Chapter 51.
Nursing Care of the Child with a Musculoskeletal Disorder
Terms
1. Apposition - the amount of end-to-end contact of bone fragments
2. Arthroscopy - direct visualization of a joint with a fiber-optic instrument
3. Cartilage - connective tissue
4. Diaphysis - central shaft of a long bone
5. Distraction - a technique that allows the cells of the brain stem that register an impulse as pain to be pre-occupied with other stimuli
so the pain impulse cannot register;use of an external device to separate opposing bones, thus encouraging new bone growth
6. Epiphyseal plate - area where the increase in the length of long bones occurs
7. Epiphysis - rounded end portion of a long bone
8. Fracture - break in the continuity or structure of bone
9. Malleoli - rounded prominence on either side of the ankles
10. Metaphysis - thin area between the diaphysis and epiphysis in long bones
11. Myopathy - disease of the muscular system
12. Periosteum - outside sensitive layer covering of central shafts of long bones
13. Remodeling - new bone tissue replacing old bone tissue
14. Sequestrum - dead bone tissue detached from adjoining healthy bone
15. Smooth Muscle - a tissue specialized for contraction, composed of smooth muscle fibers (cells), located in the walls of hollow
internal organs, and innervated by autonomic motor neurons
16. Striated muscle -
17. Traction - pulling on a body part in one direction against counterpull exerted in the opposite direction to reduce dislocation and
immobilize fractures
Musculoskeletal Disorder
Condition Signs & Symptoms Management
Congenital Club foot (Talipes) * foot cannot be *Treatment is most successful when started early in infancy, since
-foot has been twisted out of manipulated by passive delay causes muscles and bones of legs to develop abnormally, with
position in utero exercises into correct shortening of tendons
position *Nonsurgical treatment: gentle repeated manipulation of the foot or
Types: forcible correction under anesthesia and application of a wedge cast
1. Varus - inward rotation and/or a Denis Brown splint.
2. Valgus - outward rotation *Casting is changed as often as every 3-7 days over period of
3. Calcaneous - upward rotation approximately 10 weeks. Follow -up must continue for several years
4. Equinas - downward rotation after completion of active treatment to prevent recurrence of the
5. Equinovarus - foot is fixed in arthrodesis (surgical fusion of joint), releasing of tight ligaments,
plantar flexion (downward) and lengthening or transplantation of tendons
deviated medially (inward); most *follow-up care:
common 1. Muscle reeducation (by manipulation) and proper walking
2. Heels and soles of braces or shoes prescribed following correction
must be kept in repair
3. Corrective shoes may have sole and heel lifts on lateral border to
maintain proper position
*Nursing Care:
1. Observe toes for signs of circulatory impairment; make sure toes
are visible at the end of the cast
2. Exercises as ordered
3. Cast care
4. Skin care
Congenital Hip Dysplasia *limited abduction of leg *Treatment is directed toward enlarging and deepening the
Head of the femur does not lie on the affected side acetabulum by placing the head of the femur within the acetabulum
deep enough wihtin the *asymmetry of gluteal, and applying constant pressure
acetabulum and slips out on popliteal and thigh folds *Proper positioning: legs slightly flexed and abducted
movement (may be caused by *audible click when 1. Pavlik harness
lack of embryonic development abducting and externally 2. Frejka Pillow: a pillow splint that maintains abduction of the legs
of the joint or position in utero) rotating hip on the affected 3. Bryant’s traction
side: Ortolani’s sign 4. Spica cast: from the waist to below the knees
*apparent shortening of the 5. Brace
femur: Galeazzi’s sign *Surgical intervention such as open reduction with casting
* Waddling gait and *Nursing Care:
lordosis when the child 1. Adequate nutrition: small frequent feedings
begins to walk 2. Regular ROM exercises
3. Prevent circulatory impairment: elevation of casted leg, check
circulatory status,
4. Prevention of hypostatic pneumonia: frequent changing of
position: blowing bubbles to promote lung expansion
5. Cast care: skin care
