Alteration in Mobility in Children Different Forms of Achieving Immobilization Casts Traction Splints External Fixators Ambulatory Devices

Nursing Care of the Immobilize Chil Neurovascular Assessment ! " #$s o #ain o #allor o #ulselessness o #aresthesia o #aralysis

Alteration In Comfort o A ministration of #roper Analgesia o #roper Alignment of Traction o #roper #lacement of #illo%s Alteration in S&in Integrity o Change position if possible o 'se Eggcrate (attress or Sheeps&in on )e #otential for Infection o Cast Care o #in Care o *oun Care #romote Nutrition o Colloborate %ith #arents an Dietician to #lan Nutritious (eals an Snac&s #romote Normal Elimination o Increase Flui Inta&e o #rovi e +igh Fiber Diet o 'se Stool Softeners Appropriately o #rovi e #rivacy During Time of )e pan 'se #revent (uscle Atrophy an Impaire (obiltiy

o #revent Contractures o Colloborate %ith #hysical Therapy o #repare Chil an #arents for Disuse Atrophy #romote ,ro%th an Development o 'se Age Appropriate Explanations o Normalize the Chil $s Environment as much as possible o Encourage Siblings an #eers to -isit o #rovi e Age Appropriate ,ames o Collaborate %ith #arents an School to #rovi e Tutoring Nursing Diagnoses for the Chil %ho is Immobilize Impaire physical mobility r.t mechanical restrictions an physical isabilty /is& for impaire s&in integrity r.t to immobility an .or therapeutic appliances /is& for in0ury r.t impaire mobility Diversional activity eficit r.t impaire mobility1 musculos&eletal impairment1 confinement to hospital or home /is& for altere family processes r.t a chil %ith a isability or illness Fractures Etiology +ave to ifferentiate bet%een intentional an non!intentional in0ury Trauma 2 3ea ing cause of eath in chil ren 4 5 yr of age o Certain evelopmental characteristics of chil ren at various ages ma&e them more susceptible to in0ury Infants ! 66666 To lers ! 66666 School!age an a olescents !66666

 Clinical (anifestations S%elling #ain Diminishe 'se Diagnostic Evaluation !*hat Tests %ill be one6 Therapeutic (anagement ,oals of Fracture (anagement /e uction 2 o /egain Alignment an 3ength Immobilization 2 o /etain Alignment an 3ength o /estore Function o #revent Further In0ury Criteria for Determining 'se of /e uction (etho for Fractures Age of Chil Degree of Displacemnt Amount of 7verri ing Degree of E ema Con ition of S&in an Soft Tissue Sensation an Circulation Distal to the Fracture Emergency Treatment of Fractures #age 589: /api ity of )one +ealing is Inversely /elate to the Chil $s Age True or False; <<<< The ol er the chil the more =uic&ly their bone %ill heal

Cast Care (ost casts are ma e out of synthetic material A vantages Dries %ithin minutes 3ight *eight (ay get %et %ith permission of practitioner> Clean %ith soap an %ater> Dry %ith blo% ryer set on COOL *hen han ling on$t use fingertips 2 this may cause in entations 7nce cast is ry 2 ?hot spots@ in icate %hat6 *hat is the chief concern uring the first fe% hours after cast application6

Traction Types of Traction See )ox 9:!: page 58AB (anual 2 Traction applie to the bo y part by the han place istally to the fracture> Nurses typically o this uring the Application of a cast S&in Traction 2 #ull applie to the s&in surfaces an in irectly to the s&eletal surfaces> #ulling mechanism is applie to the s&in %ith a hesive material or an elastic ban age> Not to be use if there is altere s&in integrity> 3imite %eight allo%e > Types of S&in Traction )uc& extension 2 lo%er extremity Dunlop 2 C lines pull on arm /ussell 2 C lines pull on lo%er extremity )ryant 2 lo%er extremities flexe at :D egree angle 2 /arely use S&eletal 2 #ull irectly applie to the s&eletal structure by a pin1 %ire1 tongs into or through the iameter of the bone istal to the fracture> 'se %hen significant traction is re=uire > The placement of the pin or %ire puts stress on the bone1 not the surroun ing tissue :D egree flexion Dunlop traction can be use as s&eletal Devlopmental Dysplasia of the +ip EDD+F #athophysiology Cause is un&no%n> Certain factors 2 A F$s ,en er EFemaleF1 )irth or er EFirstF1 Family history1 Intrauterine position EFeet first E)reechF 1 Delivery type an postnatal positioning are &no%n to increase the

