Clinical Manifestations of Scoliosis and Meningitis

Neuro and Musculoskeletal Clinical Judgment Concept Map

• Increased Intracranial Pressure (ICP): Slide #11; Infants/children exhibit frequent vomiting, irritability, lethargy, bulging fontanel, high-pitched cry, increased head circumference, separated cranial sutures, and distended scalp veins (setting sun sign). Responses to pain may be increased or decreased.

• Infant/Child Manifestations: Poor feeding/vomiting, irritability, restlessness, lethargy, bulging fontanel, high-pitched cry, increased head circumference, separated cranial sutures, distended scalp veins (setting sun sign), headache, diplopia, mood swings, slurred speech, papilledema, nausea and vomiting (especially early morning).

• Therapeutic Interventions: Prioritize interventions based on assessment findings. Monitor vital signs every hour, keep the child near nurses' station, maintain a quiet environment, minimize visitors, elevate head of bed. Pain management, airway, oxygen, circulation.

• Important Considerations: Details to remember for patient care include signs to look for in the patient, changes in levels of consciousness. Important to remember the degree of injury and its relation to the force of impact. Recognizing changes in LOC, such as irritability and agitation, as signs to progress. Monitor input and output to assess for risk of fluid overload and cerebral edema. Important to know the progression of increased intracranial pressure or ICP, and the response to treatments.

• Clinical Judgment Connections: The big picture of patient care, putting information together to care for the child.

Concussion

• Concussion: Transient, reversible neuronal dysfunction; possible loss of consciousness (LOC), nausea, vomiting. Important assessments include monitoring for signs of increasing ICP. Understanding risk of second impact; avoidance of returning to play too early.

• Coup-Contre-Coup Injury: forward hit causing a backward hit resulting injury.

• Concussion Management: Educate the child in minimizing light and screen exposure to prevent further injury.

• Post-Concussive Syndrome: A syndrome that may include headaches and neurological issues that lingers several days to months after the initial injury.

Brain Injury Sequelae

• Behavioral Changes: Emotional instability, poor concentration, slowed responses, and inappropriate behavior are potential sequela. Physical disabilities, memory loss, communication deficits can also occur.

Contusion

• Contusion: Tearing and bruising of cerebral tissue.

Skull Fractures

• Skull Fractures: Result from significant force. Regular assessment if injuries occur. Look for associated injuries and/or cerebral issues.

Epidural Hematoma, Subdural Hematoma, Intracerebral Hemorrhage

• Epidural Hematoma: Blood clot between skull and dura.
• Subdural Hematoma: Blood clot between dura and cerebrum.
• Intracerebral Hemorrhage: Diffuse bleeding into the brain. Multi-system assessment is needed.

Hydrocephalus

• Hydrocephalus: Imbalance between production and the absorption of cerebrospinal fluid (CSF). Multi-system assessment needed; frequent feedings, monitoring vital signs, head circumference measurements.

Spinal Cord Injury

• Spinal Cord Injury: Clinical manifestations based on the level of injury. Possible loss of bowel and bladder function, flaccid paralysis, or partial paralysis, depending on the specific level of injury.

Spina Bifida

• Spina Bifida: Include loss of bowel and bladder function. Flaccid or partial paralysis is possible in extremities below the level of injury. Focus is to maintain the integrity of the sac.

Meningitis (Bacterial vs. Viral)

• Meningitis (Bacterial): Bacterial infections show symptoms like Fever, headache, photophobia, stiff neck, altered LOC (lethargy, irritability), decreased appetite, vomiting, agitation, drowsiness; and possible joint pain, purpura, and rash. Meningitis (Viral): Typically milder, causes less severe consequences than bacterial.

Cerebral Palsy

• Cerebral Palsy: Typically an anoxic event during pregnancy or at birth. Early diagnosis and intervention are vital to optimize outcomes.

Muscular Dystrophies

• Progressive, degenerative diseases related to inherited muscle diseases, resulting in progressively reduced muscle function.

Reyes Syndrome

• Toxic metabolic encephalopathy: includes fever, cerebral edema, liver problems

Seizures

• Seizure: Assessment critical for seizure activity; ensure oxygen and glucose levels are maintained in the patient.

Guillain-Barré Syndrome

• Guillain-Barré Syndrome: Possibly autoimmune in nature, characterized by progressive autoimmune polyneuropathy, causing ascending motor weakness that begins in the lower extremities and ascends bilaterally. Monitor airway and respiratory function.

Fractures

• Fractures: Assessment critical for identifying the location and severity of the fracture. Immediate pain management, immobilization, and care for fractures.

Compartment Syndrome

• Compartment Syndrome: Assess circulation and movement; possible pain, pallor, pulselessness, paresthesia, and paralysis.
• Notify provider immediately.
• Pain/burning, 5 P’s, tissue ischemia, and prolonged capillary refill, are all critical assessments.

Skeletal Traction

• 90-90 Traction: Used to treat injuries. Focus is on proper pain and neuro assessments.

Pin Care

• Pin Care: Clean skin before touching the pin.

Cast Care

• Cast Care: Assess neurovascular checks to monitor ongoing health status.

Osteomyelitis

• Osteomyelitis: Assessment of cast, skin breakdown, and infection. Treat with broad-spectrum IV antibiotics.

SCFE

• SCFE (Slipped Capital Femoral Epiphysis): Pre-adolescent or adolescent children, following a growth spurt, are at risk. Presents with pain or limping on affected side, hip, groin, or knee.

Club Feet

• Club Foot: Complex deformity of the ankle and foot that could limit movement.

Hip Dysplasia

• Hip Dysplasia: Head of femur is not properly seated in the acetabulum (socket). This is a congenital issue. Assess for Ortolani click and Galezzi sign.

Legg-Calve-Perthes

• Legg-Calve-Perthes: Avascular necrosis (death of blood supply) of the femoral head. Typically seen in children.

Scoliosis

• Scoliosis: Characterized by spinal curvature from a clinical standpoint.

Osteogenesis Imperfecta

• Osteogenesis Imperfecta: Bone fragility and deformity are hallmark features. Multiple fractures, blue sclera, discolored teeth, and thin skin are possible.