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Immobility
 

Immobility

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Immobility Immobility Presentation Transcript

  • Care of the pediatric client with mobility needs Scoliosis Congenital club foot Metatarsus adductus CHD/DDH Neural tube defects
  • Physiological problems of immobility
    • Many systems affected:
      • Muscular system
      • Skeletal system
      • Cardiovascular system
      • Respiratory system
      • Gastrointestinal
      • Renal system
      • Metabolism
      • Skin
      • Neurologic
  • Psychological impact of immobility
    • Experience losses – result in sensory deprivation
    • Responses with aggression/regression
    • Experience depression
  • Nursing interventions
    • To assist a child to cope with the psychological problems of immobility:
      • Provide substitution for one form of motion for another
      • Allow to express anger
  • Scoliosis
    • Most common spinal deformity
    • May be congenital or develop during childhood
    • Multiple potential causes, most cases idiopathic
    • Generally becomes noticeable after pre-adolescent growth spurt
  • Scoliosis diagnostic evaluation
    • Standing radiographs to determine degree of curvature
    • “ S” or “C” curve
    • Asymmetry of shoulder height, scapular or flank shape, or hip height
  • Treatment
    • Observation - if curve < 20 degrees monitor q 3-6 months
    • Brace - will not correct curvature but hopefully will decrease curvature - wear 20-23hrs daily
    • Psychological impact of brace
    • Surgery - > 50 degrees; series of rods, hooks, screws or wires to straighten spine
  • Harrington rods
  • TLSO brace
  • Nursing Considerations
    • Concerns of body image
    • Concerns of prolonged treatment of condition
    • Preoperative care
    • Postoperative care
      • TCDB, log roll, foley, pain control, IV fluids
  • Congenital clubfoot
    • True clubfoot
    • 95% are talipes equinovarus (TEV)
    • Ankle turned inward and toes are lower than the heel
  • Nursing interventions
    • Initial treatment should be non-operative
    • Begin 1 st or 2 nd week of life.
    • 5-6 cast applications over 6-8 weeks
    • 7 day intervals
  • Club foot
  • Metatarsus adductus (also called metatarsus varus)
    • Most common congenital foot deformity
    • Often result from abnormal position in uterus, usually evident at birth
    • To distinguish from true club foot is that the heel and ankle remain in neutral position
    • Treatment – PT, orthotics
  • CHD/DDH
    • A condition of abnormal development of the hip
    • Resulting in hip joint instability
    • Potential dislocation of the femur from the acetabulum in the pelvis.
  • Cause & symptoms
    • Clinical studies show a familial tendency toward hip dysplasia, with more females affected than males.
    • Higher in infants born by caesarian and breech position births
    • Hormonal changes within the mother during pregnancy , resulting in increased ligament laxity, is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the uterus
  • Signs of Developmental Dysplasia of the Hip
    • 1. Asymmetry of gluteal and thigh folds
    • Limited hip abduction
    • Apparent shortening of the femur
    • Ortolani click
  • Clinical manifestation of DDH
    • Infant
      • Shortened limb on affected side
      • Restricted abduction of hip on affected side
      • Unequal gluteal folds when infant prone
      • Positive Ortolani test
      • Positive Barlow test
    • Older infant & child
      • Affected leg shorter than the other
      • Trendelenburg sign
      • Waddling gait
  • Treatment
    • Objective is to replace the head of the femur into the acetabulum
    • Newborn to 6 months: Pavlik harness
    • Age 6 to 18 months: use traction & spica cast (surgery may be necessary)
  • Prognosis
    • If corrected soon after birth may have no apparent effect on ambulation.
    • Early diagnosis is essential
    • If go untreated - will have difficulty walking, which would result in life long pain
    • Bone structure damage
  • Nursing interventions
    • Early detection – early intervention to prevent complications
    • Parental education and understanding
    • Client follow-up
    • Managing child care with infant in cast
  • Review the following content
    • Fractures
    • Cast care
    • Tractions
  • Samuel’s story
  • Neural tube defects
    • Failed closure of neural tube
    • May involve entire length of the neural tube or small portion
    • Types:
      • Spinal bifida (myelomeningocele)
      • Meningocele
  • Myelomeningocele (Spina bifida)
    • Neural tube fails to close
    • Defect contain meninges, CSF, and nerves
    • May be anywhere along the spinal column, lumbar & lumbosacral areas most common
    • Location & magnitude of defect determine nature and extent of impairment
  •  
  •  
  • Initial management of myelomeningocele
    • Prevent infection
    • Assessment of neurologic and associated anomalies
    • Early closure in 12 – 72 hours after birth
      • Prevent stretching of other nerve roots & further damage.
  • Meningocele
    • Defect contain meninges and CSF, no neural elements
    • No neurologic deficits
  • Strategies for nursing care
    • Prevent initial infection
    • Prophylactic antibiotics
    • Observe for s/sx of meningitis
    • Prone position or side-lying to reduce pressure on sac
    • Temperature control
  • Hydrocephalus
    • Caused by an imbalance in the production & absorption of CSF
    • Dx: increased head circumference & associated neurological signs, CT & MRI
    • Tx: relief of hydrocephalus, shunt placement, management of problems
  • Strategies for nursing care
    • Assess FOC
    • Elevate HOB > 30 degrees
    • Assess for complications of VP shunt (i.e., infection & malfunctioning)
    • Post-operative
      • Routine assessment
      • Do not place on operative side
      • Watch for increased ICP, seizure activities
      • Family support
  • Ventriculoperitoneal shunt
  • Charlie’s story