Pediatric Musculoskeletal Mobility
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Questions and Answers

Which aspect of musculoskeletal development accounts for the most significant increase in muscle mass?

  • Adolescence (correct)
  • Childhood
  • Adulthood
  • Infancy

    • What condition is characterized by improper alignment of the femoral head and acetabulum?

  • Scoliosis
  • Developmental Dysplasia of the Hip (correct)
  • Osteogenesis imperfecta
  • Fractured hip

    • What percentage of total body weight does muscle mass account for in infants?

  • 50%
  • 10%
  • 40%
  • 25% (correct)

    • What can lead to restricted growth potential in tendons?

    <p>Restricted mobility</p> Signup and view all the answers

    What is the primary change in bone characteristics as children age?

    <p>Becoming more porous and pliable</p> Signup and view all the answers

    At what life stage does ossification of bones continue until completion?

    <p>Adolescence</p> Signup and view all the answers

    What characteristic of ligaments and tendons makes them stronger than bone until puberty?

    <p>Greater elasticity</p> Signup and view all the answers

    What is the main clinical implication when planning care for a child with a musculoskeletal disorder?

    <p>Integrate principles of growth, development, and safety</p> Signup and view all the answers

    What is a common consequence of continued dislocation or subluxation in developmental dysplasia of the hip (DDH)?

    <p>Avascular necrosis of the femoral head</p> Signup and view all the answers

    Which physical assessment maneuver is not used to evaluate for hip instability in newborns?

    <p>Rosenbaum test</p> Signup and view all the answers

    What therapeutic management is typically initiated for infants less than 6 months old diagnosed with DDH?

    <p>Pavlik harness</p> Signup and view all the answers

    Which factor is a known genetic predisposition for developmental dysplasia of the hip (DDH)?

    <p>Breech presentation</p> Signup and view all the answers

    What is the primary goal of therapeutic management in DDH?

    <p>Maintain the hip joint in reduction</p> Signup and view all the answers

    Which clinical manifestation may indicate developmental dysplasia of the hip (DDH)?

    <p>Asymmetry of the gluteal and thigh folds</p> Signup and view all the answers

    What can happen during fetal development that contributes to the risk of DDH?

    <p>Genetic predisposition</p> Signup and view all the answers

    Which of the following statements about the acetabulum in DDH is true?

    <p>It may be shallow or sloping</p> Signup and view all the answers

    What are common clinical manifestations of scoliosis?

    <p>Truncal asymmetry and uneven shoulder height</p> Signup and view all the answers

    What is the primary goal of diagnostic testing for scoliosis?

    <p>To stop the progression of the curve</p> Signup and view all the answers

    Which method is considered the most definitive for diagnosing scoliosis?

    <p>X-ray imaging</p> Signup and view all the answers

    What is the biggest challenge faced by patients using a Boston brace for scoliosis treatment?

    <p>Wearing the brace for 23 hours a day reliably</p> Signup and view all the answers

    What curvature degree defines severe scoliosis requiring surgical intervention?

    <p>Curvatures greater than 40°</p> Signup and view all the answers

    During the postoperative care of a 13-year-old patient who underwent spinal fusion, what is a primary nursing concern?

    <p>Assessing for signs of infection</p> Signup and view all the answers

    What is one effect of scoliosis on the ribcage?

    <p>Ribs on the convex side are forced together</p> Signup and view all the answers

    What is a common practice for screening scoliosis in children?

    <p>Screening every 6-9 months</p> Signup and view all the answers

    What is the priority nursing intervention for a young child returning from surgery in a spica cast?

    <p>Check circulation.</p> Signup and view all the answers

    During a scoliosis screening, which finding should the school health nurse assess for?

    <p>Prominent scapula</p> Signup and view all the answers

    Which nursing consideration is essential for post-operative care?

    <p>Coughing &amp; deep breathing exercises</p> Signup and view all the answers

    What is a key parental education point regarding the use of the Pavlik harness?

    <p>Check for red areas under the straps at least twice daily.</p> Signup and view all the answers

    Which of the following is NOT a component of nursing care after surgery?

