1. Musculoskeletal Disorders in Children
Nirmala priyadarshanie
BSc in Nursing

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

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

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

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

6. 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

7. 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???

8. 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!

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

10. 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

11. Kinds of Casting

12. What are the physiological and psychological concerns for this child?

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

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

15. 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

16. 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

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

18. 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

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

20. 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?

21. 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