ris& Configuration an relationship of structures

Clinical (anifestations Infants 'ne=ual s&in fol s on the thighs an buttoc&s 3imitation of ab uction on the affecte si e 'ne=ual &nee height or leg length 7l er Chil ren 3imp an Tren elenburg$s ,ait Epelvis tips for%ar on normal si e rather then up%ar F

)arlo% (aneuver 2 If the hip is islocate 1 i>e>>1 the hip can be poppe out of the soc&et 2 the test is consi ere positive 7rtolani (aneuver 2 #ositive sign is istinctive ?clun&@ %hich can be hear an felt as the femoral hea relocates anteriorily into the acetabulum

 Diagnosis of DD+ G 9 months of age 2 'ltrasoun 2 +igh inci ence of False #ositives 4 9 months of age 2 H!/ay 2 7ssification of the femoral hea occurs bet%een 9! 8 months of age #avli& +arness Dynamic splinting %ith the proximal femur centere in the acetabulum in an attitu e of flexion (a&e sure infant oesn$t %ear harness %ithout 'n ershirt an Diaper bet%een s&in an straps 'sually use for 9!" months I straps every 5!C %ee&s ue to infants rapi gro%th

7steomyelitis Etiology Ac=uire from Exogenous an +ematogeneous Sources (ost Common 7rganism66 #athophysiology Infective emboli travel from the focus of infection to the small en arteries in the bone metaphysis 2 Does not sprea to the epiphysis E+as o%n bloo supplyF Infectious process lea s to local bone estruction an abcess formation Abcess an necrotic ebris exerts pressure %ithin the rigi bone Infection sprea s beneath the periosteum Clinical (anifestations

 Fever Failure to use affecte extremity Erythema1 heat an s%elling over area of infection Ten erness in affecte area Decrease /7( in the 0oints of the affecte extermity 3aboratory Fin ings *hat bloo %or& %ill be or ere an %hat %ill it sho%6 Nursing (anagement Aggressive Antibiotic Tx for at least A %ee&s *hat antibiotics %ill be or ere for Staph Aureus6 *hat about if it is (ethicillin /esistant Staph Aureus E(/SAF6 Scoliosis Etiology In most cases cause is un&no%n 2 Can be associate %ith many ifferent con itions Complex Spinal Deformity in 9 #lanes 3ateral Curvature Spinal rotation causing rib asymmetry Thoracic hypo&yphosis

Clinical (anifestations I iopathic Scoliosis curvature typically not evi ent before 5D years of age Diagnostic Evaluation H!rays of chil in stan ing position an then use Cobb techni=ues for curve magnitu e Therapeutic (anagement )racing an Exercise EIn an 7ut of )raceF ! Not effective for curvature 4 ADJ )races )oston )race or *ilmington 2 'se more often for Scoliosis (il%au&ee )race 2 'se more often for Kyphosis Thorocolumbosacral 7rthosis ET3S7F The type of brace an the amount of %earing time E58!C9 hours. ayF is epen ent on the nature of the curve1 the age of the chil an any un erlying con itions

 Surgical /epair of Scoliosis /ealignment an Straightening %ith Internal Fixation *hat are the &ey areas of nursing focus post!operatively6666 Nursing Care #lan on page 58BC Cerebral #alsy EC#F Causes of C# 2Table AD!5 58:C Clinical Classification of C# 2 )ox AD!C pg 58:9

C#LEtiology Any perinatal or neonatal brain lesion or brain mal evelopment1 regar less of the cause1 may be lin&e to as many as MDN of the total cases of C# #renatal.postnatal Infection #renatal.postnatal hypoxia. asphyxia 7ften no i entifiable imme iate cause #reterm birth of E3)* an -3)* is single most important eterminant of C# AnoxiaLmost common cause of brain amage whenever it occurs Types of C# Spastic Athetoi . ys&inetic Ataxic (ixe . ystonic Spastic (ost common clinical type

