
Infant bones are only 65% ossified

Long bones are porous and less dense and can
bend, buckle or break easily

Growth takes place in Epiphyseal plates, and if
these are injured, can cause abnormal growth

Growing bones heal quickly and decrease need
for treatment
A congenital abnormality in which the foot is twisted
out of its normal position.

Muscles, tendons, and bones are involved in the
abnormality.
◦ Adduction and supination of forefoot
◦ Inversion of the heel
◦ Fixed plantar flexion
Stretch tightened ligaments and
tendons gently to

Return the foot to a maximal
anatomic position
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Serial manipulation

Corrective casting

Splints

Surgical correction
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Cast applied to hold foot in desired position.
Changed every 1-2 weeks until maximum
correction is achieved.
Nursing Care:
◦ Cast care
◦ Skin Care
◦ Education of parents
C
•Circulation
S
•Sensory
M
•Motion
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Unusual odor beneath the cast
Tingling, burning, numbness of toes
Drainage through cast
Swelling or inability to move toes
Toes that are cold, blue or white
Sudden unexplained fever
Pain that is not relieved by comfort measures

“Petaling” the edges of the cast

Drying of the cast

Prevention of swelling

Protecting the cast

When to call the doctor

A infant has a cast applied for treatment of
club foot. Which of the following symptoms
requires immediate attention and should be
reported to the health care provider?
A. Capillary refill of 4 seconds in the affected toes.
B. Edema in the affected toes that improves with
elevation.
C. Numbness of the toes on the affected foot.
D. Skin distal to the cast is warm
Splinting is used after casts are removed to maintain the
correction.
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Braces should fit snugly but should not interfere with
neurovascular function.
Before wearing the brace, check the skin for any areas
of redness or breakdown.
Give parents guidelines for braces.
If redness develops, arrange to have the fit of the
brace evaluated and modified.
Bar between legs is not a handle.
Teach appropriate positioning for safety to prevent
falls, and allow mobility and "tummy-time“

Parents are trained and become active
participants in the physical therapy treatments
and child’s stretching program

Nurses need to help the parents understand the
time commitment involved

Assess the parents’ ability to monitor the child
adequately for complications and confirm they
understand the signs and symptoms of the
complications

The parents of an infant with clubfoot ask how
it is treated. Which of the following
treatments should the nurse discuss with the
parents?
A.
B.
C.
D.
Weekly cast changes with manipulation
Probably surgery on the affected
Abduction device to keep the extremity in alignment
Use of a Dennis-Browne splint to achieve correction.
The head of the femur is improperly
seated in the acetabulum of the pelvis
1. Limited abduction of the affected
hip during Ortolani maneuver.
May hear a click upon movement.
Ortolani maneuver
2. Asymmetry of gluteal and thigh
fat folds when lying with legs
extended.
3. Telescoping of thigh
4. Limp and abnormal gait in older
child
Asymmetry of gluteal folds

Pavlik harness
◦ Ensures hip flexion and abduction
and does not allow hip extension
or adduction.
◦ It maintains correct position of
the femoral head in the
acetabulum.
◦ Teach parents/caregivers to
remove and apply harness
appropriately –only remove for
bathing and skin checks.
◦ Teach skin assessment
◦ Encourage cuddling infant to
promote cognitive development
and infant/caregiver bonding
A parent asks why the infant must wear a
Pavlik harness. What is the nurse's best
response? This treatment is to:
a. provide comfort and support.
b. shorten the limb on the affected side.
c. maintain the femur within the acetabulum.
d. provide outward displacement of the
femoral head.

Spica cast
◦ Covers lower half of
body except perineal area

Nursing Care
◦
◦
◦
◦
◦
Elimination/ protection of cast
Positioning
Neurovascular assessment
Skin care
Hygiene

Increased mobility and immature motor skills

Trauma

Bone diseases

Pain or tenderness at site

Immobility or decreased ROM

Deformity of extremity

Edema

Other signs – crepitus, ecchymosis, muscle
spasm and inability to bear weight
Reduction

Repositioning of the
bone fragments into
normal alignment

Application of a
device or mechanism
that maintains
alignment until
healing occurs
Retention

Application of Cast

Traction
Pull or force exerted on one part of the body

A.
B.
C.
D.
Which of the following nursing interventions
takes highest priority when caring for a child in
skeletal traction?
Assessing bowel sounds every shift
Providing adequate nutrition
Assessing temperature every 4 hours
Providing age-appropriate activities

Fat Embolism
◦ Particles of fat are carried through circulation
and lodge in lung capillaries causing:
 Pulmonary edema
 Respiratory distress with hypoxemia and respiratory
acidosis
◦ Treatment
 Increase in IV fluids
 Respiratory support and adequate oxygenation

Compartment syndrome (very serious)
Paresthesia
Pain
Pallor
Paralysis
Pulselessness

All fractures entering the hospital via ER
require social service consult for
documentation of suspected abuse or neglect.

The nurse must report all suspected abuse to
the appropriate authority.

Do not discuss the possibility of abuse with the
parents or guardians!! Do not attempt to prove
or disprove abuse.
Delayed walking – (first sign)
 Progressive, symmetric muscle wasting
 Frequent falls
 Easily tired when walking, running, or
climbing stairs
 Hypertrophied calves muscle
 Waddling wide-based gait
 Uses Gower’s maneuver to rise from floor

Unable to walk independently by
age 9 – 12.


Muscle biopsy – reveal fatty fibrous tissue that
gradually replaces muscles (the protein
dystrophin is low in the muscles of these
patients)

Elevated serum enzyme CK (creatine kinase)
Maintain ambulation and
independence for as long
as possible.
Coordinate a variety of health care
services
 Maintain activity and self-care functions
 Skin care
 Maintain bladder and bowel functioning
 Protect from respiratory infections
 Teach dietary modifications to decrease
obesity

Which of the following interventions is
INAPPROPRIATE to incorporate in the care for a
child with muscular dystrophy hospitalized with a
respiratory infection?
A.
B.
C.
D.
Physical therapy
Aggressive antibiotic therapy
Passive range of motion exercises
Complete Bedrest
Lateral S curvature of the spine

Assessment findings:
◦ Lateral curvature of spine
◦ Truncal asymmetry
◦ Uneven shoulders
◦ Prominent scapula – uneven height
◦ Rib-hump
◦ uneven hips
What is the priority psychosocial
nursing diagnosis for the
adolescent diagnosed with
scoliosis?

Pre-operative teaching
◦ Demonstrate incentive spirometer and C&DB
◦ Discuss all potential equipment (chest tubes,
IV, O2 masks & nasal canula, Foley catheter)
◦ Teach use of pumps for PCA or epidural block.
◦
◦ Demonstrate log rolling and assist out of bed.

Post-operative Care
◦ Maintain airway
◦ Neurovascular Assessment of lower extremities
◦ Teach passive and active ROM exercises
◦ Encourage independence in ADL’s
◦ Provide with resources / information on
scoliosis support groups
Post operative care of an adolescent following a
spinal fusion for scoliosis includes: (select ALL
that apply)
A.
B.
C.
D.
E.
F.
Oral analgesics for pain
Logrolling every 2 hours
Nasogastric intubation
Bilateral Neurovascular checks of lower
extremities
Use of incentive spirometer q 2 hours
Assess skin on bony prominences