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Musculoskeletal Disorders in Children. Judy Hovelson. Causes. Nonintentional injury School: playground/gym Sports Automobile accidents Child Abuse Congenital syndromes Diseases. * Immobilization*. Inability to move Weakness, injury Casts/Traction Congenital Defects.
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Musculoskeletal Disorders in Children Judy Hovelson
Causes • Nonintentional injury • School: playground/gym • Sports • Automobile accidents • Child Abuse • Congenital syndromes • Diseases
*Immobilization* • Inability to move • Weakness, injury • Casts/Traction • Congenital Defects
Physiologic effects • Significant loss of muscle strength, endurance and muscle mass • Bone demineralization leading to osteoporosis • Loss of joint mobility and contractures
Other Organ Effects • Cardiovasular • Orthostatic hypotension, increased workload, thrombus formaiton • Nursing considerations??? • Respiratory • Reduced muscle power, reduced chest expansion • Nursing considerations??
Continued.. • Gastrointestinal System • Risk of aspiration • Slowing of stool • Renal System • Bone demineralization leads to calculi formation • Neurological changes may change bladder sensation and cues • Urine may back up due to horizontal positioning
Continued… • Metabolism • Negative nitrogen balance reltaed to tissue breakdown • Decreased and inappropriate nutrition can occur • Nursing considerations??? • Skin • Poor circulation, mechanical irritation, hygiene issues, prolonged pressure • Nursing Considerations???
Psychological Effects of Immobilization • When sensory deprivation is assoicated: • Restlessness, difficulty problem solving, inability to concentrate, depression, regression, egocentrism • Monotony leads to: • Sluggish intellectual and psychomotor responses, decreased communication skills, hallucinations, disorientaion, dependence and acting out • Many Family Issues!
Immobilization Devices • What are the physiological and psychological concerns for this child?
Fractures • Common in children and elderly • Don’t usually occur in infants • Forearm fractures are common in children • Clavicle is the most frequently broken bone • In children less than 10- Often during birth • Femoral neck fractures happen with automobile accidents (ages 6and 7) • Older children – femur • Teens - knees
What are the physiological and psychological concerns for this child?
Care of the Child with a Fracture • 5 “Ps” • Pain • Pallor • Pulselessness • Parasthesia • Paralysis
Traction • Purpose • To fatigue the involved muscle and reduce spasm so the bone can realign • To position the bone ends • To immobilize the fracture site
Types of Traction • Skin – no pins, usually short term • Example - Buck’s • Skeletal – surgical, pins • Example – 90:90 traction • Nursing Cares?? • Guidelines are on page 1922-1923
Fracture Complications • Circulatory impairment • Nerve compression • Compartment syncrome • Growth plate involvement • Nonunion/Malunion • Infection • Pulmonary Emboli
Osteomyelitis • Occurs between ages 5 and 14 • Infection in the bone • Etiology not always known • Children are very ill • IV antibiotic therapy is prompt and vigorous • Immobilization is usual