Physical Effects of Immobility
Immobility can affect the integumentary system by altering tissue integrity related to decreased circulation and pressure. How often should the child be repositioned and turned?
every 2-4 hours
True or false:
There is only one type of cast for pediatric patients.
False-there are two that are commonly used plaster casts & synthetic casts, each with their own pros and cons, would be chosen based on child/injury/physician/location
True or False:
A child with CP will have an intellectual disability
True or false
Kyphosis is the lateral convex angulation in the curvature of the thoracic spine
True
Staphylococcus aureus
caused by gravitational effect on feces through the ascending colon or weakened smooth muscle tone
How often should a child in a spica cast be turned and why is it important?
-every 2 hours to help the body cast dry evenly and prevent complications of immobility
-they can take 24 to 48 hours to fully dry
-Spastic
-Dyskinetic (non-spastic)
-Ataxic
-Mixed type
Lordosis is the lateral outward curve of the cervical or lumbar curvature
False:Lordosis is the lateral INWARD curve of the cervical or lumbar curvature
True or false:
A Pavlik harness is used for older children to manage developmental dysplasia of the hip
False: this is used in management for newborns to 6 months of age and its purpose is that with time, motion, gravity, the hip will work into a more abducted and reduced position. They will wear for 22-24 hours/day for around 6-12 weeks
Immobility can cause venous stasis.
List 3 nursing interventions/considerations to manage this
-frequent position changes
-ensure adequate fluid intake
-passive or active range of motion
-anti-embolism stockings or SCD's
-measure circumference of extremities
-anticoagulants
-monitor for PE
List 5 teaching topics for a parent/child in a newly placed cast
(any extremity/spica)
-elevate for the first day
-neurovascular checks
-restrict strenuous activities for the first few days
-weight bearing status
-do not put anything in the cast
-keep a clear path for ambulation
-if crutches how to use
-avoid denting the cast (specific to plaster)
-showering
-carseat
-diapering
-feeding positioning
Name 2 types of therapy that are used for children with CP
-physical therapy
-occupational
-speech
2 nursing assessments for a post-operative spinal fusion patient to correct scoliosis
-wound assessment
-circulation
-VS (including BP's!)
-neurologic assessments
-Neurovascular assessments
-pain assessments
2 problems that can be seen related to the myelomeningocele defect in an infant
-hydrocephalus (#1)
-paralysis
-orthopedic deformaties
-club foot
-genitourinary abnormalities
-GI malformations
-chiari malformation
-seizures
Describe how immobility affects the skeletal system.
DOUBLE JEOPARDY
What electrolyte imbalance happens related the changes immobility causes in the skeletal system
-osteoporosis
-causes pathological fractures
-causes extraosseous bone formation (hip/knee/elbow/shoulder)
-renal calculi
-calcium deposits
**** hypercalcemia *****
Cast removal teaching for patient and family
(2 examples)
-it can be scary/anxiety provoking for child (prep them with child life or by talking them through it
-they can keep the cast of they want to (offer this)
-they may have decreased muscle mass will return function/appearance once they resume normal activities (unless significant trauma)
-skin will be caked with dead skin and sweat, mineral oil or lotion will help with this, do not rub or scrub it off it may bleed
What medication is commonly used to help with spasticity in patients with CP?
-baclofen
Management for scoliosis (list 2)
-bracing with TLSP
-exercise/physical therapy
-operative (curves more than 45-50 degrees)
True or false
In older children with Spina Bifida they may undergo a procedure called Antegrade continence enema (ACE) that will allow for bowel continence and better quaility of life
True
Page 1021
List 3 ways immobility can effect the respiratory system
Additionally, list 3 nursing interventions/nursing considerations related to the respiratory system in an immobilized child
-decreased need for oxygen
-decreased chest expansion and diminished vital capacity
-poor abdominal tone and distention (interferes with diaphragmatic excursion)
-loss of respiratory muscle strength (poor cough)
-mechanical or biochemical secretion retention (causes pneumonia/atelectasis)
-deep breathing
-positioning
-prone positioning
-proper alignment when sitting
-chest percussion/drainage/vibration/suctioning
-IS
-monitor breath sounds
-adequate hyrdration
6 P's of compartment syndrome
-pain
-pulselessness
-pallor
-paresthesia
-paralysis
-pressure
Box 29.3
-delayed gross motor development
-abnormal motor performance
-alterations in muscle tone
-abnormal postures
-reflex abnormalties
-associated disabilities
Box 30.2 page 1007
ages of screening for scoliosis in adolescents for boys and girls
-girls at age 10 and 12 years old
-boys either 13 or 14 years old
What type of allergy are spina bifida patients at risk of having?
latex!
-often seen allergic to foods such as banana, avocado, kiwi, and chesnut