Effects of Immobilization and Compartment Syndrome

Effects of Immobilization

• Decreased muscle strength and endurance leads to muscle atrophy and reduced joint mobility.
• Increased workload on the heart and risk of thrombus formation due to reduced mobility.
• Reduced orthostatic tolerance and venous return.
• Increased risk of aspiration due to reduced respiratory effort.
• Impaired mobility worsens negative calcium and nitrogen balance.
• Changes in gravitational force and renal stasis.
• Altered perception of self and environment, leading to frustration, helplessness, anxiety, depression, anger, aggression, and developmental concerns.

Compartment Syndrome

• Pain disproportionate to injury, especially with stretching, is an early sign.
• Poikilothermia (cool limb) is another early sign.
• Paresthesia (tingling, pins, and needles) is another early sign.
• Paralysis is a later sign.
• Pulselessness (lack of palpable pulse) is a very late sign.
• Pallor in the affected limb.
• Fasciotomy is performed if pulses do not return.

Cast Care - Do’s

• Keep the cast elevated on pillows for the first day and elevate only during rest after the first day.
• Expose the plaster cast to air until it dries.
• Lift and support wet plaster casts with the palms of the hands.
• Observe for swelling, discoloration.
• Check movement and sensation frequently.
• Encourage frequent rest for a few days.
• For arm or hand casts, keep in a sling most of the time and support on pillows at chest level.
• For leg casts, elevate the injured leg when sitting.
• Keep small items away from young children.
• Examine the skin at the cast edges and pad if needed.
• Incontinence: protect with waterproof tape and plastic and use diapers.
• Manage pain associated with swelling by elevating and applying ice.

Cast Care - Don't’s

• Do not allow the cast to hang in a dependent position for more than 30 minutes.
• Do not stand on the injured leg for too long.
• Do not put anything inside the cast.
• Do not place the cast in water.

Fractures

• Complete vs. Incomplete: Complete fractures break the bone completely, Incomplete fractures break the bone partially.
• Greenstick: A type of incomplete fracture where the tension side of the bone breaks, but the compression side only bends.
• Simple vs. Compound/Open: Simple fractures do not break through the skin. Open fractures involve the bone breaking through the skin.
• Complicated: Complicated fractures damage other organs or tissues.
• Transverse/Oblique/Spiral: Fractures can be transverse (across the bone), oblique (angled), or spiral (twisted).
• Comminuted: Comminuted fractures have multiple bone fragments.

Osteomyelitis

• Inflammation and infection of bony tissue from an external or infectious (hematogenous) source.
• Can be subacute or spreading.
• Early signs mimic arthritis and leukemia.
• Marked leukocytosis.
• Bone scans and bone cultures via biopsy or aspirate are used for diagnosis.
• Treatment involves vigorous IV antibiotics for 3 to 4 weeks to months, bed rest, and immobility of the limb.
• Amputation may be necessary if the infection does not resolve.

DDH (Developmental Dysplasia of the Hip)

• Hip instability present at birth, particularly associated with breech deliveries.
• Diagnosis: Ortolani and Barlow tests until the baby is walking (1 to 4 weeks of age), and radiographic exam.
• Signs and Symptoms: Galeazzi sign and limp/leg discrepancy in older children.
• Management: Pavlik Harness or cast to promote normal growth and development.

Overuse Syndromes/Injuries

• Syndromes resulting from repetitive microtrauma with inflammation of the involved structure.
• Examples: Tennis elbow, Osgood-Schlatter disease.
• Signs and Symptoms: Pain, tenderness, swelling, disability.
• Causes: Repetitive muscle contraction, repetitive weight-bearing activities like running, gymnastics, and basketball.
• Tibial fractures are the most common stress fracture.
• Stress Fractures: Begin after starting an activity, characterized by pinpoint pain, aching, swelling, and resolution with rest.
• Management: Rest, ice, NSAIDs.

Torticollis

• Congenital or acquired limited neck motion with the neck flexed to the affected side.
• Management: Heat, NSAIDs (Motrin), physical therapy if congenital.

Female Athlete Triad

• A combination of amenorrhea (absence of menstruation), osteoporosis, and eating disorders.

Tonsillectomy Nursing Concerns

• Airway: Careful positioning, frequent swallowing can indicate bleeding, observe for hemorrhage, suction at the bedside.
• Bleeding: Check for frequent swallowing, minimize agitation and crying, avoid suctioning, a small amount of bleeding is normal around 7 to 10 days due to scabbing.
• Comfort: Control with Tylenol/Motrin, cool water or crushed ice, flavored ice pops, avoid red or brown-colored foods and fluids, no straws, if refusing oral meds, administer PR pain meds.
• Food: Gelatin, cooked fruits, sherbet, soup, mashed potatoes.