 #resents as hypotonia most often Types of Spastic C# Oua riparesis EtetraparesisF Four extremities involve .severe isability Speech an s%allo%ing ifficulties Tongue protrusion EincompleteF 3abile emotions in some patients Diplegia (onoplegia Triplegia #araplegia #ossible (otor Signs of C# #oor hea control after age 9! A months Stiff or rigi limbs Arching bac&.pushing a%ay Floppy tone 'nable to sit %ithout support at age M months Clenche fists after age 9 months #ossible )ehavioral Signs of C# Excessive irritability No smiling by age 9 months Fee ing ifficulties #ersistent tongue thrusting Fre=uent gagging or cho&ing %ith fee s Cerebral #alsy an IO *i e variation "DN!8DN of C# patients have normal IO Difficult to assess /igi 1 atonic1 an =ua riparetic C# have highest inci ence of profoun impairment ,oals of Therapy for C# Establish locomotion1 communication1 an self!help ,ain optimum integration of motor functions Correct associate efects as early an effectively as possible #rovi e e ucational opportunities #romote socialization experiences #harmacologic to Decrease Spasticity in C# )otulinum toxin type A E)otoxF )aclofen 7ral Implante pump for intrathecal a ministration Dantrolene so ium EDantriumF Diazepam E-aliumF Associate Disabilities an #roblems in Chil ren %ith C# Intellectual Impairment Attention Deficit.+yperactivity Disor er EAD+DF Seizures Drooling

Difficulty Fee ing 2 *hich can lea to Aspiration Impaire ,as Exchange 7rthope ic complications -isual E Nystagmus an amblyopiaF an +earing 3oss Constipation Dental problems 2 Caries (alocclusion ,ingivitis Nursing (anagement of the Chil %ith C# +olistic approach Inter isciplinary *hat other isciplines %oul be involve in this chil $s care66 See Nursing Care #lan on pages 5BDC!5BD9 +ypotonia ?Floppy infant syn rome@ (uscles feel atrophie 1 mar&e hea lag1 often have poor suc& Diagnostic evaluation Therapeutic management an nursing consi erations Infantile Spinal (uscular Atrophy ES(A Type 5F Also calle *er nig!+offmann isease Autosomal recessive trait (ost common paralytic form of floppy infant syn rome Econgenital hypotoniaF Infantile S(ALCharacteristics #rogressive %ea&ness an %asting of s&eletal muscles Degeneration occurs in spinal cor an brainstem1 resulting in atrophy of s&eletal muscles Age of onset variableP earlier onset has poorest prognosis Interme iate S(A EType CF (anifests bet%een C an 5C months of age First1 %ea&ness of arms an legsP later1 generalize %ea&ness #rominent pectus excavatum (ovements absent uring relaxation.sleep 3ife span B months to B years Muscular Dystrophy #seu ohypertrophic EDucheneF (uscular Dystrophy ED(DF ! the most common 2 An H! 3in&e Inheritance #attern 2 About 5.9 of all cases represent ne% mutations (utation of the gene that enco es ystrophin 2 #rotein pro uct in s&eletal muscle DMD Clinical (anifestations *hen oes muscle %ea&ness begin to emonstrate itself6 #elvic *ea&ness *a ling gait 2 lor osis 2 fall fre=uently ,o%er$s Sign (uscle Atrophy 2 Calf muscle hypertrophies 2 Fatty infiltrates 7ccasional (ental Deficiency

 Increasing /espiratory Distress

Nursing (anagements ,enetic Counseling 2 #renatal Testing E#olymere Chain /eaction ActivityF Encourage Exercise 2 Delays %heelchair confinement Inter isciplinary Consultation Talipes E=uinovarus AKA Clubfoot See )ox 55!8 #athophysiology 2 'n&no%n 2 There is a strong familial ten ency Therapeutic (anagement 2 Involves 9 Stages A> Correction of the Deformity )> (aintenance of the Correction C> Follo%!up to avoi reoccurrence Serial Casting begins shortly after birth> (ore severe cases %ill re=uire surgery After correction is achieve the infant may %ear a splint to prevent reocurrence> Osteogenesis Imperfecta (OI) At least " ifferent types of 7I Clinical Features inclu e varying egrees of; )one Fragility1 Deformity an Fracture )lue Sclerae +earing 3oss Dentinogenesis Imperfecta Inheritance #attern (a0ority of cases 2 autosomal ominant1 although the most severe form emonstrates autosomal recessive Classification of 7I 2 See )ox 9:!5" page 58B" Therapeutic (anagement 2 (ainly supportive Stu y Ouestions 5> A 8 year!ol has a cast applie for a fracture ra ius> The nurse completes an orthope ic assessment on this chil > *hich of the follo%ing symptoms re=uires

