Musculoskeletal Disorders in Children Nirmala priyadarshanie BSc in Nursing

Causes Nonintentional injury School: playground/gym Sports Automobile accidents Child Abuse Congenital syndromes Diseases

*Immobilization* Inability to move Weakness, injury Casts/Traction Congenital Defects

Physiologic effects Significant loss of muscle strength, endurance and muscle mass Bone demineralization leading to osteoporosis Loss of joint mobility and contractures

Other Organ Effects Cardiovasular Orthostatic hypotension, increased workload, thrombus formaiton Nursing considerations??? Respiratory Reduced muscle power, reduced chest expansion Nursing considerations??

Continued.. Gastrointestinal System Risk of aspiration Slowing of stool Renal System Bone demineralization leads to calculi formation Neurological changes may change bladder sensation and cues Urine may back up due to horizontal positioning

Continued… Metabolism Negative nitrogen balance reltaed to tissue breakdown Decreased and inappropriate nutrition can occur Nursing considerations??? Skin Poor circulation, mechanical irritation, hygiene issues, prolonged pressure Nursing Considerations???

Psychological Effects of Immobilization When sensory deprivation is assoicated: Restlessness, difficulty problem solving, inability to concentrate, depression, regression, egocentrism Monotony leads to: Sluggish intellectual and psychomotor responses, decreased communication skills, hallucinations, disorientaion, dependence and acting out Many Family Issues!

Immobilization Devices What are the physiological and psychological concerns for this child?

Fractures Common in children and elderly Don’t usually occur in infants Forearm fractures are common in children Clavicle is the most frequently broken bone In children less than 10- Often during birth Femoral neck fractures happen with automobile accidents (ages 6and 7) Older children – femur Teens - knees

Kinds of Casting

What are the physiological and psychological concerns for this child?

What are the nursing considerations regarding a child with a cast?... Cast care Compartment syndrome Psychological influences Pain Management Immobilization

Care of the Child with a Fracture 5 “Ps” Pain Pallor Pulselessness Parasthesia Paralysis

Traction Purpose To fatigue the involved muscle and reduce spasm so the bone can realign To position the bone ends To immobilize the fracture site

Types of Traction Skin – no pins, usually short term Example - Buck’s Skeletal – surgical, pins Example – 90:90 traction Nursing Cares?? Guidelines are on page 1922-1923

Fracture Complications Circulatory impairment Nerve compression Compartment syncrome Growth plate involvement Nonunion/Malunion Infection Pulmonary Emboli

Osteomyelitis Occurs between ages 5 and 14 Infection in the bone Etiology not always known Children are very ill IV antibiotic therapy is prompt and vigorous Immobilization is usual

How you are going to recognize congenital hip disorders with neonates? What are the maneuvers to confirm it..

What do you know about babies with hip Fracture? List the factors, that the health care profession should concern of.? What are the complications based on that?

Nursing Process: The Child in an Orthopedic Device or Cast Acute Pain related to discomfort of orthopedic device or cast Risk for Impaired Skin Integrity related to pressure of the cast on the skin surface Risk for Delayed Growth and Development related to restricted mobility secondary to orthopedic device or cast Deficient Knowledge of family caregivers related to home care of the child in the orthopedic device or cast