NURS 307 PEDIATRICS CARING FOR
THE CHILD WITH CHRONIC
CONDITIONS LECTURE NOTES WITH
ATI FOR WEEK 6 2025-2026 (A+
Verified and Graded) WEST COAST
UNIVERSITY
, N307 Week 6 ATI
Caring for the Child with a Chronic Condition, Alterations in
Musculoskeletal Function, Alterations in Skin Integrity
The Child with Chronic Conditions
● A CHRONIC CONDITION is an illness that lasts at least 3 months
○ Genetic, inheritable
○ Congenital defect or damage during fetal development
○ Insult or injury associated with birth
○ Acquired conditions through injury or acute medical condition
● Limitations
○ Disfigurement
○ Dependency on medication or diet
○ Dependency on medical technology to function
○ Need for medical care and services beyond needs of a healthy child
○ Ongoing treatments at home or at school
Role of the Nurse
● Roles
○ Health supervision through span of childhood
○ Multidisciplinary collaboration
○ Partners in care with parents for home management
○ Community referrals
○ Planning educational services
○ Promoting well-being of child and family
○ Promotion of G/D of siblings
● New diagnosis
○ Page 251 for age appropriate approaches
○ Address fears and concerns
○ Sibling response/ adjustment monitoring, family stress response
● Discharge planning and home care
○ Provide contact information, community resources
○ Decrease/alleviate fears and anxieties
○ Support groups
, ○ Social services, financial planning, time management, ongoing assistance PRN
● Coordination of care
○ In home care coordination
○ Case managers
○ Organization of multidisciplinary team, appts, contact information, access to
resources
Community Site of Care
● Office or health center
○ Routine visits and episodic occurrences
● Specialty referral centers
○ Regional centers, clinics
○ PT/OT, Nutritionist
● Schools
○ Entitled by law to free education
○ Educational system planning
■ IFSP, IEP, IHP, ITP (see page 254-255)
■ Parents are the greatest advocates to ensure child’s needs are met
○ Promote autonomy and self-care skills if possible
● Home care
○ Extensive training, education, preparation for family/caregivers
○ Risk for caregiver burden
○ Respite care necessary
○ Emergency preparedness
■ Battery packs, feeds, back-up technologies
Alterations in Musculoskeletal Function: Feet and Legs
● Please review pp. 826-830
● Metatarsus adducts
○ Most common foot deformity
○ Inward turning of forefoot, “in-toeing”, “pigeon-toed”
○ Equal in males and females; common in multiples
○ Seen in CP, more likely cause from intrauterine positioning
○ Treatment can be exercising if foot is flexible (during diaper changes); may
resolve over time, otherwise casting necessary
● Club foot
○ Foot twisted out of normal position
○ More often in boys than girls; usually bilateral
○ Etiology unknown; intrauterine positioning? Vascular issues? Genetics?
, ○ Three areas of deformity: midfoot down, hindfoot inward, forefront toward heel
and upward
○ Lower leg atrophies, lengths normal
○ Dx by visual inspection
○ Early treatment; serial casting - then splinting; otherwise surgery at 3-12 months
with pins repositioning foot
■ May need braces or corrective shoes
Alterations in Musculoskeletal Function: Hip
● Developmental Dysplasia of the Hip (DDH)
○ Femoral head and acetabulum improperly aligned
■ Dislocation
■ Subluxation
■ Dysplasia
○ 4:1 females to males, 80% unilateral affecting left hip more often
○ May be due to developmental events or positioning in 3rd trimester
○ Limited adduction of hip, asymmetry of gluteal and thigh folds, telescoping of
thigh
■ Significant limp
■ Diagnosis by?
