Alteration in Mobility in Children
Content
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$s sign 55> A chil is suspecte of having osteomyelitis> *hich of the follo%ing bloo values supports this iagnosis6 Choose all that apply A> Decrease %hite bloo cell E*)CF count )> #ositive bloo cultures C> Increase hematocrit E+ctF D> Elevate ES/ EErthrocyte se imentation rateF
Nursing Care of the Immobilize Chil Neurovascular Assessment ! " #$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
