Mobility_student ppt PDF

Concept: Mobility Pediatric Patient NU 495 J E N N I F E R K I N G , M S N, R N, C B C  Concept: Mobility C O N C E P T UA L D E F I N I T I O N: “ S TAT E O R Q UA L I T Y O F B E I N G M O B I L E O R M O VA B L E ” ( H U E T H E R & M C C H A N...

Concept: Mobility Pediatric Patient NU 495 J E N N I F E R K I N G , M S N, R N, C B C  Concept: Mobility C O N C E P T UA L D E F I N I T I O N: “ S TAT E O R Q UA L I T Y O F B E I N G M O B I L E O R M O VA B L E ” ( H U E T H E R & M C C H A N C E , 2 0 1 0 A S C I T E D I N G I D D E N S , 2 0 1 3 , P. 2 3 9 ) EXEMPLARS D E V E L O P M E N TA L D Y S P L A S I A O F T H E H I P SCOLIOSIS  Objectives Integrate principles of growth, development, and safety when planning care 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 involving the hip or spine  Basic Pediatric Principles Related to Musculoskeletal Development Muscles  All 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 Basic Pediatric Principles Related to Musculoskeletal Development Bones  All bones present at birth  Ossification continues throughout adolescence  More porous, pliable  Less dense  Cartilage gradually replaced at epiphysis  Growth happens at the epiphysis plate  Bone healing is rapid Developmental Hip Dysplasia  Developmental Dysplasia of the Hip (DDH) Improper alignment of the femoral head and the acetabulum creating instability in the hip.  Developmental Dysplasia of the Hip (DDH) Etiology  Genetic predisposition  May happen early during fetal development  Mechanical forces late in pregnancy The hip can only develop Pathophysiology normally if the femoral head is properly maintained within the  Hip instability acetabulum  Subluxation  Complete dislocation  Developmental Dysplasia of the Hip (DDH) 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  Developmental Dysplasia of the Hip (DDH) Clinical manifestations  Limited abduction  Asymmetry of the gluteal and thigh folds  Developmental Dysplasia of the Hip (DDH) Physical assessment on all Diagnostic testing NBs conducted to evaluate for hip  Allis sign instability  Barlow and Ortolani maneuvers 6 months of age  Developmental Dysplasia of the Hip (DDH) Therapeutic Management Goal: Maintain the hip joint in reduction allowing the femoral head and acetabulum to develop properly Developmental Dysplasia of the Hip (DDH) Maintains the hip Clinical therapy in flexion and  Newborn to 6 months abduction  Pavlik harness: Prevents extension & adduction  > 6 months  Bryant traction  Closed reduction and spica cast   Developmental Dysplasia of the Hip (DDH) Sophie is a 2-week-old infant born vaginally in a breech presentation. Prior to discharge she was noted to have hip instability. At today’s follow-up appointment, it is recommended to receive diagnostic studies to confirm the diagnosis of developmental hip dysplasia and begin treatment as soon as possible to promote proper development. What diagnostic test Diagnosis of DDH is would Sophie receive at confirmed. What course of this point? treatment is expected? Subluxation Pavlik of the right Harness hip Developmental Dysplasia of the Hip (DDH) Parent/Family Education Priority Teaching Points Growth & Safety Developmen t What concepts would Mobility Skin Perfusion you focus on? integrity Pavlik Harness Nursing Considerations Safety Perfusion Skin Integrity Neurovascula Positioning Assess skin r checks under straps Onesie & No knee/thigh Assess skin swaddling socks under folds harness Adjustmen t of straps Car seat Diaper under by Keep skin safety harness specialist clean & dry only Developmental Dysplasia of the Hip (DDH) Growth & Educatio Mobility Developmen n t Move legs & Keep on for arms freely Move legs & prescribed arms freely hours/day Encourage Straps adjusted activity by specialist Q1- 2 weeks Tummy time Compliance & Follow-up appts  Pavlik Harness Nursing Considerations Priority nursing considerations  Pavlik harness  Neurovascular checks  Assess skin integrity  Developmentally appropriate play  Tummy time  Parent education  Worn for 23 hours/day at first  Proper fit Readjustment of straps q1-2 weeks  Shirt & diaper under harness  Think Like a Nurse Parent/Family Education Priority Teaching Points Elimination Pain control patterns Development al play & Cast Care & support Perfusion Skin integrity  Developmental Dysplasia of the Hip (DDH) Key Bryant traction Points Spica cast  Ensure correct weight used  Cast care concerns  Never remove/add weight  Frequent position changes  Assess body