 weeks until maximum correction is achieved.
Nursing Care:
◦Cast care ◦Skin Care◦Education of parents
Unusual odor beneath the cast Tingling, burning, numbness of toes Drainage through cast Swelling or inability to move toes Toes that are cold, blue or white Sudden unexplained fever Pain that is not relieved by comfort
measures
“Petaling” the edges of the cast
Drying of the cast
Prevention of swelling
Protecting the cast
When to call the doctor
A infant has a cast applied for treatment of club foot. Which of the following symptoms requires immediate attention and should be reported to the health care provider?
A. Capillary refill of 4 seconds in the affected toes. B. Edema in the affected toes that improves with elevation. C. Numbness of the toes on the affected foot. D. Skin distal to the cast is warm
Splinting is used after casts are removed to maintain the correction.
Braces should fit snugly but should not interfere with neurovascular function.
Before wearing the brace, check the skin for any areas of redness or breakdown.
Give parents guidelines for braces. If redness develops, arrange to have the fit of the brace
evaluated and modified. Bar between legs is not a handle. Teach appropriate positioning for safety to prevent falls,
and allow mobility and "tummy-time“
Parents are trained and become active participants in the physical therapy treatments and child’s stretching program
Nurses need to help the parents understand the time commitment involved
Assess the parents’ ability to monitor the child adequately for complications and confirm they understand the signs and symptoms of the
complications
The parents of an infant with clubfoot ask how it is treated. Which of the following treatments should the nurse discuss with the parents?
A.Weekly cast changes with manipulationB.Probably surgery on the affectedC.Abduction device to keep the extremity in
alignmentD.Use of a Dennis-Browne splint to achieve
correction.
The head of the femur is improperly seated in the acetabulum of the pelvis
1. Limited abduction of the affected hip during Ortolani maneuver. May hear a click upon movement.
2. Asymmetry of gluteal and thigh fat folds when lying with legs extended.
3. Telescoping of thigh
4. Limp and abnormal gait in older
child
Ortolani maneuver
Asymmetry of gluteal folds
Pavlik harness◦ Ensures hip flexion and
abduction and does not allow hip extension or adduction.
◦ It maintains correct position of the femoral head in the acetabulum.
◦ Teach parents/caregivers to remove and apply harness appropriately –only remove for bathing and skin checks.
◦ Teach skin assessment
◦ Encourage cuddling infant to promote cognitive development and infant/caregiver bonding
A parent asks why the infant must wear a Pavlik harness. What is the nurse's best response? This treatment 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.
Spica cast◦ Covers lower half of
body except perineal area Nursing Care
◦ Elimination/ protection of cast◦ Positioning◦ Neurovascular assessment◦ Skin care◦ Hygiene
Increased mobility and immature motor skills
Trauma
Bone diseases
Pain or tenderness at site
Immobility or decreased ROM
Deformity of extremity
Edema
Other signs – crepitus, ecchymosis, muscle spasm and inability to bear weight
Reduction
Retention
Repositioning of the bone
fragments into normal alignment
Application of a device or mechanism that maintains alignment until healing occurs
Application of Cast
Traction
Pull or force exerted on one part of the body
Which of the following nursing interventions takes highest priority when caring for a child in skeletal traction?
A.Assessing bowel sounds every shiftB.Providing adequate nutritionC.Assessing temperature every 4 hoursD.Providing age-appropriate activities
Fat Embolism◦Particles of fat are carried through
circulation and lodge in lung capillaries causing: Pulmonary edema Respiratory distress with hypoxemia and
respiratory acidosis
◦Treatment Increase in IV fluids Respiratory support and adequate oxygenation
Compartment syndrome (very serious)
All fractures entering the hospital via ER require social service consult for documentation of suspected abuse or neglect.
The nurse must report all suspected abuse to the appropriate authority.
Do not discuss the possibility of abuse with the parents or guardians!! Do not attempt to prove or disprove abuse.
Delayed walking – (first sign) Progressive, symmetric muscle wasting Frequent falls Easily tired when walking, running, or climbing stairs
Hypertrophied calves muscle Waddling wide-based gait Uses Gower’s maneuver to rise from floor Unable to walk independently by age 9 – 12.
Muscle biopsy – reveal fatty fibrous tissue that gradually replaces muscles (the protein dystrophin is low in the muscles of these patients)
Elevated serum enzyme CK (creatine kinase)
Maintain ambulation and independence for as long
as possible.
Coordinate a variety of health care services
Maintain activity and self-care functions Skin care Maintain bladder and bowel functioning Protect from respiratory infections Teach dietary modifications to decrease obesity
Which of the following interventions isINAPPROPRIATE to incorporate in the care for
a child with muscular dystrophy hospitalized
with a respiratory infection?
A.Physical therapyB.Aggressive antibiotic therapyC.Passive range of motion exercisesD.Complete Bedrest
Lateral S curvature of the spine
Assessment findings:◦Lateral curvature of spine◦Truncal asymmetry◦Uneven shoulders◦Prominent scapula – uneven height◦Rib-hump◦uneven hips
What is the priority psychosocial nursing
diagnosis for the adolescent diagnosed with scoliosis?
Pre-operative teaching ◦Demonstrate incentive spirometer and C&DB
◦Discuss all potential equipment (chest tubes, IV, O2 masks & nasal canula, Foley catheter)
◦Teach use of pumps for PCA or epidural block.◦ ◦Demonstrate log rolling and assist out of bed.
Post-operative Care◦Maintain airway
◦Neurovascular Assessment of lower extremities
◦Teach passive and active ROM exercises
◦Encourage independence in ADL’s
◦Provide with resources / information on scoliosis support groups
Post operative care of an adolescent following a
spinal fusion for scoliosis includes: (select ALL
that apply)
A. Oral analgesics for painB. Logrolling every 2 hoursC. Nasogastric intubationD. Bilateral Neurovascular checks of lower
extremitiesE. Use of incentive spirometer q 2 hoursF. Assess skin on bony prominences