¶ … Hip dysplasia in children [...] nursing care and considerations of the child with congenital or developmental hip dysplasia. Hip dysplasia occurs actually quite commonly in infants and children all over the world. There are some special considerations nurses should use when caring for these patients, including recognizing the early symptoms of hip dysplasia in infants and children, and fully understanding the treatment necessary to help the family cope with the disease. Treating and diagnosing children is often much more difficult than diagnosing and treating older patients who can communicate more effectively, so the nurse must be patient, cognizant, and highly aware of the disease, its indicators, and its treatment.
Hip dysplasia in infants and children used to be known by two terms, developmental dysplasia of the hip (DDH), or congenital dislocation of the hip (CDH). However, today, most professionals refer to the condition as DDH. Hip dysplasia occurs when the head of the femur (thigh bone) does not fit correctly into the pelvis, creating a hip joint that does not match. The condition can be quite mild to extremely severe. Sometimes the femur is just slightly out of adjustment, and sometimes it can be extremely out of adjustment, not meet at all, or be severely dislocated. The condition can occur at birth, or can develop as the baby grows and develops. Sometimes it occurs in both hips, and sometimes only one. Sometimes the condition shows up at the time of birth, and other times it does not show up until the baby begins trying to walk. For some reason that has not been discovered, the condition seems to occur more in girls than boys ("Developmental," 2004). In addition, it occurs more in first-born children. The condition occurs in about four out of every 1,000 births, and for some reason is more prevalent in Lapps and Native Americans ("Hip," 2004).
An exact cause is also not known, but many healthcare professionals believe there are several different items that can contribute to the condition, including: certain body hormones cause the baby or child's hip joint to be very loose. Genetic links which mean that DDH is passed down in the family. The baby is in breech position in the uterus before it is born, and swaddling clothes that keep a baby's hips straight all the time ("Developmental," 2004). Others firmly believe the condition only begins in the womb (D'Alessandro and Huth, 2002). Sometimes the condition is evident at birth, but often the signs do not show up until the baby is older. Often, well-baby check-ups are the first indication that the condition is present. Some of the signs of the condition are: extra folds or wrinkles on the thigh under the child's buttocks. The child may not be able to move the effected hip as well as the other one. Laying flat on the back, one of the child's legs may look shorter than the other one. The child may seem to have a funny "waddling" walk or may sway toward the affected side. Caregivers may hear or feel "pops" and "clicks" in the baby's hip with special movement tests ("Developmental," 2004). The doctor may order an MRI, ultrasound, CT scan, or x-rays for further diagnosis. Recently, it has been discovered that ultrasound seems to give a more accurate diagnosis of the condition than other types of scans ("Hip," 2004). Some children may have to have surgery or traction to straighten the limb, or they may have to wear a splint known as a Pavlik Harness that helps to hold the hips in the correct position. Sometimes, older children have to wear a spica, or lower-body cast. All of these decisions for treatment are based on the severity of the problem and the age of the child.
Treatment of the problem should begin as soon as it is discovered, and the ultimate goal of treatment is to align the bones correctly. If the problem is not treated early and effectively, the child may continue to have problems with the hip throughout their lives, and the condition can often lead to debilitating arthritis. Studies have also shown that surprisingly, some children born with DDH will simply outgrow the condition, and never need treatment (Berant, 1999).
There are many important considerations for nurses to remember when caring for these young patients. First, many of the infants are so young they cannot talk, so they cannot let caregivers know what hurts. Patience is probably one of the key factors in treating and caring for these young patients, because they do not understand what is happening, or the treatment, which can often be painful when placed in a splint, brace, or cast. The most common form of treatment...
Muscular dystrophy and myasthenia gravis are complicated conditions. According to the research, muscular dystrophy is a "group of familial disorders that cause degeneration of skeletal muscle fibers" (Carroll, 2008, p 1633). Many researchers believe that the different types are each caused by different biochemical defects. For example, Duchenne Muscular Dystrophy is thought t be the result of a single gene defect "thought to be caused by a deletion of a
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