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PEDIATRICS UNIT 3

PEDIATRICS UNIT 3. Revised 2012. MUSCULOSKELETAL DISORDERS. Developmental Hip Dysplasia. Head of femur displaced due to shallow hip socket Causes: Heredity, environmental. Treatment. Pavlik Harness to maintain abduction Casting. Nursing Interventions. Box 31-8

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PEDIATRICS UNIT 3

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  1. PEDIATRICS UNIT 3 Revised 2012

  2. MUSCULOSKELETAL DISORDERS

  3. Developmental Hip Dysplasia • Head of femur displaced due to shallow hip socket • Causes: • Heredity, environmental

  4. Treatment • Pavlik Harness to maintain abduction • Casting

  5. Nursing Interventions • Box 31-8 • Care of the Child in a Cast pg 1036

  6. Legg Calve Perthes Disease • Decreased blood supply to femoral head • Tissue death • Tissue regeneration

  7. Clinical Manifestations Insidious Pain Limp Limited ROM

  8. Medical Managment • Bedrest • Traction • Brace/harness • Nursing Interventions are???

  9. Scoliosis • Lateral curvature of the spine • Diag: • Screening exams • xray

  10. Medical Management • < 20% - no tx • Moderate – brace • Severe - surgery

  11. Nursing Intervention • Family education and support • Skin care (Box 31-8) • Pre/post op care

  12. Talipes • “club foot” • Idiopathatic • Genetic or environmental • TX Casting; change q wk, corrective shoes • Nrsg Interventions are ???

  13. Nursing Interventions • Parent education • Cast care

  14. Duchennes Muscular Dystrophy • Gradual progressive skeletal muscle wasting and weakness • Sex linked inherited

  15. Clinical Manifestations • Weakness • Falling • Gowers sign • Dx Muscle bx & electromylogram

  16. Treatment • No cure • Prevent infection

  17. Nursing Interventions • Family teaching • ROM – exercises • Nutrition/discourage obesity • Maintain independence • Refer to MDA

  18. Septic Arthritis • Infection in joint • Irritation and damage to synovial membrane

  19. Signs & Symptoms • Pain • Edema • Redness / warmth • Decrease ROM • Fever

  20. Treatment • Aspirate and irrigate in OR • ABX

  21. Nursing Interventions • Pain meds • Joint immobilization • ROM

  22. Meningitis • Infection of meninges • Bacterial most common

  23. Signs & Symptoms • + Kernig sign • + Brudzinski sign • Photophobia

  24. Bulging fontanels • Nuchal rigidity • Fever • HA • Vomiting

  25. Diagnostic tests • CSF • + for culture, WBC, protein

  26. Nursing Interventions • Prevention with Hib vaccine as early as 2 mos. old • Isol. for 24h after start of ABX • Decrease stimulation, neuro checks, observe for seizures

  27. Decreased stimulation • Neuro checks • Observe for seizures

  28. Hydrocephalus • Increased CSF in ventricles of brain • Bulging fontanels • Dilated scalp veins • ^ head size/ ^ ICP

  29. Medical Management • Tumor removal • Ventriculoperitoneal shunt

  30. Nursing Interventions • Pre/post op care • Assess ICP • Position on non-operative side

  31. Cerebral Palsy • Motor neuron impairment • Difficulty controlling muscles • Chronic disability

  32. Signs & Symptoms • Arching of back • Involuntary movements • Extension and scissoring of legs • See Box 31.9

  33. Medical Management • No specific treatment • Botox • Baclofen Pump

  34. Nursing Interventions • Encourage independence • Encourage mobility • Protective head gear • Praise • Teach ROM & appropriate play activities to parents

  35. Seizures • Excessive abnormal brain activity • Most are idiopathic • Petit Mal • Grand Mal • EEG

  36. Medical Management • Drug Therapy (pg. 1046) • Single drug therapy • Dosage modifications • Normal EEG and seizure free x 2 yrs

  37. Nursing Interventions • O2 and suction at bedside • Side lying during seizure • Protect from injury, note begin & end time, clinical manifestions of seizure and post seizure behavior

  38. Spina Bifida • Neural tube deficit • Occulta • Meningocele • Myelomeningocele

  39. Clinical Manifestations No sensory or motor function below deficit May have paralysis, incontinence, clubfoot or subluxated hip

  40. Medical Management Surgery to replace contents VP Shunt Corrective surgeries Continuous neurological assmts Assist family to cope

  41. Nursing Interventions See Box 31-10 pg. 1047 Pre-op cover lesion w/ saline soaked gauze Post-op Prone for 10-14 days

  42. Neuroblastoma • Tumor growth from nerve cells • Location: retroperitoneal, usually in adrenals or liver • Mets head, neck, chest, pelvis • s/s depend on location

  43. Medical Management • Surgery ( if localized ) • Radiation • Chemo

  44. Nursing Interventions • Same as for other cancers i.e. psych support, allow expression of fears & concerns • Be a good listener

  45. Lead Poisoning • Serious preventable health problem • SourcesInhaled / ingested • Stored in bones • Leads to anemia

  46. Clinical Manifestations Anemia Abdominal pain, lethargy Learning difficulties Decreased attention span & hearing G & D failure

  47. Diagnostic Tests 1) Blood levels 2) H & P w/ environment assmt. 3) x-ray of stomach & long bones 4) Urine studies Tx Chelation Therapy

  48. Nursing Interventions • Environmental & health questionaire • Education for prevention(Box 31-10) • Provide support, understanding and resources

  49. Strabismus • Results in “cross-eyed” • Extra ocular muscles lack coordination

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