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33 Cards in this Set

  • Front
  • Back
 Congenital Defects
Developmental Dysplasia of the Hip (DDH)
Congenital Clubfoot
Metatarsus Adductus
 Developmental Dysplasia of the Hip (DDH)
 DDH
an abnormal development of the hip
 DDH health history
 Health history

breech birth
girls>boys
>Caucasian
family history
cultural factors
 Assessment for DDH
 Galeazzi’s sign
asymmetry of gluteal and thigh folds with shortening of thigh
 Barlow hip adduction
Ortoloni sign abduction (clunk) when spreading
 Alli’s sign
shortening of the femur
 Trendelenburg sign with lordosis

 Ultrasound before 4 months
 X ray after 4-6 months
 DDH Treatment - early diagnosis
 Early diagnosis allows the femoral had and acetabulum to develop normally
 Early treatment
Birth to 6 months
 Pavlik Harness
 Parent education (p. 1476)
-Initially worn continuously; then short periods off for 3-5 months
Bath, feeding, playing only in the harness
-Weekly checks for strap adjustment
-Skin care
-lotions, powders
-clothing, diapering
DDH Treatment - late diagnosis
 Late diagnosis (older infant and child)
Loss of range of motion
affected leg is shorter than the other
early osteoarthritis
waddling gait
 Age 6-18 months
 Disorder not recognized until child walks
-limb shortening
-contractures adductions and flexion

traction
closed reduction under anesthesia
or
open reduction
hip spica casting for 2-4 months
ALL OLDER CHILDREN WILL REQUIRE SURGERY
 Metatarsus Adductus
assessment (“pigeon toe”)
 Medial deviation of forefoot
 Health history
intrauterine positioning
 Physical exam
Passive ROM normal
Types I and II.
Passive ROM limited
Type III
 Treatment metatarsus adductus
 Reassurance, Stretching
Types I and II
 Type III
Serial casting
Surgery
 Congenital Clubfoot
Talipes equinovarus
 Health history
1 to 2/1000
Boys >girls
50% bilateral
associated with DDH, spina bifida
postural
Congenital Clubfoot
 Physical examination
Plantar flexion of foot
-Forefoot adduction and supination
-Ankle equinus
Congenital Clubfoot
Treatment
 Serial casting with
cast changes 1-2 weeks
 Denis Browne splint
 Surgery if normal alignment of foot not achieved by 3 months
 The Child in A Cast
 Cast Issues
 Swelling can continue after cast is put on
 Elevate to decrease risk, permanent damage within 6-8 hrs

 Nursing Assessment
Swelling and…..
 Pain
 Persistent pain an hour after medication
 Pallor
 Discoloration of exposed extremities (pallor or cyanosis)
 Pulselessness
 Decreased pulses or temperature of extremities
 Paresthesia
 Abnormal sensation
 Paralysis
 Decreased movement of distal extremities
 Developmental regression from a cast
autonomy young children
initiative preschooler
industry school age
independence adolescent
 Acquired Orthopedic Defects
 Idiopathic scoliosis
 Legg-Calve-Perthes
 Slipped Capital Femoral Epiphysis
 Septic Arthritis
 Juvenile idiopathic Arthritis
 Types of Scoliosis
 Congenital, associated with other syndromes, idiopathic (65%)
 Idiopathic scoliosis
lateral curvature of the spine >10%
-infantile < age 3
-juvenile age 4-10 prior to adolescence
-adolescent age 11-17
most high incidence due to rapid growth
Major concerns of scoliosis
Major concerns respiratory then cardiovascular compromise related to shape of the thoracic cage
 Assessment Scoliosis Inspection
 Use of scoliometer
Adams Bend over test
scoliosis screening early adolescence
prevent progression
decrease impact on respiratory and cardiac system
 Scoliosis Treatment
 < 10°-normal

 10°- 20°
observation, exercise
 20°- 50°
bracing
 > 45° surgery
fused in segments
 > 60º risk of cardiopulmonary involvement
 Scoliosis Surgery Nursing Care
 Pre-operative Period
routine surgical pre-op teaching
turning, deep breathing, coughing
preoperative autologous donation of blood
Auscultation heart and lungs secondary to compromise
 Legg Calve Perthes
Assessment
 Inspection
Painless limp, Trendelenburg gait
or pain in hip, thigh or knee >with activity
Internal rotation of hip
Abduction limited

