DISORDERS AFFECTING COMFORT, REST, ACTIVITY, AND MOBILITY


Musculoskeletal Disorders

Orthopedic conditions in infants and children are many and varied, but treatment is based on basic principles of nursing care. Table 5-23 and Figures 5-15 and 5-16 offer a quick review of the major pediatric orthopedic conditions.

Neuromuscular Disorders

  1. Cerebral palsy
    1. Introduction: Cerebral palsy (CP) is the most common permanent physical disability of childhood. It is a neuromuscular disorder of the pyramidal motor system resulting in the major problem of impaired voluntary muscle control. The damage appears to be fixed and nonprogressive, and the cause is unknown. However, although a variety of factors have been implicated in the etiology of CP, it is now known that CP results more commonly from prenatal brain abnormalities.
    2. Assessment: Most common type of cerebral palsy— spastic.
      1. Delayed developmental milestones.
      2. Tongue thrust with difficulty swallowing and sucking. Poor weight gain. Aspiration may occur.
      3. Increased muscle tone: “scissoring” (legs crossed, toes pointed).
      4. Persistent neonatal reflexes.
      5. Associated problems:
        1. Mental retardation in 30% of children with cerebral palsy (70% are normal).
        2. Sensory impairment: vision, hearing.
        3. Orthopedic conditions: congenital dysplasia of hip, clubfoot.
        4. Dental problems: malocclusion.
        5. Seizures.