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MUSCULOSKELETAL DISORDERS

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Adduction and supination of forefoot with an inversion (varis) ... Muscular Dystrophy. Duchennes- 13 types. Onset of symptoms. Prognosis ... Muscular dystrophy ... – PowerPoint PPT presentation

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Title: MUSCULOSKELETAL DISORDERS


1
MUSCULOSKELETAL DISORDERS
  • By Marlene Meador RN, MSN
  • Fall 2006

2
Talipes Equinovarus (Clubfoot)
  • Adduction and supination of forefoot with an
    inversion (varis) of the heel and fixed plantar
    flexion.
  • Etiology unknown
  • 75 of abnormalities of the foot (11000)

3
Clinical Manifestations
  • Focus on early detection
  • Rocker bottom foot
  • Fixed position
  • Diagnostic tests
  • Ultrasound
  • CT
  • MRI

4
Treatment
  • Corrective casting every 3-14 days
  • Dennis Browne splints- horizontal bar attached to
    foot plates

5
Nursing Care
  • Care of Casts
  • CMS assessment
  • Keep dry/clean
  • Assess placement

6
Evaluation
  • Regular check-ups
  • Prognosis
  • ROM after removal of casts

7
?????
  • An 18 month old is scheduled for application of a
    plaster cast to correct a clubfoot. The post-op
    plan should include which of the following
    measures?
  • a. Elevate the cast above the level of the heart
  • b. Handle cast with fingertips
  • c. Reposition the child every 2 hours
  • d. Spray the cast with an acrylic protectant

8
Congenital Dislocation of Hip
  • Malrotation of the hip at birth
  • Improper formation or function of acetabulum

9
Clinical Manifestations
  • Gluteal folds
  • Ortolanis sign
  • Shorter femur
  • Prominence of femur

10
Clinical Manifestations cont
  • Limited abduction
  • Barlow Maneuver
  • Signs and Symptoms in older child

11
Diagnostic Tests
  • Ultrasound
  • CT and MRI
  • X-ray

12
Surgical Treatment
  • Release muscles and tendons
  • Application of body- spica cast

13
Treatment
  • Splinting of hip- Pavlick harness
  • Hip maintained in flexion and abduction
  • Deepen acetabulum from pressure of femur head

14
?????
  • A parent asks why her infant must wear a Pavlik
    harness. The nurse responds that he purpose of
    this device is to
  • Provide comfort and support
  • Shorten the limb on the affected side
  • Maintain the femur within the acetabulum
  • Provide outward displacement of the femoral head.

15
Treatment with Spica Cast
  • For complex cases and older children
  • Dislocated -some closed and open reductions

16
Nursing Management
  • Case finding and referral
  • Teach parent application of harness
  • Protect skin
  • Bring environment to child
  • Safety

17
Spica Cast Care
  • Use palms to handle cast
  • Bar between the legs is not a handle!
  • Use pillows for positioning
  • Keep cast clean dry

18
Fractures
  • Greenstick fracture- most common type in kids lt 3
    years
  • MVA -frequent cause of bone injury in 4-7 year
    olds
  • Porous

19
Pathophysiology
  • Epiphyseal plate
  • Pliable and porous

20
Fractures
  • Occur as a result of direct or indirect force
  • Repeated stress on the bone
  • Pathologic conditions

21
Healing
  • Rapid in children
  • 1 week for every year of life up to 10 years of
    age

22
Assessment
  • Pain (PROM) lthint does not mean premature rupture
    of membranesgt
  • Tenderness
  • Edema
  • Limited movement
  • Distortion of limb

23
Nursing Care
  • Casting
  • Traction
  • Compartment syndrome
  • Surgical intervention

24
Muscular Dystrophy
  • Duchennes- 13 types
  • Onset of symptoms

25
Prognosis
  • Ability to walk lost by age 9-12
  • Death occurs 9-10 years after diagnosis
  • 13500 children effected

26
Diagnosis
  • Muscle biopsy
  • Serum enzyme CK
  • Electromyogram
  • EEG (75 are abnormal)

27
Nursing Care
  • Promote optimal health
  • Goal keep child ambulatory
  • Assess muscle weakness
  • Respiratory function
  • Nutritional status
  • OT, PT

