Transcript Musculoskeletal

Module 8
MUSCULOSKELETAL/MOBILITY
OVERVIEW

Musculoskeletal system is composed of the
 bones
 muscles
 joints
 tendons
 ligaments
 cartilage
TYPES OF BONES
Long bones- tibia, fibula, femur, humerus, ulna
 Sort bones- such as those in wrist and ankle
 Flat bones- skull, sternum, ribs
 Irregular bones- pelvis, vertebrae, scapula

TYPES OF MUSCLES
Skeletal (striated)- voluntary muscles; deltoid,
biceps, gluteal, etc..
 Smooth (short-fibered)- involuntary muscles; GI
tract, lungs, pupils, etc..
 Cardiac (striated, special function)

PEDIATRIC DIFFERENCES
Fibrous membrane still exists between the
cranial bones (fontanels)
 Posterior closes between 2-3 months, anterior
stays open until approx. 18 months of age to
allow for brain and skull growth
 Secondary ossification occurs as the long
bones grow
 Calcium intake during childhood and
adolescence is essential for bone density

PEDIATRIC DIFFERENCES
Growth takes place in the epiphyseal plates,
injury in this portion is of concern in childhood
 Rapid bone growth facilitates healing after a
fracture
 Can have growing pains because of rapid
growth as well
 Long bones are porous and less dense; bones
can bend, buckle or break

PEDIATRIC DIFFERENCES
In utero thoracic and sacral spine are convex
curves (rounded)
 Cervical region becomes concave as baby can
hold head up
 When learning to stand, the lumbar region
becomes concave
 Abnormalities can occur- scoliosis, lordosis,
kyphosis
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PEDIATRIC DIFFERENCES
Muscular system is almost completely formed
at birth
 The length and circumference grow, but not the
number
 Maximum diameter for girls 10 years of age; 14
in boys
 Strength continues to increase until 25-30 yrs

MUSCULAR SYSTEM
Almost completely formed at birth
 Muscles don’t increase in number, just length
and circumference
 Fibers reach maximum diameter around 10
years of age for girls and 14 yrs in boys
 Strength continues until 25-30 yrs of age
 Until puberty, ligaments and tendons are
stronger than bone

Ligaments are the structural support
connecting bones
 Tendons connect bones to muscles

PEDIATRIC DIFFERENCES
Cervical and lumbar areas become concave
 Bowed legs (genu varum) in infant
 Knock knees (genu valgum) in preschool child
 Resolve with growth
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STRUCTURAL DEFORMITIES
Developmental dysplasia of the hip
 Scoliosis, kyphosis, lordosis

DDH
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Femoral head and
acetabulum are
improperly aligned
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Hip instability
Dislocation
Subluxation
Dysplasia of acetabulum
Figure 28–10 The asymmetry of the
gluteal and thigh fat folds is easy to see in
this child with developmental dysplasia of
the hip.
DDH
Left hip more often than right
 Maternal estrogen may be a link to laxity of
joint, especially in females
 Possible cultural factors
 Assessment

 Limited
abduction of affected hip
 Asymmetric gluteal and thigh folds
 Allis’ sign; Ortolani-Barlow maneuver
DDH

Treatment
 Pavlik
harness
 Skin traction- Bryant’s traction
 Casting
 Pain control
 Prevent complications from immobility
 Promote normal growth and development
DDH

Figure 28–11 The
most common
treatment for DDH in a
child under 3 months of
age is a Pavlik harness.
A shirt should be worn
under the harness to
prevent skin irritation (it
was omitted for clarity in
this photograph).
DDH

Figure 28–12 For
infants older than 3
months of age, skin
traction is commonly
used for treatment of
DDH
SCOLIOSIS

