Effects of Immobilization PDF

Musculoskeletal Effects of Immobilization Decreased Increased Other Muscle strength/endurance and joint Workload of heart and risk for N...

Musculoskeletal Effects of Immobilization Decreased Increased Other Muscle strength/endurance and joint Workload of heart and risk for Negative calcium and nitrogen balance mobility, muscles atrophy thrombus Alteration of gravitational force and Bone demineralization Risk for aspiration renal stasis Orthostatic tolerance and venous Hypercalcemia (renal calculi) and Altered perception of self and return urinary retention environment Respiratory effort, normal movement of Risk for ischemia and damage Dependent edema secretions, ventilation Frustration, helplessness, anxiety, Catabolism Bowel mobility depression, anger including Hypercalcemia and osteoporosis Metabolic rate, production of stress developmental, aggression hormones, need for CO2 Circulation/pressure and decreased healing capacity Ability to void in supine position and urethral peristalsis Environmental stimuli 5 P’s Compartment Syndrome Cast Care 1. Pain that is out of proportion or Pain and point DO Keep elevated on pillows for the first day and keep of tenderness occurs with stretching–EARLY sign elevated just when resting after first day 2. Poikilothermia (cool limb) Expose the plaster cast to air until dry Pulse 3. Paresthesia (tingling, pins, and Lift and support wet plaster casts with palms of Distal needles) hands 4. Paralysis Observe for swelling and discoloration/check Pallor movement and sensation frequently 5. Pulselessness (not palpable at Encourage frequent rest for a few days Paresthesia distal) – LATE sign Arm or hand: keep in sling most of the time and Distal 6. Pallor in affected limb support on pillows at chest level Cut off cast Leg: elevate injured leg when sitting Paralysis Do not elevate Keep small items away from young kiddos Distal Examine skin at cast edges and pad if needed Fasciotomy if pulses do not return Incontinence: protect with waterproof tape and plastic and use diapers Manage pain associated with swelling with elevation and ice DO Allow to hang in dependent position for >30 NOT minutes Stand on injured leg for too long Put anything inside the cast Place in water Fractures Osteomyelitis DDH Overuse Syndromes/injuries TYPES Inflammation and infection of Hip instability after birth Syndromes from repetitive Complete vs. incomplete bony tissue from external or associated with breech microtrauma w inflammation –Greenstick where infectious (hematogenous) deliveries of the involved structure compressed side bends but source Tennis elbow and  tension side breaks May be subacute or DX: Ortolani and Barlow tests Osgood-Schlatter disease Simple vs. compound/open spreading until baby is walking (1-4 –Bone goes through skin in S/S: abrupt S/S that resemble weeks of age) and S/S: pain, tenderness, compound arthritis and leukemia, marked radiographic exam swelling, disability –Open need OR, abx, cover, leukocytosis, may have normal and checking for 5 P’s early x-rays S/S: Galeazzi sign and limp/leg Injuries occur as result of Complicated discrepancy in older kiddos repeated muscle contraction –Fragments damaged other DX: bone scan and bone Repetitive weight-bearing organs/tissues culture via biopsy or aspirate MNG: Pavlik Harness or cast, sports like running, Transverse/oblique/spiral skin integrity and promote gymnastics, and basketball –Spiral is indicative of abuse MNG: STAT vigorous IV abx for normal G/D Tibial fracture most common Comminuted 3/4 weeks to months, monitor Stress fractures –Small fragments break from hematologic, renal, hepatic the shaft and lie in responses to tx, bed rest and S/S: pain that begins after surrounding tissue immobility of limb, starting an activity, pinpoint amputation if it does not pain, aching, swelling, resolves S/S: general swelling, pain, resolve with rest tenderness, diminished function, may have bruising, MNG: rest, ice, NSAIDs severe muscular rigidity, crepitus DX: X-ray MNG: promote healing, prevent injury/complications, reassess pulses, skin color, and temperature, palpation of cast for hot spots, alleviate pressure on nerves, treat pain, check for compartment syndrome Neonatal (2-3 weeks), early (4 weeks), later (6-8 weeks), adolescence (8 weeks) Torticollis or “wry neck”: congenital or acquired limited neck motion with neck flexed to affected side MNG: heat, NSAIDs (Motrin), PT if congenital Female Athlete Triad: amenorrhea, osteoporosis, eating disorders Respiratory Tonsillectomy Nursing Concerns: Airway Positioning, too much swallowing can indicate blood trickling, observe for hemorrhage, suction at bedside Bleeding Check for frequent swallowing, prevent recurrent bleeding, quiet environment, minimize agitation and crying, NO SUCTIONING, small