Case Studies

Client profile: Lauren

1. Laurens clinical manifestations (asymmetry of thigh and gluteal folds,
right hip abduction, and right upper leg shorter than left are
significant signs of dysplasia of the hip.
2. The potential causes of Laurens musculoskeletal manifestations
could be genetic factors but most likely is due to breech vaginal
delivery.
3. In order to prepare Laurens care plan it would be helpful for the
nurse to first perform physical examination, assess skin, respiratory
and circulatory status, family resources, and to take in consideration
Laurens age and developmental stage.
4. Developmental dysplasia of the hip (DDH) refers to a variety of
conditions in which the femoral head and the acetabulum are
improperly aligned with an unstable connection. Including hip
instability, dislocation (displacement of the bone from its normal
articulation with the joint), subluxation (partial dislocation) and
acetabular dysplasia (abnormal cellular or structural development
leading to instability).
5. Hip instability is present in 1 in 100 newborns and dislocation occurs
in 1.5 to 20 in 1,000 births. The condition affects girls four times as
often as boys. Unilateral in 80% of affected children and the left hip is
affected three times as often as the right.
6. Prior to discharge Laurens priorities are: cast care, harness
alignment, pain control, and prevent complications from immobility.
7. An orthopedic device must commonly used for infants younger than 6
months is the Paul harness. It is a dynamic splint that allows
movement. It ensures hip flexion and abduction but does not allow
hip extension or adduction.
8. Priorities of care after fitting the device are care of the cast,
alignment, prevent complications from immobility, skin care, and
promotion of normal growth and development.
9. The nurses best response to this question is one that reassures the
mother that she will be able to breast feed Lauren and encourage
breast feeding.
10.*Instruct about general cast care, positioning, bathing, toileting, and
age-appropriate diversional activities.
*Emphasize the importance of performing neurovascular checks and
reporting any abnormalities immediately.
*Be sure that parents understand that the bar between the legs on
the cast is not to be used for holding or turning the child. The bar is
used to position the legs at the proper distance; using it to lift can
cause the cast to fracture, weaken, or disintegrate.
*Make appropriate referrals for periodic assessment by a visiting
nurse or home health nurse.
*Provide the family with resource to care for the child.

11.Laurens condition can impact growth and development due to lack of

movement, decrease appetite, decreased interaction and stimulation.
Engage the child in activities that stimulate the upper extremities and
all five senses. Provide stimulating toys and position the toys within
the childs reach and interact with the child as much as possible.