NURS 307 PEDIATRICS PEDIATRIC
MUSCULOSKELETAL &
DERMATOLOGICAL LECTURE
NOTES FOR WEEK 6 2025-2026 (A+
Verified and Graded) WEST COAST
UNIVERSITY.
,Pediatric Musculoskeletal, Neuromuscular, and Dermatological Disorders
Musculoskeletal Disorders: Fractures
Fracture Types
● Complete Broken completely across vs Incomplete Not all the way
● Simple (closed) vs Compound (open) Bone is protruding
● Complicated Tissue/organ involvement
Signs and Symptoms
● Pain
● Crepitus
● Deformity
● Edema
● Ecchymosis
● Warmth or redness
● Decreased use of affected area
Diagnostic
● Radiograph- determines position of the bone
Treatment
● Splints & braces
○ Splints:
■ Often used for simple and stable FX, sprains, and other soft tissue injuries
○ Braces:
■ Custom fitted to support and control movement
● Casts
○ Uses:
■ To immobilize a reduced fracture
■ To correct or prevent deformity
■ Apply uniform pressure to underlying soft tissue
■ Support/stabilize weakened joints
○ Types of Casts:
■ Fiberglass
■ Plaster
○ Patient Management:
■ Assess injured area and skin
■ Elevate above the heart for 24-48 hours
■ Mark drainage to monitor
○ Patient Teaching:
■ No heat lamps or warm hair dryers
■ Clean with damp cloth if soiled
■ No foreign objects inside cast
○ Complications:
■ Compartment Syndrome:
● Increased pressure within a confined space
● Decreases blood supply and perfusion
● Ischemia= necrosis
● S/S: dusky, pale, cool skin, delayed cap refill, unrelenting pain
● Hallmark sign: pain occurs or intensifies with passive range of motion
● Splint/cast may be loosed or removed and cast bivalved
● If not relieved and re-vascularized may need a fasciotomy
■ Neurovascular checks – 5 P’s:
● Pain
● Pallor
● Pulselessness
● Paresthesia
, ● Paralysis
■ Pressure Ulcers:
● Caused by pressure on soft tissues - LE sites most susceptible (heels, malleoli,
etc.)
● Caution when patient reports a “hotspot” and tightness under the cast
● Warmth, odor, pain
● May need opening or bi-valving of cast to allow for inspection and treatment
● “Window edema” - swelling of underlying tissue that bulges through the window
opening
■ Disuse Syndrome:
● Deterioration of body systems as a result of prescribed or unavoidable MS
inactivity
● Isometric Exercises-preventative
● Perform hourly while patient is awake
● Muscle setting exercises
○ Other Casts:
■ Body or Spica Cast:
● Body cast: immobilizes spine
● Spica cast: hip or shoulders
■ Cast Syndrome:
● Psychological - anxiety
● Physiological - compression of superior mesenteric artery/duodenum
○ Decreased GI motility
○ Abdominal distention & discomfort
○ Nausea, vomiting
● May need to bivalve or window cast over abdomen
● External Fixators
○ Uses:
■ To manage complex open FX with soft tissue damage
■ Humerus, forearm, femur, tibia and pelvis
■ Provides skeletal stability for severe comminuted FX while permitting TX of soft tissue
damage
■ Pins through tissue and bone- external equipment provides FX in proper alignment
○ Nursing Management:
■ Patient education regarding the device and post surgical care
■ Post-op= elevate above the heart to decrease swelling
■ Neurovascular checks
■ Assess pin sites for infection (prevent osteomyelitis)
■ Provide pin care
○ Pin Care:
■ Aseptic technique
■ Completed once daily or once weekly per order
■ Cleanse each pin separately to avoid cross-contamination with non-shedding material (
gauze, cotton-tip swab)
■ Use chlorhexidine solution 2mg/mL
■ Cleanse as per orders
■ Document pin site appearance
● Traction
○ Traction:
■ Direct pulling force applied to a fractured extremity that results in alignment of bones
■ Reduces fracture, lessens muscle spasms, relieves pain, corrects or prevent deformities,
promotes rest
■ May need traction in more than one direction to achieve the desired line of pull
■ Usually a short-term intervention until external or internal fixator are possible
MUSCULOSKELETAL &
DERMATOLOGICAL LECTURE
NOTES FOR WEEK 6 2025-2026 (A+
Verified and Graded) WEST COAST
UNIVERSITY.