    <p>Immediate return to full activity</p> Signup and view all the answers

    Which is an appropriate method for managing discomfort related to a Pavlik harness?

    <p>Use a thin diaper over the harness.</p> Signup and view all the answers

    Which of the following assessments is crucial when monitoring for complications after positioning changes following surgery?

    <p>Assess for skin breakdown.</p> Signup and view all the answers

    What should the nurse monitor for post-operatively regarding the patient’s activity level?

    <p>Activity should gradually increase.</p> Signup and view all the answers

    What is the primary diagnostic test indicated for diagnosing developmental dysplasia of the hip (DDH)?

    <p>Ultrasound</p> Signup and view all the answers

    How long should the Pavlik harness be worn initially to treat DDH?

    <p>23 hours/day</p> Signup and view all the answers

    Which of the following is a priority nursing consideration for a child in a Pavlik harness?

    <p>Perform neurovascular checks</p> Signup and view all the answers

    What should be assessed regularly under the straps of a Pavlik harness?

    <p>Skin integrity</p> Signup and view all the answers

    In a spica cast, how should diapers be managed?

    <p>Change frequently to keep the skin clean</p> Signup and view all the answers

    What should parents be educated about regarding the positioning of a child in a spica cast?

    <p>Frequent position changes are necessary</p> Signup and view all the answers

    What is the approximate duration for wearing an abductor brace after the removal of a spica cast?

    <p>2 months</p> Signup and view all the answers

    What type of scoliosis is most commonly observed during adolescence?

    <p>Idiopathic</p> Signup and view all the answers

    What degree of spinal curvature is considered abnormal?

    <p>10°</p> Signup and view all the answers

    Which nursing intervention is essential for a child in a spica cast to control pain?

    <p>Administer acetaminophen or ibuprofen</p> Signup and view all the answers

    What specific condition requires frequent skin assessments under the Pavlik harness?

    <p>Skin breakdown</p> Signup and view all the answers

    What is a common teaching point regarding proper fit of the Pavlik harness?

    <p>Specialist adjusts straps every 1-2 weeks</p> Signup and view all the answers

    What education should parents receive regarding tummy time for a child in treatment for DDH?

    <p>Encourage daily tummy time to promote development</p> Signup and view all the answers

    Study Notes

    Mobility

    • State or quality of being movable
    • Exemplars include developmental dysplasia of the hip and scoliosis

    Objectives

    • Integrate principles of growth, development, and safety when caring for a child requiring braces, casts, traction, and surgery
    • Identify clinical manifestations of conditions of the hip or spine that would impact a child’s mobility
    • Devise an individualized nursing plan of care for a child with a musculoskeletal disorder of the hip or spine
    • Muscles:
      • Present at birth
      • Grow in length and mass
      • Muscle mass accounts for 25% of total body weight in infants
        • Adults muscle mass is 40% of TBW
      • Most rapid growth occurs during adolescence
    • Ligaments and tendons:
      • Stronger than bone until puberty
      • Tendons grow in length as a result of pressure
        • Restricted mobility = restricted growth potential
    • Bones:
      • All bones present at birth
      • Ossification continues throughout adolescence
      • Bones are more porous, pliable, and less dense
      • Cartilage is gradually replaced at the epiphysis
      • Growth happens at the epiphysis plate
      • Bone healing is rapid

    Developmental Dysplasia of the Hip (DDH)

    • Improper alignment of the femoral head and acetabulum creates instability in the hip
    • Etiology:
      • Genetic predisposition
      • Can occur early during fetal development
      • Mechanical forces late in pregnancy:
        • Hip can only develop normally if the femoral head is properly maintained within the acetabulum
    • Pathophysiology:
      • Hip instability
      • Subluxation
      • Complete dislocation
    • Dysplasia of the hip:
      • Acetabulum is shallow or sloping
        • Continued dislocation or subluxation can lead to complications:
          • Avascular necrosis of the femoral head
          • Hip instability
          • Limited ROM
          • Palsy of the femoral nerve
          • Early onset of osteoarthritis
    • Clinical manifestations:
      • Limited abduction
      • Asymmetry of the gluteal and thigh folds
    • Diagnostic Testing:
      • Allis sign
      • Barlow and Ortolani maneuvers
        • Physical assessment of all newborns conducted to evaluate for hip instability
    • Therapeutic Management:
      • Goal: Maintain the hip joint in reduction, allowing the femoral head and acetabulum to develop properly
    • Clinical Therapy:
      • Newborn to 6 months:
        • Pavlik harness: Prevents extension and adduction