Tonsillectomy Home Teaching

• Do’s: Discourage coughing/putting objects in the mouth, alternate Tylenol/Motrin, stay ahead of pain for the first 48 hours by waking them up, limit activity, observe for signs of dehydration.
• Don’ts: Eat spicy or irritating foods, gargle or brush vigorously.

Asthma

• Chronic inflammatory disorder characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness.
• Inflammation causes recurrent wheezing, breathlessness, chest tightness, and cough.
• Most common chronic disease of childhood.
• Risk Factors: History of allergies or atopic dermatitis, hereditary, gender, smoking, African American, low birth weight, overweight.

Classic Asthma Symptoms

• Dyspnea (shortness of breath).
• Wheezing.
• Coughing.
• Chest tightness and pain in older children.
• Gradual or abrupt onset.
• Symptoms are worse at night or during exercise.
• Coughing at night without infection.
• Course, loud, prolonged expiration.
• Generalized wheezing.

Asthma Severity Classification

• Mild: Symptoms more than two times a week, but 80% of days are symptom-free.
• Moderate: Daily symptoms, nighttime symptoms one to two times a month (0 to 4 years) or more than once a week (5 to 11 years).
• Severe: Continuous daily symptoms, frequent nighttime symptoms.

Status Asthmaticus

• Respiratory distress continues despite vigorous therapeutic measures.
• Some cases have concurrent respiratory infection.
• Can result in respiratory failure and death.
• Severe Respiratory Distress: Remains sitting upright, refuses to lie down, sudden agitation, agitated child who suddenly becomes quiet, diaphoresis, pale.
• Management: Frequent administration of short-acting beta-agonists, humidified oxygen to maintain SpO2 above 90%, IV corticosteroids, and magnesium sulfate, close monitoring (PICU), heart monitor and pulse oximeter on, IV fluids.
• If using magnesium sulfate, monitor for hypotension and have a fluid bolus ready.

Bronchiolitis (RSV)

• An acute viral infection that occurs when bronchial mucosa swells and fills with mucus and exudate.
• Typically affects infants under 3 months.
• Begins with an upper respiratory infection (URI).
• Infants may not have many clinical signs.
• Peak symptoms typically occur on days 3 to 5.
• Early symptoms: Rhinorrhea (runny nose) and low-grade fever.
• Later symptoms: Wheezing, retractions, crackles, dyspnea, tachypnea, diminished breath sounds.

Bronchiolitis Management

• Home management (most cases): Adequate fluid intake and fever-reducing medications.
• Hospital management: Oxygen, bronchodilators, IV fluids, tube feedings, steroids, intubation, contact precautions, frequent suctioning, and monitoring.
• Hospitalization is recommended for infants with poor feeding, lethargy, respiratory distress, hypoxemia, or apnea.
• Prevention: Synagis (Palivizumab) every 30 days until the end of the RSV season (for preterm infants).

Dehydration

• Diarrhea: 10 mL/kg for each stool is present.
• Mild Dehydration (3 to 5% weight loss): 100 mL/kg (15%).
• Moderate Dehydration (6 to 9% weight loss): Slowed capillary refill (2 to 4 seconds), oliguria.
• Severe Dehydration (10% or more): Tenting, cool/acrocyanotic/mottled skin, oliguria/anuria.
• Management of Moderate Dehydration: Replace lost fluids equal to depletion, maintenance fluids, and electrolytes, address the root cause, monitor I&Os, VS, UA (SG).
• Management of Severe Dehydration: Rapid fluid replacement is contraindicated due to the risk of water intoxication and cerebral edema, replace lost fluids slowly, monitor for signs of fluid overload.

Dehydration Types:

• Isotonic Dehydration: Water loss equals electrolyte loss (most common).
• Hypotonic Dehydration: Electrolyte loss is greater than water loss, fluid shifts into the ICF leading to shock.
• Hypertonic Dehydration: Water loss is greater than electrolyte loss, fluid shifts into the ECF, increases the risk of seizures, but lower risk of shock.

Shock

• Hypovolemic Shock: Reduction in circulating blood volume due to trauma, bleeding, burns, or diarrhea.
• Distributive Shock: Vascular abnormality causes maldistribution of blood supply.
• Types of Distributive Shock: Neurogenic, anaphylactic, septic shock.

Shock Signs and Symptoms

• Hypovolemic Shock: Normal to increased respiratory rate, compensated stage – normal blood pressure, narrow pulse pressure, tachycardia, weak peripheral pulses, pale/cool skin, prolonged capillary refill greater than 2 seconds.
• Distributive Shock: Normal to increased respiratory rate, may have crackles, normal to decreased blood pressure, tachycardia, weak peripheral pulses, warm skin.

This quiz covers the physiological effects of immobilization on muscle strength, endurance, and overall health. It also discusses compartment syndrome, its signs, symptoms, and the critical nature of timely intervention. Understand the implications of reduced mobility on bodily systems and learn to identify early warning signs of complications.