amount normal around 7-10 days d/t scab Comfort Control with Tylenol/Motrin, cool water or crushed ice, flavored ice pops, avoid fluids or food with red or brown color, no straws, if refusing to take meds by mouth get PR pain meds Food: gelatin, cooked fruits, sherbet, soup, mashed potatoes Home DO: discourage coughing/putting objects in mouth, alternate Tylenol/Motrin, stay ahead for the first 48 hrs. by waking Teaching them up, limit activity, observe for signs of dehydration (no tears, no diapers >8 hours, cracked lips, sunken eyes)  DO NOT: eat spicy or irritating foods, gargle or brush vigorously Asthma Status Asthmaticus Bronchiolitis (RSV) Chronic inflammatory disorder Respiratory distress continues despite Acute viral infection that occurs when characterized by recurring sx, airway vigorous therapeutic measures bronchial mucosa swells and filled with obstruction, and bronchial Can result in respiratory failure and mucus and exudate hyperresponsiveness death Typically affects infants under 3 months Inflammation causes recurrent Some cases has concurrent respiratory Begins with URI wheezing, breathlessness, chest infection tightness, and cough S/S: infants may not have many clinical Most common chronic disease of Severe respiratory distress: remains signs, typical peak at day 3-5 childhood sitting upright, refuses to lie down, Early: rhinorrhea and low-grade fever sudden agitation, agitated child who Progressed to lower airways: wheezing, RFX: hx of allergies or atopic dermatitis, suddenly becomes quiet, diaphoresis, retractions, crackles, dyspnea, tachypnea, hereditary, gender, smoking, pale diminished breath sounds African-American, LBW, overweight MNG: frequent admin of short-acting Home MNG (most): adequate fluid Classic 3: dyspnea, wheezing, coughing beta-agonists, humidified oxygen to keep intake and fever reducing meds S/S: chest tightness and pain in older SpO2 >90%, IV corticosteroids and Hospital MNG: oxygen, bronchodilators, kiddos, gradual or abrupt onset or magnesium sulfate, close monitoring IV fluids, tube feedings, steroids, preceded by URI, sx worse at night or (PICU), heart monitor and pulse ox on, IV intubation, contact precautions, frequent during exercise fluids suctioning and monitoring Common: coughing at night w/o If using mag sulfate watch for HOTN –Hospitalization recommended for those infection and have fluid bolus ready with poor feeding, lethargy, respiratory Sounds: course, loud, prolonged distress, hypoxemia, or apnea! expiration, generalized wheezing Prevent with Synagis (Palivizumab) Q30 days until end of RSV season (preterm Mild -Sx >2x/week but 80% -PEF variability: 20-30% -Minor limitation on normal activity -Short acting beta-agonist use >2x/week but not daily Moderate -Daily sx -Nighttime sx 1-2x/month (0-4 yrs.) or >1x/week but not daily (5-11 yrs.) -PEF/FEV1: 75-80% -PEF variability: >30% -Some limitation on normal activity -Short-acting beta-agonist use daily Severe -Continual daily sx -Frequent nighttime sx -PEF/FEV1: 5% 10 mL/kg for each stool is diarrhea present  Mild 100 mL/kg (15%) S/S: 3-5% weight loss in infants, 3-4% S/S: 6-9% weight loss in infants, 6-8% S/S: 4), slowed capillary refill (2-4), oliguria tending, cool/acrocyanotic/mottled skin, oliguria/anuria MNG: 100 mL/kg oral rehydration over 4-6 hours MNG: replace loss to equal depletion, maintenance fluids and electrolytes, root cause, I&Os, VS, UA (SG) SG within 1.-16-1.022 in kiddos SG within 1.001-1.020 in NB Isotonic Dehydration Hypotonic Dehydration Hypertonic Dehydration Water loss = electrolyte loss Electrolyte loss > water loss Water loss > electrolyte loss Most common form seen in kiddos ICF concentration > ECF in which fluid Most dangerous dehydration in kiddos goes into ICF and results in shock Fluid goes into ECF S/S: losses from ECF = decreased plasma volume that affects skin, muscles, and S/S: more severe physical signs S/S: seizure risk but lower risk of shock kidneys Na 150 mEq/L Na WNL = 130-150 mEq/L MNG: sodium bicarb for acidosis, do not MNG: rapid fluid replacement CI due to Hypovolemic shock is greatest threat give K+ until child voids and kidney risk for water intoxication and cerebral function is assessed edema MNG: when severe use isotonic 0.9% NS Risk for cerebral edema when giving K+ or LR to match serum osmolality of due to Na lag 285-300 mOsm/kg then maintenance fluids 1.5-2x Shock Hypovolemic Shock Distributive Shock Reduction in circulating blood volume Due to vascular abnormality causing maldistribution of blood Trauma, bleeding, burns, diarrhea supply Neurogenic/anaphylactic shock, septic shock S/S: normal–increased RR, compensated–normal BP, narrow pulse pressure, tachycardia, weak peripheral pulses, pale/cool S/S: normal–increased RR, may have crackles, skin, >2 cap. refill, decreased UO (