1. Define the vocabulary terms listed 2. Describe the musculoskeletal changes that occur from infancy 3. Identify two ways in which the bones of a toddler differ from those of an adult 4. List the home instruction needed for a infant in a Pavik harness 5. Describe the nursing care of a child with Duchenne muscular dystrophy 6. Discuss the nursing measures for a child in a body cast 7. List various types of pediatric fractures 8. Identify the pathophysiology of Legg-Calvé-Perthes disease and the management approach 9. Formulate a nursing care plan for the adolescent confined in a brace for the treatment of scoliosis 10. Describe several measures designed to prevent sports injury From birth to approximately 6 months of age, abduction of the hips is maintained with the use of the Pavlik harness (Figure 17-3). The harness is worn full time until stability is attained plus 2 months, then a decrease in wearing time begins. Weaning time from the harness is gradual until normal hip function is established by ultrasound or x-ray. The Pavlik harness allows the infant to move the legs. If the dislocation is severe or has not been detected until the child has begun to walk, it may be necessary to use traction. This pulls the head of the femur down to the correct position opposite the acetabulum. After the traction has stretched the muscles enough to allow the hip to be placed in the acetabulum, the dislocation is reduced with general anesthesia and a spica cast is applied to hold the abduction. This type of cast is shown in Figure 17-4. The length of time that the child remains in the cast varies according to progress, growth, and the condition of the cast; however, it is usually from 3 to 4 months. During this time, the cast may be changed about every 6 weeks. Sometimes surgery is necessary. In this case, open reduction of the dislocation or repair of the shelf of the hip bone is done. A cast is applied after surgery to keep the femur in the correct position. After removal of the spica cast, some children may require an abduction brace. The brace is worn for 4 to 8 weeks, and then only at nighttime for 1 to 2 years (Canale and Beaty, 2008). For children 6 to 18 months of age, the Pavik harness is less effective and traction is required. • Congenital problems involving the central nervous system (e.g., hydrocephalus, hemorrhage) • Postnatal trauma (head injuries) or infections (meningitis, encephalitis) • Conditions of pregnancy or labor that interfere with oxygen reaching the fetal brain (e.g., premature separation of the placenta, prolonged labor) • Exposure during pregnancy to infections (e.g., German measles or rubella, cytomegalovirus, toxoplasmosis) or toxins Nurses function as team members along with personnel from many other disciplines in the care of the child with muscular dystrophy. The child should be encouraged to be as active as possible to delay muscle atrophy. Swimming and other activities that promote ROM and mobility for as long as possible are helpful. Nurses provide support for the many daily issues that occur by referring parents to other parents, camp programs, respite care, the Muscular Dystrophy Association (www.mdausa.org), public health nurses, home health agencies, family therapists, and eventually hospice care. Although there is no cure at present, different drug therapies, genetic engineering, and stem cell research are beginning to show promise and continue to be investigated (Quintero et al., 2009).
Musculoskeletal Disorders
evolve.elsevier.com/Price/pediatric/
Musculoskeletal System
Developmental Dysplasia of the Hip
Treatment
Cerebral Palsy
Duchenne Muscular Dystrophy
Treatment and Nursing Care
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Musculoskeletal Disorders
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