○ 60-80% resolve by 2 months, under 3 months Pavlik Harness; Bryant’s traction;
surgery at 6 months with spica cast, or 18 months with casting and bracing
○ AAP recommends to screen until walking 1-2 years
○ Late diagnosis has lower prognosis for full function
● Legg Calves Perthes Disease
○ Self-limited avascular necrosis of femoral head
■ 4:1 males to females, 2-13 years old- peaks at 7
■ Unilateral or bilateral
○ Caused by interruption of blood supply to femoral epiphysis, may be genetic, mild
traumatic injury, breech position
○ Delayed skeletal maturation, increased thyroid levels
■ Common in LBW, increased maternal age, smoking, Caucasian, Chinese,
Japanese
○ 4 stages of manifestations (Table 29-3)
■ Hip pain, limp; exacerbation with activity, relief with rest; limited ROM,
atrophy of affected thigh, muscle spasms, increased pain
○ Treatment with abduction casting and bracing; surgery in severe cases to release
adductor muscle, treat bone
○ Late diagnosis or left untreated may lead to osteoarthritis, leg length discrepancy,
hip dysfunction
THE CHILD WITH CHRONIC
CONDITIONS LECTURE NOTES WITH
ATI FOR WEEK 6 2025-2026 (A+
Verified and Graded) WEST COAST
UNIVERSITY
, N307 Week 6 ATI
Caring for the Child with a Chronic Condition, Alterations in
Musculoskeletal Function, Alterations in Skin Integrity
The Child with Chronic Conditions
● A CHRONIC CONDITION is an illness that lasts at least 3 months
○ Genetic, inheritable
○ Congenital defect or damage during fetal development
○ Insult or injury associated with birth
○ Acquired conditions through injury or acute medical condition
● Limitations
○ Disfigurement
○ Dependency on medication or diet
○ Dependency on medical technology to function
○ Need for medical care and services beyond needs of a healthy child
○ Ongoing treatments at home or at school
Role of the Nurse
● Roles
○ Health supervision through span of childhood
○ Multidisciplinary collaboration
○ Partners in care with parents for home management
○ Community referrals
○ Planning educational services
○ Promoting well-being of child and family
○ Promotion of G/D of siblings
● New diagnosis
○ Page 251 for age appropriate approaches
○ Address fears and concerns
○ Sibling response/ adjustment monitoring, family stress response
● Discharge planning and home care
○ Provide contact information, community resources
○ Decrease/alleviate fears and anxieties
○ Support groups
, ○ Social services, financial planning, time management, ongoing assistance PRN
● Coordination of care
○ In home care coordination
○ Case managers
○ Organization of multidisciplinary team, appts, contact information, access to
resources
Community Site of Care
● Office or health center
○ Routine visits and episodic occurrences
● Specialty referral centers
○ Regional centers, clinics
○ PT/OT, Nutritionist
● Schools
○ Entitled by law to free education
○ Educational system planning
■ IFSP, IEP, IHP, ITP (see page 254-255)
■ Parents are the greatest advocates to ensure child’s needs are met
○ Promote autonomy and self-care skills if possible
● Home care
○ Extensive training, education, preparation for family/caregivers
○ Risk for caregiver burden
○ Respite care necessary
○ Emergency preparedness
■ Battery packs, feeds, back-up technologies
Alterations in Musculoskeletal Function: Feet and Legs
● Please review pp. 826-830
● Metatarsus adducts
○ Most common foot deformity
○ Inward turning of forefoot, “in-toeing”, “pigeon-toed”
○ Equal in males and females; common in multiples
○ Seen in CP, more likely cause from intrauterine positioning
○ Treatment can be exercising if foot is flexible (during diaper changes); may
resolve over time, otherwise casting necessary
● Club foot
○ Foot twisted out of normal position
○ More often in boys than girls; usually bilateral
○ Etiology unknown; intrauterine positioning? Vascular issues? Genetics?
, ○ Three areas of deformity: midfoot down, hindfoot inward, forefront toward heel
and upward
○ Lower leg atrophies, lengths normal
○ Dx by visual inspection
○ Early treatment; serial casting - then splinting; otherwise surgery at 3-12 months
with pins repositioning foot
■ May need braces or corrective shoes
Alterations in Musculoskeletal Function: Hip
● Developmental Dysplasia of the Hip (DDH)
○ Femoral head and acetabulum improperly aligned
■ Dislocation
■ Subluxation
■ Dysplasia
○ 4:1 females to males, 80% unilateral affecting left hip more often
○ May be due to developmental events or positioning in 3rd trimester
○ Limited adduction of hip, asymmetry of gluteal and thigh folds, telescoping of
thigh
■ Significant limp
■ Diagnosis by?
○ 60-80% resolve by 2 months, under 3 months Pavlik Harness; Bryant’s traction;
surgery at 6 months with spica cast, or 18 months with casting and bracing
○ AAP recommends to screen until walking 1-2 years
○ Late diagnosis has lower prognosis for full function
● Legg Calves Perthes Disease
○ Self-limited avascular necrosis of femoral head
■ 4:1 males to females, 2-13 years old- peaks at 7
■ Unilateral or bilateral
○ Caused by interruption of blood supply to femoral epiphysis, may be genetic, mild
traumatic injury, breech position
○ Delayed skeletal maturation, increased thyroid levels
■ Common in LBW, increased maternal age, smoking, Caucasian, Chinese,
Japanese
○ 4 stages of manifestations (Table 29-3)
■ Hip pain, limp; exacerbation with activity, relief with rest; limited ROM,
atrophy of affected thigh, muscle spasms, increased pain
○ Treatment with abduction casting and bracing; surgery in severe cases to release
adductor muscle, treat bone
○ Late diagnosis or left untreated may lead to osteoarthritis, leg length discrepancy,
hip dysfunction
