Case Studies
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Case Studies Client profile: Lauren 1. Lauren’s clinical manifestations (asymmetry of thigh and gluteal folds, right hip abduction, and right upper leg shorter than left are significant signs of dysplasia of the hip. 2. The potential causes of Lauren’s musculoskeletal manifestations could be genetic factors but most likely is due to breech vaginal delivery. 3. In order to prepare Lauren’s care plan it would be helpful for the nurse to first perform physical examination, assess skin, respiratory and circulatory status, family resources, and to take in consideration Lauren’s age and developmental stage. 4. Developmental dysplasia of the hip (DDH) refers to a variety of conditions in which the femoral head and the acetabulum are improperly aligned with an unstable connection. Including hip instability, dislocation (displacement of the bone from its normal articulation with the joint), subluxation (partial dislocation) and acetabular dysplasia (abnormal cellular or structural development leading to instability). 5. Hip instability is present in 1 in 100 newborns and dislocation occurs in 1.5 to 20 in 1,000 births. The condition affects girls four times as often as boys. Unilateral in 80% of affected children and the left hip is affected three times as often as the right. 6. Prior to discharge Lauren’s priorities are: cast care, harness alignment, pain control, and prevent complications from immobility. 7. An orthopedic device must commonly used for infants younger than 6 months is the Paul harness. It is a dynamic splint that allows movement. It ensures hip flexion and abduction but does not allow hip extension or adduction. 8. Priorities of care after fitting the device are care of the cast, alignment, prevent complications from immobility, skin care, and promotion of normal growth and development.
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Transcript of Case Studies
Case Studies
Client profile: Lauren
1. Lauren’s clinical manifestations (asymmetry of thigh and gluteal folds, right hip abduction, and right upper leg shorter than left are significant signs of dysplasia of the hip.
2. The potential causes of Lauren’s musculoskeletal manifestations could be genetic factors but most likely is due to breech vaginal delivery.
3. In order to prepare Lauren’s care plan it would be helpful for the nurse to first perform physical examination, assess skin, respiratory and circulatory status, family resources, and to take in consideration Lauren’s age and developmental stage.
4. Developmental dysplasia of the hip (DDH) refers to a variety of conditions in which the femoral head and the acetabulum are improperly aligned with an unstable connection. Including hip instability, dislocation (displacement of the bone from its normal articulation with the joint), subluxation (partial dislocation) and acetabular dysplasia (abnormal cellular or structural development leading to instability).
5. Hip instability is present in 1 in 100 newborns and dislocation occurs in 1.5 to 20 in 1,000 births. The condition affects girls four times as often as boys. Unilateral in 80% of affected children and the left hip is affected three times as often as the right.
6. Prior to discharge Lauren’s priorities are: cast care, harness alignment, pain control, and prevent complications from immobility.
7. An orthopedic device must commonly used for infants younger than 6 months is the Paul harness. It is a dynamic splint that allows movement. It ensures hip flexion and abduction but does not allow hip extension or adduction.
8. Priorities of care after fitting the device are care of the cast, alignment, prevent complications from immobility, skin care, and promotion of normal growth and development.
9. The nurse’s best response to this question is one that reassures the mother that she will be able to breast feed Lauren and encourage breast feeding.
10. *Instruct about general cast care, positioning, bathing, toileting, and age-appropriate diversional activities. *Emphasize the importance of performing neurovascular checks and reporting any abnormalities immediately. *Be sure that parents understand that the bar between the legs on the cast is not to be used for holding or turning the child. The bar is used to position the legs at the proper distance; using it to lift can cause the cast to fracture, weaken, or disintegrate. *Make appropriate referrals for periodic assessment by a visiting nurse or home health nurse.*Provide the family with resource to care for the child.
11. Lauren’s condition can impact growth and development due to lack of movement, decrease appetite, decreased interaction and stimulation. Engage the child in activities that stimulate the upper extremities and all five senses. Provide stimulating toys and
position the toys within the child’s reach and interact with the child as much as possible.