Abnormal curvature of the spin
 Congenital
 Idiopathic
 Acquired
Can be structural or compensatory
 More often in girls than boys
 Ages 10-13 is highest incidence
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SCOLIOSIS
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Figure 28–15 A child may have
varying degrees of scoliosis. For
mild forms, treatment will focus
on strengthening and stretching.
Moderate forms will require
bracing. Severe forms may
necessitate surgery and fusion.
Clothes that fit at an angle, such
as this teenage girl’s shorts, and
anatomic asymmetry of the back
provide clues for early detection.
ASSESSEMENT
Most commonly right thoracic, left lumbar
 Ribs forced closer together
 Uneven shoulders
 Uneven hips, one-sided rib hump
 Prominent scapula
 X-ray
 Can also us CT, MRI, bone scan for degree of
curvature
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SCOLIOSIS TREATMENT
Limit or stop the progression
 Rehab
 Bracing- Boston brace
 Spinal fusion
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SCOLIOSIS
Nursing concerns?
 Nursing consideration?
 Nursing diagnoses?
 Nursing interventions?
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CHRONIC CONDITIONS

Juvenile Rheumatoid Arthritis- Chapter 17
 Chronic
autoimmune inflammatory disease
 More common in girls
 Ages 2-5, or 9-12
 Can enter into remission, or become chronic
 Joint inflammation
 Decreased
 Swelling
 pain
mobility
JRA
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Figure 17–5 Joint
inflammation and
destruction in
rheumatoid arthritis
Diagnosis made by
jistory and assessment
findings
Onset before 17 yrs of
age, persisting for
>6weeks
JRA ASSESSMENT
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Pain
Impaired mobility
Interference with growth
and development
Fever
Rash
Lymphadenopathy
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Splenomegaly
Hepatomegaly
Limp
Favor one extremity
Slow or uneven growth
Pain
Swelling
JRA
Pauciarticular- knees, ankles, elbows, more
common in girls
 Systemic arthritis- males and females equally;
high fever, polyarthirits and rheumatoid rash;
affects internal organs and joints
 Polyarticular arthritis; many joints (5 or more),
particularly small joints (hands, fingers, hips,
knees feet, ankles and neck)
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DIAGNOSIS
May occur for a limited time and them improve,
may recur periodically, or may last for 3-6
months or longer
 No specific lab test, but can run

 Rheumatoid
factor
 Human leukocyte antigen B27
 Antinuclear antibody (ANA)
 ESR
TREATMENT
Drug therapy
 Physical therapy
 Surgery
 Relieve pain
 Prevent contractures
 Aspirin or NSAIDS
 Steroids

NURSING CARE
Pain relief
 Promoting mobility
 Adequate nutrition
 Promotion of growth and development
 Prevent contractures
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ACUTE FRACTURES
Break in bone integrity
 Result from direct trauma-falls, sports injuries,
abuse, MVA
 Result from bone diseases- osteogenesis
imperfecta
 Occur frequently in children because bones are
less dense and more porous
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FRACTURE SX
Pain
 Abnormal positioning
 Edema
 Immobility or decreased ROM
 Ecchymosis
 Guarding
 Crepitus
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Common sites
 Clavicle
 Tibia
 Ulna
 Femur
 Distal
forearm of ulna and radius most common
TYPES OF FRACTURES
DIAGNOSIS
X-ray
 Examination and palpation
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NURSING CARE
Good hx, identify cause of injury
 Pain management
 Cast care
 Traction
 Internal vs. external fixation
 Care post realignment
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 Open
reduction
 Closed reduction
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Complications
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Pain
Infection
Vascular injury
Malunion
Non union
Fat or bone embolus
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Assessment for
compartment syndrome
Delayed G & D
Neurovascular
assessment
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Pain
Pulses
Paraesthesias
NURSING CARE
Maintain proper alignment
 Monitor neurovascular status
 Promote mobility
 Home care teaching
 Pain management
 Prevention of infection
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SKELETAL TRACTION
SKIN TRACTION
EXTERNAL FIXATION
SPICA CAST
NURSING-FRACTURES
Diagnoses
 Considerations
 Priorities
 Medications
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 Analgesics
 Antibiotics
 Muscle
relaxers