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  • Immobility

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