skeletal system disorders

Nursing care of child with skeletal system disorders

1. Seminar on “Skeletal System” Presented by Mr. Arvind Joshi

2. Embryology Major parts arise from mesoderm of embryo Osteoprogenitor cells become differentiated into osteoblasts Surrounded by the bone matrix, osteoblasts becum mature bone cells ( osteocytes ) Vertebrae & ribs are 1 st to form( 4 th & 6 th wk) Buds of upper & lower limbs (5 th wk) Cartilagenous skeleton gets replaced by bone(8 th wk) Primitive joint cavities develop (10 th wk)

3. Anatomy Endosteum ( interfares marrow space with trabecular bone) Central haversian channel(surrounds the blood vessels) 3 rd envelope – periosteum - blood vessels from the periosteum penetrate the bone & connect with the blood vessels

4. Classification of bones: Long bones Short bones Flat bones Irregular bones

5. Physiology Functions of bone: Give rigid support to the spinal cord,extremities & movable joints They supply the points of attachment for locomotive muscles They protect the neural structures blood forming elementsof the bone marrow Bone undergoes 2 physiological processes: Modelling & remodelling

6. Diagnostic criteria: Sr. tests helps in assessing skeletal problems CPK,SGOT,SGPT,LDH are elevated in muscular disease WBC & Hb levels are elevated in traumatic injury Bone marrow aspiration Bone scan ( scintigraphy ) Computerized axial tomography Electromyography Joint aspiration Radiography ESR CRP Blood culture

7. Bone marrow aspiration

8. Joint aspiration

9. Common medical treatments Traction Explanation: application of a pulling force on an extremity or body part Indications: fracture reduction, dislocation, correction of deformities Nsg implications : Ensure wt hang free Maintain prescribed weights Elevate head/foot of bed only with physical order Monitor for complications

10. Casting – application of plaster or fiber glass material to form a rigid material to immobilise a body part Indication : same Nsg implications: Assess frequently Protect cast from moisture Teach family how to care for cast at home 3) Splinting- temporary stiff support of injured area Indication - fracture reduction, immobilisation & support of sprains Nsg implications : same as above

11. Nsg care in casts Apply plastic wraps to the perineal area Use a bedpan Tuck 2 diapers Nsg care in traction: Pad bony prominences Gently massage the back

12. 4) Fixation – surgical reduction of a fracure /skeletal deformitywith an int /ext pin or fixation device Indication: fracture,skeletal deformities Nsg implications : Assess for excess drainage No additional care 5) Cold therapy- application of ice bags,commercial cold packsor cold compress Indication – in ac injuries for vasoconstriction, thereby decreasing pain & swelling Nsg implications: Apply for 20 – 30 mins Discontinue when numb Place a towel

13. splinting

14. 6)Crutches- ambulatory devices that transfer body weight from lower to upper extremities Indication : whenever weight is contraindicated Nsg implications: Teach child appropraite ambulation Top of crutch should reach 2 – 3 fingers below the axillae

15. 7) Orthotics, braces:- adaptive positioning devices specially fitted for each child ( used to maintain proper body allignment ) Indication- treat developmental dysplasia of the hip,scoliosis Nsg implications: Provide frequent assessments Cotton undergarments worn under the brace Encourage family

16. orthotics

17. 9)Physical therapy,occupational therapy- focusses on attainment or improvement of gross motor skills Focusses on refinement of fine motor skills,feeding ,ADLs Indication: Promote developmental activities Restore function after injury/surgery Nsg implications : Provide follow up Ensure adequate communication

18. Club foot Refers to the congenital deformities involving the bones,muscles,ligaments & tendons of the foot. Club foot consists of: Talipus varus Talipus equinus Cavus Talipus calcanus Talipus valgus Talipus varus

19. Etiology: Unknown

20. Classification: Postural Neurogenic Syndromic Idiopathic

21. Medical therapy Treatment starts with birth Wear split casts – “Denis Browne splint Passive exercises Surgery if required Nursing management

22. Nsg management Family members need to know the cast care Imporatnce of dennis browne splint Not to change the angle of the shoes Give daily passive exercises,schedule the specific time

