alteration in mobility in children

8/12/2019 Alteration in Mobility in Children

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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 #aino #alloro #ulselessnesso #aresthesiao #aralysis


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Alteration In Comforto Aministration of #roper Analgesiao #roper Alignment of Tractiono #roper #lacement of #illo%s

Alteration in S&in Integrityo Change position if possibleo 'se Eggcrate (attress or Sheeps&in on )e

#otential for Infectiono Cast Careo #in Careo *oun Care

#romote Nutritiono Colloborate %ith #arents an Dietician to #lan Nutritious (eals an Snac&s

#romote Normal Eliminationo Increase Flui Inta&eo #rovie +igh Fiber Dieto 'se Stool Softeners Appropriatelyo #rovie #rivacy During Time of )epan 'se

#revent (uscle Atrophy an Impaire (obiltiy


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o #revent Contractureso Colloborate %ith #hysical Therapyo #repare Chil an #arents for Disuse Atrophy

#romote ,ro%th an Developmento 'se Age Appropriate Explanationso Normalize the Chil$s Environment as much as possibleo Encourage Siblings an #eers to -isito #rovie Age Appropriate ,ameso Collaborate %ith #arents an School to #rovie 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 3eaing cause of eath in chilren 4 5 yr of age

o Certain evelopmental characteristics of chilren at various ages ma&ethem more susceptible to in0ury

Infants ! 66666 Tolers ! 66666 School!age an aolescents !66666


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Clinical (anifestations S%elling #ain Diminishe 'se

Diagnostic Evaluation !*hat Tests %ill be one6 Therapeutic (anagement

,oals of Fracture (anagement /euction 2

o /egain Alignment an 3ength Immobilization 2

o /etain Alignment an 3engtho /estore Functiono #revent Further In0ury

Criteria for Determining 'se of /euction (etho for Fractures Age of Chil Degree of Displacemnt Amount of 7verriing Degree of Eema

Conition of S&in an Soft Tissue Sensation an Circulation Distal to the Fracture Emergency Treatment of Fractures

#age 589: /apiity of )one +ealing is Inversely /elate to the Chil$s Age

True or False;


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Cast Care (ost casts are mae out of synthetic material

Avantages 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 hanling on$t use fingertips 2 this may cause inentations

7nce cast is ry 2 ?hot spots@ inicate %hat6 *hat is the chief concern uring the first fe% hours after cast application6

Traction Types of Traction See )ox 9:!: page 58B

(anual 2 Traction applie to the boy part by the han place istally to thefracture> Nurses typically o this uring the Application of a cast

S&in Traction 2 #ull applie to the s&in surfaces an inirectly to the s&eletal surfaces>#ulling mechanism is applie to the s&in %ith ahesive material or an elastic banage>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 lines pull on arm /ussell 2 lines pull on lo%er extremity )ryant 2 lo%er extremities flexe at : 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 significanttraction is re=uire> The placement of the pin or %ire puts stress on the bone1 notthe surrouning tissue

: egree flexion Dunlop traction can be use as s&eletal

Devlopmental Dysplasia of the +ip DD+ #athophysiology

Cause is un&no%n> Certain factors 2 F$s ,ener Female1 )irth orer First1 Family history1 Intrauterine position Feet first )reech 1 Delivery type an postnatal positioning are &no%n to increase the


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ris& Configuration an relationship of structures

Clinical (anifestations Infants

'ne=ual s&in fols on the thighs an buttoc&s 3imitation of abuction on the affecte sie 'ne=ual &nee height or leg length

7ler Chilren 3imp an Trenelenburg$s ,ait pelvis tips for%ar on normal sie

rather then up%ar

)arlo% (aneuver 2 If the hip is islocate1 i>e>>1 the hip can be poppe out of the soc&et2 the test is consiere positive

7rtolani (aneuver 2 #ositive sign is istinctive ?clun&@ %hich can be hear an felt asthe femoral hea relocates anteriorily into the acetabulum


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Diagnosis of DD+ G 9 months of age 2 'ltrasoun 2 +igh incience 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

attitue of flexion (a&e sure infant oesn$t %ear harness %ithout 'nershirt an Diaper bet%een

s&in an straps 'sually use for 9!" months straps every 5! %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 +as o%n bloo supply Infectious process leas to local bone estruction an abcess formation Abcess an necrotic ebris exerts pressure %ithin the rigi bone Infection spreas beneath the periosteum

Clinical (anifestations


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Fever Failure to use affecte extremity Erythema1 heat an s%elling over area of infection Tenerness in affecte area Decrease /7( in the 0oints of the affecte extermity

3aboratory Finings *hat bloo %or& %ill be orere an %hat %ill it sho%6 Nursing (anagement

Aggressive Antibiotic Tx for at least %ee&s *hat antibiotics %ill be orere for Staph Aureus6 *hat about if it is (ethicillin /esistant Staph Aureus (/SA6

Scoliosis Etiology

In most cases cause is un&no%n 2 Can be associate %ith many ifferentconitions

Complex Spinal Deformity in 9 #lanes 3ateral Curvature Spinal rotation causing rib asymmetry Thoracic hypo&yphosis

Clinical (anifestations Iiopathic Scoliosis curvature typically not evient before 5 years of age

Diagnostic Evaluation H!rays of chil in staning position an then use Cobb techni=ues for curve

magnitue Therapeutic (anagement

)racing an Exercise In an 7ut of )race ! Not effective for curvature 4 J )races

)oston )race or *ilmington 2 'se more often for Scoliosis (il%au&ee )race 2 'se more often for Kyphosis Thorocolumbosacral 7rthosis T3S7 The type of brace an the amount of %earing time 58!9 hours.ay is

epenent on the nature of the curve1 the age of the chil an any unerlyingconitions