,Pediatric Musculoskeletal, Neuromuscular, and Dermatological Disorders
Musculoskeletal Disorders: Fractures
Fracture Types
● Complete Broken completely across vs Incomplete Not all the way
● Simple (closed) vs Compound (open) Bone is protruding
● Complicated Tissue/organ involvement
Signs and Symptoms
● Pain
● Crepitus
● Deformity
● Edema
● Ecchymosis
● Warmth or redness
● Decreased use of affected area
Diagnostic
● Radiograph- determines position of the bone
Treatment
● Splints & braces
○ Splints:
■ Often used for simple and stable FX, sprains, and other soft tissue injuries
○ Braces:
■ Custom fitted to support and control movement
● Casts
○ Uses:
■ To immobilize a reduced fracture
■ To correct or prevent deformity
■ Apply uniform pressure to underlying soft tissue
■ Support/stabilize weakened joints
○ Types of Casts:
■ Fiberglass
■ Plaster
○ Patient Management:
■ Assess injured area and skin
■ Elevate above the heart for 24-48 hours
■ Mark drainage to monitor
○ Patient Teaching:
■ No heat lamps or warm hair dryers
■ Clean with damp cloth if soiled
■ No foreign objects inside cast
○ Complications:
■ Compartment Syndrome:
● Increased pressure within a confined space
● Decreases blood supply and perfusion
● Ischemia= necrosis
● S/S: dusky, pale, cool skin, delayed cap refill, unrelenting pain
● Hallmark sign: pain occurs or intensifies with passive range of motion
● Splint/cast may be loosed or removed and cast bivalved
● If not relieved and re-vascularized may need a fasciotomy
■ Neurovascular checks – 5 P’s:
● Pain
● Pallor
● Pulselessness
● Paresthesia
, ● Paralysis
■ Pressure Ulcers:
● Caused by pressure on soft tissues - LE sites most susceptible (heels, malleoli,
etc.)
● Caution when patient reports a “hotspot” and tightness under the cast
● Warmth, odor, pain
● May need opening or bi-valving of cast to allow for inspection and treatment
● “Window edema” - swelling of underlying tissue that bulges through the window
opening
■ Disuse Syndrome:
● Deterioration of body systems as a result of prescribed or unavoidable MS
inactivity
● Isometric Exercises-preventative
● Perform hourly while patient is awake
● Muscle setting exercises
○ Other Casts:
■ Body or Spica Cast:
● Body cast: immobilizes spine
● Spica cast: hip or shoulders
■ Cast Syndrome:
● Psychological - anxiety
● Physiological - compression of superior mesenteric artery/duodenum
○ Decreased GI motility
○ Abdominal distention & discomfort
○ Nausea, vomiting
● May need to bivalve or window cast over abdomen
● External Fixators
○ Uses:
■ To manage complex open FX with soft tissue damage
■ Humerus, forearm, femur, tibia and pelvis
■ Provides skeletal stability for severe comminuted FX while permitting TX of soft tissue
damage
■ Pins through tissue and bone- external equipment provides FX in proper alignment
○ Nursing Management:
■ Patient education regarding the device and post surgical care
■ Post-op= elevate above the heart to decrease swelling
■ Neurovascular checks
■ Assess pin sites for infection (prevent osteomyelitis)
■ Provide pin care
○ Pin Care:
■ Aseptic technique
■ Completed once daily or once weekly per order
■ Cleanse each pin separately to avoid cross-contamination with non-shedding material (
gauze, cotton-tip swab)
■ Use chlorhexidine solution 2mg/mL
■ Cleanse as per orders
■ Document pin site appearance
● Traction
○ Traction:
■ Direct pulling force applied to a fractured extremity that results in alignment of bones
■ Reduces fracture, lessens muscle spasms, relieves pain, corrects or prevent deformities,
promotes rest
■ May need traction in more than one direction to achieve the desired line of pull
■ Usually a short-term intervention until external or internal fixator are possible
