NUR 340 Unit 12 Mobility;
Musculoskeletal System
Muscles Assessment - answer mass, movements, asymmetry, physical activity,
developmental milestones met, tenderness, weakness
Joints Assessment - answer smooth and symmetric, tenderness, inflammation, ROM,
crepitus, masses, recent trauma.
Bones Assessment - answer Masses, length the same, alignment, mobility, spinal
screening, child play any sports.
Tendons & Ligaments Assessment - answer Move full ROM, pain upon movement,
recent injury, grinding, crepitus, what sports does child play.
Fine Motor Movement - answer Distal (fingers and toes)
Gross Motor Movement - answerProximal (arms and legs)
Congenital Clubfoot - answerP: Complex deformity of ankle and foot. Inversion,
eversion, plantar and/or dorsiflexion.
Congenital Clubfoot Treatment - answerSerial casting and gentle manipulation for 6-10
weeks
Congenital Clubfoot Nursing Care - answerCast care
assessment of skin and perfusion
Parent teaching (follow up, cast care, etc.)
Developmental Dysplasia of The Hip (DDH) - answerFormerly called congenital hip
dysplasia or congenital dislocation of the hip.
Three Degrees:
Acetabular Dysplasia
Subluxation
Dislocation
Acetabular Dysplasia - answerPreluxation: mildest form of DDH, femoral head remains
in the acetabulum.
Subluxation - answerDDH: Partial dislocation of the hip.
, Dislocation - answerDDH: Femoral head loses contact with the acetabulum and is
displaced posteriorly and superiorly; ligaments are elongated and taut.
DDH in The Infant - answershortened limb on the affected side.
Restricted abduction of the hip on affected side.
Unequal gluteal folds when the infant is prone.
Positive Ortolanis
Positive Barlows
Ortolani's Test - answerHis is reduced by abduction. DDH
Barlow Test - answerHis is dislocated by adduction.
DDH in Older Infant and Child - answeraffected leg is shorter than the unaffected leg.
Telescoping or piston mobility of the joint.
Trendelenburg sign.
Greater trochanter is prominent and appears above the line from the anteriosuperior
iliac spine to the tuberosity of the ischium.
Marked lordosis if bilateral dislocation.
Waddling gait if bilateral dislocation.
DDH Therapeutic Management - answerEarly intervention.
Newborn-6months: Pavlik harness for abduction of the hip. Must be worn continuously
for 6-12 weeks.
6months-24months: Unrecognized until child begins to walk. Use traction, surgical
reduction and cast immobilization (spica).
Older Child: surgery, casting, bracing; management is difficult after 4 years of age.
Education: General cast care, neuro checks, feedings, safety, toys, and assessments.
Legg-Calve-Perthes - answerSelf-limiting, idiopathic, occurs in juvenile age 3-12 years,
more common in male sage 4-8 years.
P: caused is unknown, but involves disturbed circulation to the femoral head with
ischemic aseptic necrosis.
Avascular Necrosis of the femoral head.
Insidious Onset: may have a history of a limp (with or without pain), soreness or
stiffness, or limited ROM, vague history of trauma.
Pain and limp most evident on arising and at the end of activity.
Management of Legg-Calve-Perthes - answerGoal is to keep the head of the femur in
the acetabulum.
NSAIDs for inflammation.
Containment with braces, traction, casting.
Initially non-weight bearing to reduce inflammation; PT and active motion later.
Surgery in some cases.
Musculoskeletal System
Muscles Assessment - answer mass, movements, asymmetry, physical activity,
developmental milestones met, tenderness, weakness
Joints Assessment - answer smooth and symmetric, tenderness, inflammation, ROM,
crepitus, masses, recent trauma.
Bones Assessment - answer Masses, length the same, alignment, mobility, spinal
screening, child play any sports.
Tendons & Ligaments Assessment - answer Move full ROM, pain upon movement,
recent injury, grinding, crepitus, what sports does child play.
Fine Motor Movement - answer Distal (fingers and toes)
Gross Motor Movement - answerProximal (arms and legs)
Congenital Clubfoot - answerP: Complex deformity of ankle and foot. Inversion,
eversion, plantar and/or dorsiflexion.
Congenital Clubfoot Treatment - answerSerial casting and gentle manipulation for 6-10
weeks
Congenital Clubfoot Nursing Care - answerCast care
assessment of skin and perfusion
Parent teaching (follow up, cast care, etc.)
Developmental Dysplasia of The Hip (DDH) - answerFormerly called congenital hip
dysplasia or congenital dislocation of the hip.
Three Degrees:
Acetabular Dysplasia
Subluxation
Dislocation
Acetabular Dysplasia - answerPreluxation: mildest form of DDH, femoral head remains
in the acetabulum.
Subluxation - answerDDH: Partial dislocation of the hip.
, Dislocation - answerDDH: Femoral head loses contact with the acetabulum and is
displaced posteriorly and superiorly; ligaments are elongated and taut.
DDH in The Infant - answershortened limb on the affected side.
Restricted abduction of the hip on affected side.
Unequal gluteal folds when the infant is prone.
Positive Ortolanis
Positive Barlows
Ortolani's Test - answerHis is reduced by abduction. DDH
Barlow Test - answerHis is dislocated by adduction.
DDH in Older Infant and Child - answeraffected leg is shorter than the unaffected leg.
Telescoping or piston mobility of the joint.
Trendelenburg sign.
Greater trochanter is prominent and appears above the line from the anteriosuperior
iliac spine to the tuberosity of the ischium.
Marked lordosis if bilateral dislocation.
Waddling gait if bilateral dislocation.
DDH Therapeutic Management - answerEarly intervention.
Newborn-6months: Pavlik harness for abduction of the hip. Must be worn continuously
for 6-12 weeks.
6months-24months: Unrecognized until child begins to walk. Use traction, surgical
reduction and cast immobilization (spica).
Older Child: surgery, casting, bracing; management is difficult after 4 years of age.
Education: General cast care, neuro checks, feedings, safety, toys, and assessments.
Legg-Calve-Perthes - answerSelf-limiting, idiopathic, occurs in juvenile age 3-12 years,
more common in male sage 4-8 years.
P: caused is unknown, but involves disturbed circulation to the femoral head with
ischemic aseptic necrosis.
Avascular Necrosis of the femoral head.
Insidious Onset: may have a history of a limp (with or without pain), soreness or
stiffness, or limited ROM, vague history of trauma.
Pain and limp most evident on arising and at the end of activity.
Management of Legg-Calve-Perthes - answerGoal is to keep the head of the femur in
the acetabulum.
NSAIDs for inflammation.
Containment with braces, traction, casting.
Initially non-weight bearing to reduce inflammation; PT and active motion later.
Surgery in some cases.