23. Complications: Residual deformity Awkward gait Wt bearing Disturbance to the epiphysis

24. Congenital hip dysplasia Common types : subluxation & dislocation Incidence Etiology: Unknown Familial tendency Oligohydrominos Breech position Pathophysiology

25. Diagnostic evaluation: Physical assessments: Inspection Palpation Ultrasound Plain hip X- rays Medical therapy Nsg mgt

26. Nsg mgt Correct application of diapers & splints Specific guidelines to be told for removal Cast care to be explained Prevent skin breakdown Use of plastic drapes Change wet diapers Elevate 30 40 degrees Keep a roll under the limb arch to dec stress on the cast

27. Complications Avascular necrosis Loss of ROM Femoral nerve palsy Early osteoarthritis

28. Osteomyelitis Bacterial infection of the bone & marrow caused by pathogens Etiology: Staphy aureus Streptococcus Incidence : bet 3 – 12 yrs

29. DE: Elevated WBC,ESR,CRP Positive blood cultures Deep soft swelling(tissue) on X-Ray Changes on ultrasound or CT scan Medical therapy: Antibiotics Drainage of infected site Immobilization – splint,cast,traction

30. Nursing management Detailed history Inspect extremity Palpate Maintain bed rest Administer antipyretics Skin care Teach parents Encourage use of unaffected extremities

31. Fracture Trauma resulting in the break in the continuity of the bone Incidence: 40% boys & 25% girls suffer by age 16 Etiology: Accidental trauma Non – accidental trauma Other disease process

32. Repair of a fracture; Inflamatory phase Reparative phase Remodelling phase DE: X- Rays CT scan MRI

33. Types of fracture:

34. Management Repositioning: reduction- open & closed Traction- skin & skeletal

35. Open reduction

36. Nursing management: Immobilise the limb Use of cold therapy Elevate the injured limb Administer TT Assess for 5 P’s – pain , pulseness , pallor, paresthesia , paralysis Administer analgesics Advise parents- preventing fracture, family education

37. Complications: Infection Avascular necrosis Bone shortening Compartment syndrome Vascular/nerve injuries Later - osteoarthritis

38. Polydactyly syndactyly

39. Polydactyly / syndactyly Polydactyly – is the presence of extra digits on the hand/foot Syndactyly – is webbing of fingers /toes Treatment – Tying off the additional digit Or surgical removal No t/t for syndactyly Management – If tied – observe for necrosis of tissue.

40. Nursing diagnosis Impaired physical related to injury,pain,weaknessas evidenced by inability to move an extremity or ambulate. Risk for constipation related to immobility Self care deficit related to immobility as evidenced by inability to perform hygiene care. Risk for impaired skin integrity related to immobility,casting,traction,use of braces Risk for delayed devptrelated alteration in extremities

41. Recent advances

42. Introduction - Skeletal Fluorosis in India & Its Relevance to the West - Fluoride Action Network, May 2004 Included below are recent newspaper articles detailing the impact of skeletal fluorosis in India. Skeletal fluorosis is a bone disease caused by excessive consumption of fluoride. In India, the most common cause of fluorosis is fluoride-laden water derived from borewells dug deep into the earth While fluorosis is most severe and widespread in the two largest countries - India and China - UNICEF estimates that " fluorosis is endemic in at least 25 countries across the globe. The total number of people affected is not known, but a conservative estimate would number in the tens of millions."

43. Common causes of fluorosis include: inhalation of fluoride dusts/fumes by workers in industry, use of coal as an indoor fuel source (a common practice in China), and consumption of fluoride from drinking water. In China, the World Health Organization recently estimated that 2.7 million people have the crippling form of skeletal fluorosis , while in India, 17 of its 32 states have been identified as "endemic" areas, with an estimated 66 million people at risk and 6 million people seriously afflicted. According to scientific surveys, skeletal fluorosis in India and China occurs when the fluoride concentration in water exceeds 1 part per million ( ppm ), and has been found to occur in communities with only 0.7 part per million (SOURCE: Singh 1961; Singh 1963; Jolly 1970; Siddiqui 1970; Susheela 1993; Choubisa 1997; Xu 1997; Bo 2003). The Chinese government now considers any water supply containing over 1 ppm fluoride a risk for skeletal fluorosis (SOURCE: Bo 2003).

44. Thankyou