imme iate attention an shoul be reporte to the (D6 A> Capillary refill of A secon s in the affecte foot )> E ema in the affecte han s that improves %ith elevation C> The chil escribing feeling of the affecte han being ?asleep an tingling>@ D> S&in surroun ing the cast is %arm an ry C> *hich of the follo%ing nursing care measures ta&es highest priority in caring for a chil in s&eletal traction6 A> Assessing bo%els soun s every shift )> Assessing temperature every A hours C> #rovi ing a e=uate nutrition D> #rovi ing Age!appropriate activities 9> *hich of the follo%ing statements ma e buy the caregiver of a chil being ischarge %ith osteomyelitis re=uires further teaching by the nurse6 A> ?I can stop the antibiotics %hen I see that my chil is feeling better>@ )> ?*e %ill ma&e sure that our chil has plenty of calcium an protein>@ C> ? I %ill loo& at the I- site for signs of infection a couple of times a ay>@ D> ?(y chil %on$t ta&e physical e ucation at school until allo%e by the octor> A> *hich of the follo%ing statements ma e by a parent of a chil %ith 7steogenis Imperfecta E7>I>F nee s clarification by the nurse6 A> ?(y chil may be able to participate in sports>@ )> ?There are no me ications available to help this isease process>@ C> ?Surgery may be nee e to place ro s in the bone for stability>@ D> ?(y chil %ill nee to be home schoole to protect him from in0ury>@ "> *hich of the follo%ing interventions is inappropriate to incorporate into the plan of care for a chil %ith Duchene (uscular Dystrophy hospitalize for a respiratory infection6 A> #hysical therapy )> Aggressive antibiotic therapy C> #assive /7( exercises D> Strict )e rest 8> A 5A!year!ol has been fitte %ith a (il%au&ee brace> *hich of the follo%ing Einclu e all that applyF shoul the nurse inclu e in teaching about this brace6 A> The brace shoul only be %orn %hen the a olescent is sleeping or in the recumbent position )> The brace shoul be %orn next to the s&in C> Exercises to increase pelvic tilt shoul be one several times per ay %hile in the brace D> The a olescent shoul experience no pain as a result of %earing the brace> B> An infant is place in a #avli& +arness for Developmental Dysplasia of the +ip> *hich of the follo%ing statements Einclu e all that applyF ma e by a parent in icates

incorrect &no%le ge of the care of this infant6 A> ?The straps of the harness shoul be %orn next to the s&in>@ )> ?The harness shoul be %orn for 8 hours a ay>@ C> ?It %ill ta&e a long time for my chil to %al& an cra%l>@ D> ?I can move my chil aroun on a large s&ateboar >@ M> *hich of the follo%ing symptoms is not typical in an a olescent %ith i iopathic scoliosis6 A> )ac& pain )> 'ne=ual hip heights C> 'ne=ual shoul er heights D> 'neven %aist angles :> #ostoperative care of an a olescent follo%ing a spinal fusion for scoliosis inclu es; A> 7ral analgesia for pain )> 3ogrolling %hen repositione C> Nasogastric tube for ecompression D> Straight catheterization every A hours 5D> A 9 year!ol chil is suspecte of having Duchenne$s muscular ystrophy> *hich of the follo%ing assessment fin ings by the nurse %oul support this iagnosis6 A> A history of elaye cra%ling )> Inability to ambulate in epen ently C> Difficulty climbing stairs D> ,o%er$s sign 55> A chil is suspecte of having osteomyelitis> *hich of the follo%ing bloo values supports this iagnosis6 Choose all that apply A> Decrease %hite bloo cell E*)CF count )> #ositive bloo cultures C> Increase hematocrit E+ctF D> Elevate ES/ EErthrocyte se imentation rateF