Imaging
X-rays
MRI
 Legg Calve Perthes Medical Treatment
 Wide abduction traction
 Relieve spasms, stretches contractures, restore hip motion
 Partial ambulation cane crutches
 Casting 4-6 weeks or Bracing
 To keep the femoral head in the acetabulum
 If range of motion cannot be maintained
 Developing, preventable deformity that can be controlled
 Surgery
 To keep the femur in the acetabulum, screws, 6-8 weeks
 Slipped Femoral Capital Epiphysis
 Epiphysis of the femur slips off the head of the femur in a posterior direction
Health History
 Boys > girls
 9-16-years old
 Obesity
 African American>Caucasian
 Acute hip pain sudden onset with inability to bear weight
 Chronic hip pain slower onset pain and limp
 History of referred pain or groin, medial thigh or knee
 Assessment Slipped Capital Femoral Epiphysis
 Inspection
Limp, Trendelenburg gait
 Decreased range of motion in hip
Loss of abduction and internal rotation
 ~ 50% have bilateral involvement

Imaging
Xray Frogs Leg view
Bone scan
CT scan
Slipped Capital Femoral Epiphysis treatment
 Prevent further slippage until the growth plate closes
 Treatment options
 Bedrest, traction, crutches but no wheelchairs
 While waiting for surgery
 Surgery to fix the femoral head to the growth plate
 24-48 hours after diagnosis
 Crutches post op for weeks to months
 Ortho care for 18-24 months, limits on sports
Septic Arthritis
 Septic arthritis is an infection in a joint
-trauma or wound infection
-distal infection
-adjacent osteomyelitis near the joint
 Health History Septic Arthritis
 Age 3-7, under 10 years
 Warmth, tenderness, erythema, pain of joint
 Accompanying upper respiratory infection
Recent history of trauma or venipuncture
 Hip most common joint affected
labs for septic arthritis
Normal or elevated WBC count
Signs of inflammation
ESR and C Reactive protein
Culture
Positive blood culture
 Treatment Septic Arthritis
 Goal
Prevent avascular necrosis of joint head
Maintain function, motion and strength
Medical emergency
joint aspiration; IV antibiotics in hospital
 Juvenile Idiopathic Arthritis
 Chronic autoimmune inflammatory disease of the joints
 Unknown cause
 Erosion of the synovium and destruction of articular cartilage – causes adhesions and stiffening (ankylosis) of the joint
 70% inactive after childhood
30% have progressive arthritis into adulthood
JIA Types
 Pauciarticular onset
Most common type
 4 or fewer joints, usually knee
 More at risk for vision problems
 Polyarticular onset
 5 joints, small joints
 Systemic onset
 Enlarged spleen, liver, lymphadenopathy, pericarditis. pulmonary involvement ; pleuritis
 JIA
Health History
 Unknown cause with girls > boys
 1-3 years
 8-10 years
 Always starts before age 16
 Swelling, warmth, pain and joint stiffness
irritability or fussiness, or play refusal
Fever x 2 weeks
 JIA
Medications
 NSAIDs
 Approved for children
 Naproxen, ibuprofen, tolmectin
 Very effective side effect GI upset - take with food
 Methotrexate
 Used in combination with NSAIDs for failures
 Must closely monitor liver function, CBC
 Birth defects – birth control for teens
 JIA
Medications
 Corticosteroids
 Corticosteroids are reserved for
 Incapacitating arthritis
 Orally at lowest dose for shortest time
 Intraarticular injections
 Uveitis
 Use corticosteroids as eye drops
 JIA
Medications
Tumor Necrosis Factor Inhibitor
 Used when Methotrexate fails
 Etanercept (Enbrel)
interfere with immune system
live virus vaccines, not with active infection
twice weekly subcut injection
 JIA
Nursing Considerations
 Promotion of general health
 Routines, include school attendance
avoid social isolation
start school day later in morning
double books
 Maintenance of rules and discipline
allow as much self-care as possible
 Splints for sleeping
 Balanced diet
 Exercise, swimming
 Medical treatment for minor illnesses