Pediatric Nursing Demystified

Attach a sequential pneumatic compression device to the patient’s legs

when the patient is not mobile to prevent stasis of blood in the legs and

to prevent emboli from developing.

Nursing Intervention

Assess the impact of the fracture on the child’s growth. Fractures to a

child’s epiphysis might impede the child’s growth.

Frequently assess circulation in the affected limb to ensure that edema

following a fracture does not restrict blood flow to the limb.

Assess for nerve compression syndrome—pain, tingling, and numbness.

 Assess for compartment syndrome as a result of increased pressure

from edema—pain, pallor, pulselessness, paresthesia, and paralysis.

Assess for osteomyelitis, which is an infection that might result from an

open fracture or from surgery to reduce a fracture. Signs are irritability,

abrupt fever, lethargy, pain, and warmth.

Assess for pulmonary embolism resulting from a fat, air, or blood

emboli that occur within the first 24 hours following a fracture. Adoles-

cents are at the greatest risk. Signs are sudden, severe dyspnea and chest

pain.

Traction care:

• Assess the position and placement of bandages and straps.


• Assess neurovascular status.


• Treat pain.


• Assess the patient’s psychological response to the treatment.


• Assess the pin sites for infection, inflammation, and bleeding.


• Clean the pin site if ordered with a cotton-tipped sterile applicator
  soaked with normal saline or saline/hydrogen peroxide solution.
  Apply antibacterial ointment if ordered.
  Minimize immobility by performing range-of-motion exercises and
  ambulate when possible to prevent loss of muscle strength, impaired
  joint mobility, and venous stasis and increased bone catabolism.
  Teach the patient and parents about the fracture and treatment.

Nursing alert Open or remove the cast immediately at the first signs of com-

partment syndrome to prevent tissue damage and necrosis. Elevate the head of

bed, administer oxygen to the patient, and notify the health-care provider at

the first signs of pulmonary embolism.

Hip Dysplasia

What Went Wrong?

Hip dysplasia occurs as a result of abnormal development of the hips during

fetal development. There are three categories of hips dysplasia:

4

CHAPTER 13/ Musculoskeletal Conditions^285