      • 6 months:

        • Bryant traction
        • Closed reduction and spica cast

    Pavlik Harness Nursing Considerations

    • Safety:
      • Neurovascular checks
      • No swaddling
      • Car seat safety:
        • Adjustments of straps by specialist only
    • Perfusion:
      • Assess skin under straps
      • Assess skin folds
      • Keep skin clean and dry
    • Skin integrity:
      • Onesie and knee/thigh socks under harness
      • Diaper under harness
    • Growth & Development:
      • Move legs and arms freely
      • Encourage activity
      • Tummy time
    • Education:
      • Keep harness on for prescribed hours/day
      • Straps adjusted by specialist every 1-2 weeks
      • Compliance and follow-up appointments

    Spica Cast Nursing Considerations

    • Pain:
      • Acetaminophen or ibuprofen
    • Perfusion:
      • Neurovascular checks
    • Skin integrity:
      • Cast care: petal/ soft edges
      • Handle with palms of hands
      • Keep skin clean and dry
      • Nothing in the cast
    • Elimination:
      • Diaper under cast
      • Change diaper frequently
    • Growth & Development:
      • Tummy time
      • Age-appropriate play
    • Safety:
      • Car seat
      • Injury prevention

    Scoliosis

    • Complex deformity of the spine
      • Lateral S or C curvature
      • Greater than 10 degrees is abnormal
    • Etiology:
      • Idiopathic:
        • Lateral curve with vertebral rotation
        • Occurs most often during adolescence
      • Congenital
      • Acquired
    • Pathophysiology:
      • Structural changes occur as a result of curvature:
        • Ribs on the concave side are forced together
        • Ribs on the convex side separate
        • Narrowing of the vertebral canal
    • Clinical Manifestations:
      • Truncal asymmetry
      • Uneven shoulder height
      • Prominent scapula
      • One-sided rib hump
    • Diagnostic Testing:
      • Inspection:
        • Early detection lessens deformity
        • Goal: Stop progression of the curve
      • Scoliometer
      • X-ray:
        • Most definitive
      • Screenings:
        • Screened every 6-9 months

    Scoliosis Clinical Therapy

    • Mild: Curvatures of 10-20 degrees
      • Exercise
      • Follow-up evaluations
    • Moderate: Curvatures of 20-40 degrees
      • Prevents further curvature
      • Boston brace
        • Biggest issue is 23 hours/day compliance
    • Severe: Curvatures greater than 40 degrees
      • Surgery:
        • Spinal fusion: Harrington rod
          • Stabilizes the spine

    Scoliosis Nursing Considerations

    • Pre-operative:
      • Preparation for what to expect
    • Post-operative:
      • Pain control
      • Neurovascular checks
      • Coughing and deep breathing
      • Position changes
      • Activity will gradually increase
      • Pre-medicate for activity

    Review Questions

    • A school health nurse is screening for scoliosis. Which finding would the nurse assess for? 1. Prominent scapula
    • A young child has just returned from surgery in a spica cast. The priority nursing intervention would be which of the following? 2. Check circulation
    • Which of the following is appropriate for the nurse to include in parental education regarding the Pavlik harness? Select all that apply. * 3. Check at least two or three times a day for red areas under the straps and 4. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper

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    Description

    This quiz addresses the principles of pediatric mobility related to musculoskeletal development. It focuses on clinical manifestations of hip and spine conditions and the nursing care needed for children with these disorders. Explore how growth and development impact treatment strategies for children requiring specialized care.

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