Topic 6: The Child with Musculoskeletal or Articular Dysfunction (Part 1) PDF

Children with Musculoskeletal or Articular Dysfunction (Part 1) CHAPTER 48  Objectives 6.1 Analyze history and physical assessment findings related to intracranial pressure regulation, neuromusculoskeletal disorders, and endocrine disorders. 6.2 Analyze diagnostic data rel...

Children with Musculoskeletal or Articular Dysfunction (Part 1) CHAPTER 48  Objectives 6.1 Analyze history and physical assessment findings related to intracranial pressure regulation, neuromusculoskeletal disorders, and endocrine disorders. 6.2 Analyze diagnostic data related to intracranial pressure regulation, neuromusculoskeletal disorders, and endocrine disorders. 6.3 Manage family-centered nursing care for children with intracranial pressure regulation, neuromusculoskeletal disorders, and endocrine disorders. 6.4 Examine nursing considerations in the use of pediatric medication for intracranial pressure regulation, neuromusculoskeletal disorders, and endocrine disorders. 2  Effects of Immobilization One of the most difficult aspects of illness in a child is immobility Frequent reasons for immobility: Congenital defects Degenerative disorders Infections or injuries that impair integumentary, neurologic, or musculoskeletal systems Therapies that prolong immobilization Soft-Tissue Injury Contusion Damage to soft tissue, subcutaneous tissue, and muscle Escape of blood into tissues causes ecchymosis (black-and- blue discoloration) Swelling, pain, disability Crush injuries Dislocation Displacement of normal position of opposing bone ends or of bone ends to socket Occurs when force of stress on ligament is sufficient to cause displacement Pain: Increases with active or passive movement of affected extremity Hip dislocation: Potential loss of blood supply to head of femur  Sprain vs. Strain SPRAIN STRAIN Trauma to a joint from ligament A microscopic tear to partially or completely torn or musculotendinous unit stretched by force Similar to sprain May be associated with damage to blood vessels, muscles, Swollen, painful to touch tendons, and nerves Generally incurred over time Presence of joint laxity as indicator of severity Rapid onset of swelling with disability  Fractures Common injury in children Methods of treatment are different in children than in adults Rare in infants, warrants investigation Distal forearm: The most frequently broken bone in childhood  Types of Fractures Simple or closed: Does not produce a break in the skin Open or compound: Fractured bone protrudes through the skin Complicated: Bone fragments have damaged other organs or tissues Comminuted: Small fragments of bone are broken from fractured shaft and lie in surrounding tissue Fracture Lines  Growth Plate Injuries Weakest point of long bones: The cartilage growth plate (epiphyseal plate) Frequent site of damage during trauma May affect future bone growth Treatment: May include surgical open reduction and internal fixation to prevent growth disturbances  Bone Healing and Remodeling Bone healing is typically rapid healing in children Neonatal period: 2 to 3 weeks Early childhood: 4 weeks Later childhood: 6 to 8 weeks Adolescence: 8 to 12 weeks Diagnosis and Management of Fractures Diagnostic evaluation Radiographs History taking Suspicion of fracture in a young child who refuses to walk or crawl Goals of fracture management Reduction and immobilization Restoring function Preventing deformity Assessment of Fractures: The Six Ps Pain and point of tenderness Pallor Pulselessness Paresthesia: Sensation distal to the fracture site Paralysis: Movement distal to the fracture site Pressure  Cast Care Elevate casted extremity for first day Observe the extremities (fingers/toes) for swelling, discoloration Check movement and sensation of fingers/toes Do not allow child to put anything inside the cast Cool hair dryer can help with itching  References Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2023). Maternal child nursing care (7th ed.). Elsevier-Mosby. 16