alignment &  Supine & prone pressure points  Never use the bar for  Medicate for pain and muscle positioning spasms Pain control Spica Cast Nursing Considerations Perfusio Skin Pain n integrity Acetaminophe Neurovascular Cast care: n or IBU checks petal/ soft edges Handle with palms of hands Keep skin Nothing in the clean & dry cast Spica Cast Nursing Considerations Growth & Elimination Developme nt Diaper under cast Tummy time Safety Change diaper Age- frequently appropriate Car seat play Injury prevention  Developmental Dysplasia of the Hip (DDH) Abductor brace  Worn for approximately 2 months after spica cast removed  Support and ensure healing Scoliosis  Scoliosis Complex deformity of the spine  Lateral S or C curvature  >10° is abnormal Etiology  Idiopathic  Lateral curve with vertebral rotation  Occurs most often during adolescence  Congenital  Acquired  Scoliosis What concerns may the nurse have regarding significant Pathophysiology curvature?  Structural changes occur as a result of curvature  Ribs on the concave side are forced together  Ribs on the convex side separate Respiratory CV  Narrowing of the vertebral canal Pain  Scoliosis Clinical manifestations  Truncal asymmetry  Uneven shoulder height  Prominent scapula  One-sided rib hump  Scoliosis Diagnostic testing  Inspection  Early detection lessens deformity  Goal: Stop progression of curve  Scoliometer  X-ray  Most definitive  Screenings  Screened every 6-9 months  Scoliosis What is this Clinical therapy teenager’s biggest concern?  Mild: curvatures of 10-20°  Exercise  Follow-up evals  Moderate: curvatures of 20-40°  Prevents further curvature  Boston brace  Biggest issue is 23 hrs/day COMPLIANCE  Scoliosis  Severe: curvatures of >40°  Surgery  Spinal fusion Harrington rod Purpose Stabilize the spine  Scoliosis Let’s plan our nursing care for a 13-year-old patient preparing for spinal fusion due to a spinal curvature of 50° due to scoliosis. What would be the nurse’s priority concerns? Educate Prepare for what is to Answer come questions  Scoliosis As the nurse receiving the 13-year-old patient from the OR after spinal fusion and placement of the Harrington rod, what are your priority nursing concerns and interventions? Pain assessment Assess dressing & VS and drains neurovascular checks C/DB Position changes = Monitor for Log Rolling infection  Scoliosis Nursing considerations  Pre-operative  Preparation for what to expect  Post-operative  Nursing Care Pain control Neurovascular checks Coughing & deep breathing Position changes Activity will gradually increase Pre-medicate for activity A school health nurse is screening for scoliosis. Which finding would the nurse assess for? 1. Prominent scapula 2. Allis sign 3. Evenness in arm length 4. Alignment of shoulders over hips  A young child has just returned from surgery in a spica cast. The priority nursing intervention would be which of the following? 1. Elevate head of bed. 2. Check circulation. 3. Turn to right side. 4. Offer sips of water. Which of the following is appropriate for the nurse to include in parental education regarding the Pavlik harness? Select all that apply. 1. Apply lotion or powder to minimize skin irritation. 2. Put clothing under the harness for maximum effectiveness of the device. 3. Check at least two or three times a day for red areas under the straps. 4. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper. Thank You Questions?  References  Adam Medical Encyclopedia. (2013). Legg-Calve Perthes Disease. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00 02244/  Blanco, J.S., Doyle, S.M., Scher, D.M., Sink, E.L., Widman, R.F. (2012). Developmental hip dysplasia: Overview. Retrieved from http://www.hss.edu/conditions_developmental-pedia tric-hip-dysplasia-overview.asp  International Hip Dysplasia Institute. (2018). Closed reduction. Retrieved from https://hipdysplasia.org/developmental-dysplasia-of- the-hip/child-treatment-methods/closed-reduction/  References  London, M.L. Ladewig, P.A.W., Davidson, M.R., Bal, J.W., Bindler, R.C.M., and Cowen, K.J. (2014). Maternal and Child Nursing Care (4th ed.). Upper Saddle Rive, NJ: Pearson.  Ricci, S.S., Kyle, T., and Carman, S. (2017). Maternity and pediatric nursing (3rd ed.). Philadelphia, PA: Wolters, Kluwer, Lippincott, Williams, and Wilkins.  Sommers, S., Johnson, J., Roberts, K., Redding, S.R., Churchill, L., Elkins, C.B., and Roland, P. (2013). RN nursing care of children: Content mastery series review module (9th ed). Assessment Technologies Institute