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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 58B

Cerebral #alsy C# Causes of C# 2Table !5 58:

Clinical Classification of C# 2 )ox ! pg 58:9

C#LEtiology Any perinatal or neonatal brain lesion or brain malevelopment1 regarless of the cause1

may be lin&e to as many as M of the total cases of C# #renatal.postnatal Infection #renatal.postnatal hypoxia. asphyxia 7ften no ientifiable immeiate 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


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#resents as hypotonia most oftenTypes of Spastic C#

Ouariparesis tetraparesis Four extremities involve.severe isability Speech an s%allo%ing ifficulties

Tongue protrusion incomplete 3abile emotions in some patients Diplegia (onoplegia

Triplegia #araplegia

#ossible (otor Signs of C# #oor hea control after age 9! 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 Feeing ifficulties

#ersistent tongue thrusting Fre=uent gagging or cho&ing %ith fees

Cerebral #alsy an IO *ie variation "!8 of C# patients have normal IO Difficult to assess

/igi1 atonic1 an =uariparetic C# have highest incience 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 #rovie eucational opportunities #romote socialization experiences

#harmacologic to Decrease Spasticity in C# )otulinum toxin type A )otox )aclofen

7ral

Implante pump for intrathecal aministration Dantrolene soium Dantrium Diazepam -alium Associate Disabilities an #roblems in Chilren %ith C#

Intellectual Impairment Attention Deficit.+yperactivity Disorer AD+D Seizures Drooling


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Difficulty Feeing 2 *hich can lea to Aspiration Impaire ,as Exchange 7rthopeic complications -isual Nystagmus an amblyopia an +earing 3oss Constipation

Dental problems 2 Caries (alocclusion ,ingivitis

Nursing (anagement of the Chil %ith C# +olistic approach Interisciplinary

*hat other isciplines %oul be involve in this chil$s care66 See Nursing Care #lan on pages 5B!5B9

+ypotonia ?Floppy infant synrome@

(uscles feel atrophie1 mar&e hea lag1 often have poor suc& Diagnostic evaluation Therapeutic management an nursing consierations

Infantile Spinal (uscular Atrophy S(A Type 5 Also calle *ernig!+offmann isease Autosomal recessive trait (ost common paralytic form of floppy infant synrome congenital hypotonia

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

Intermeiate S(A Type (anifests bet%een an 5 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

#seuohypertrophic Duchene (uscular Dystrophy D(D ! 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 encoes ystrophin 2 #rotein prouct in s&eletal muscleDMD

Clinical (anifestations *hen oes muscle %ea&ness begin to emonstrate itself6 #elvic *ea&ness

*aling gait 2 lorosis 2 fall fre=uently ,o%er$s Sign

(uscle Atrophy 2 Calf muscle hypertrophies 2 Fatty infiltrates 7ccasional (ental Deficiency


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Increasing /espiratory Distress

Nursing (anagements ,enetic Counseling 2 #renatal Testing #olymere Chain /eaction Activity Encourage Exercise 2 Delays %heelchair confinement Interisciplinary Consultation

Talipes E=uinovarus AKA Clubfoot See )ox 55!8 #athophysiology 2 'n&no%n 2 There is a strong familial tenency 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 inclue 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

Stuy Ouestions 5> A 8 year!ol has a cast applie for a fracture raius> The nurse completes an

orthopeic assessment on this chil> *hich of the follo%ing symptoms re=uires


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immeiate attention an shoul be reporte to the (D6 A> Capillary refill of secons in the affecte foot )> Eema in the affecte hans that improves %ith

elevation C> The chil escribing feeling of the affecte han being

?asleep an tingling>@ D> S&in surrouning the cast is %arm an ry

> *hich of the follo%ing nursing care measures ta&es highest priority in caring fora chil in s&eletal traction6

A> Assessing bo%els souns every shift )> Assessing temperature every hours C> #roviing ae=uate nutrition D> #roviing Age!appropriate

activities 9> *hich of the follo%ing statements mae 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 eucation at school until allo%e by the

octor>

> *hich of the follo%ing statements mae by a parent of a chil %ith 7steogenisImperfecta 7>I> nees clarification by the nurse6

A> ?(y chil may be able to participate in sports>@ )> ?There are no meications available to help this isease process>@

C> ?Surgery may be neee to place ros 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 respiratoryinfection6

A> #hysical therapy )> Aggressive antibiotic therapy C> #assive /7( exercises D> Strict )erest

8> A 5!year!ol has been fitte %ith a (il%au&ee brace> *hich of the follo%inginclue all that apply shoul the nurse inclue in teaching about this brace6

A> The brace shoul only be %orn %hen the

aolescent 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 aolescent 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 inclue all that apply mae by a parent inicates


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incorrect &no%lege 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 aolescent %ith iiopathicscoliosis6 A> )ac& pain )> 'ne=ual hip heights C> 'ne=ual shouler heights D> 'neven %aist angles

:> #ostoperative care of an aolescent follo%ing a spinal fusion for scoliosisinclues;

A> 7ral analgesia for pain )> 3ogrolling %hen repositione C> Nasogastric tube for ecompression D> Straight catheterization every hours

5> A 9 year!ol chil is suspecte of having Duchenne$s muscular ystrophy>*hich of the follo%ing assessment finings by the nurse %oul support this iagnosis6

A> A history of elaye cra%ling )> Inability to ambulate inepenently C> Difficulty climbing stairs D> ,o%er$s sign

55> A chil is suspecte of having osteomyelitis> *hich of the follo%ing bloo valuessupports this iagnosis6 Choose all that apply

A> Decrease %hite bloo cell *)C count )> #ositive bloo cultures C> Increase hematocrit +ct

D> Elevate ES/ Erthrocyte seimentation rate

alteration in mobility in children

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