28
Scoliosis
  • Curve greater than 25 degrees
  • Functional
  • Postural
  • Compensatory
  • Structural
  • Idiopathic (70-80 of all cases)
  • Congenital
  • Neuromuscular
  • Poliomyelitis
  • Cerebral palsy
  • Muscular dystrophy

29
????
  • The school nurse would screen an adolescent for
    scoliosis by instructing him/her to
  • Bend forward at the waist and allow upper
    extremities to dangle
  • Lie prone on an examination table
  • Stand with shoulders placed against the wall to
    check evenness
  • Sit on a chair and raise shoulders

30
Manifestations
  • Progression- 1 degree per month
  • Observation of curves
  • Texas response to funding issues
  • 6th 8th grades

31
Bracing
  • Used for skeletally immature http//milwaukee.brac
    e.nu/

32
????
  • An adolescent must wear a Milwaukee brace. Which
    of the following actions would the nurse take to
    promote optimal functioning for the teen?
  • Discourage participation in ADLs.
  • Teach appropriate application, removal and care
    of skin and brace.
  • Discourage sports like golf and tennis encourage
    sedentary activities.
  • Teach non-weight bearing techniques.

33
Rods
  • Recommended for curves gt40 degrees
  • Goal fuse spine to prevent progression
  • Why is surgery the recommended treatment for
    progressive curvature?

34
Post-op Care
  • Pain management
  • Monitor Neurovascular status
  • Monitor HH
  • Log Roll, sit, ambulate
  • Dressing changes
  • Report vomiting WHY???

35
What would you teach a child to expect in the
immediate post-op period?
  • Frequent neurovascular assessments
  • Need to CTDB every 2 hours (IS)
  • Possibility of IV, chest tubes
  • Use of post-op analgesia

36
Discharge
  • As sited in text
  • No contact jarring activities for 6-12 months
  • X-rays q 1-2 years until bone solidly fused
  • Once fused may resume normal activity levels,
    skiing, sports, etc

37
Osteosarcoma
  • Most common primary malignancy of the bone
  • Etiology
  • Genetic
  • Radiation therapy

38
Pathophysiology
  • Originate in bone-producing cells that invade the
    medullary canal of the bone
  • Incidence is higher in most rapidly growing bones
    in adolescents
  • Distal femur
  • Proximal tibia
  • Proximal humerus

39
Assessment
  • Progressive insidious or intermittent pain
  • Palpable mass
  • Progressive limping
  • Pathologic fractures at tumor (late sign)

40
Diagnosis
  • X-ray
  • CT
  • MRI
  • Biopsy of tumor
  • Lab tests
  • CBC
  • ALP
  • LDH

41
Therapeutic Management
  • Surgery
  • Chemotherapy
  • Radiation
  • Amputation

42
Nursing Care
  • Site of tumor
  • History of injuries
  • Current activity level
  • Psychosocial history
  • Body image

43
Nursing Interventions
  • Preoperative teaching
  • Infection
  • Pain
  • Risk for hemorrhage
  • Risk for pneumonia
  • Post operative

44
Ewings Sarcoma
  • Second most common bone tumor
  • Mimics infection
  • Etiology
  • No know cause or genetic link

45
Pathophysiology
  • No defining characteristics
  • Invades midshaft of long bones
  • Metastasis

46
Diagnosis
  • Biopsy to differentiate from other neoplastic
    processes

47
Therapeutic Management
  • Chemotherapy
  • Surgery
  • Radiation

48
Rabdomyosarcoma
  • Malignancy of muscle, or striated tissue
  • Etiology associated with familial cancer syndromes

49
Pathophysiology
  • Subtypes
  • Embryonal
  • Alveolar
  • Pleomorphic
  • Prognosis depends on excision of tumor, rate of
    metastasis

50
Diagnosis
  • Soft to hard, non-tender, immobile mass
  • Limited range of motion in effected extremity
  • In pelvic tumors organ function disrupted
  • CT, bone marrow aspiration and biopsy

51
Treatment
  • Chemotherapy
  • Surgery
  • Radiation

52
Nursing Considerations
  • Palpation of tumor
  • Family support
  • Facilitate education
  • Postoperative
  • Infection
  • Hemorrhage
  • Edema
  • NG tube/drains

53
If you have further questions
  • Contact me via email
  • mmeador_at_austincc.edu
  • Marlene Meador RN, MSN
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