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Course: Pediatric Nursing

Topic: Nursing Care of Child with Musculoskeletal Disorders Part III

The Nurses International Community

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Module Goals

Learners will be able to:

Define Osteomyelitis and Rickets
List causes of Osteomyelitis and Rickets
Discuss the signs and symptoms of Osteomyelitis and Rickets
Describe common diagnostic procedures for the above disorders
Explain common medical treatments for the above disorders
Discuss the nursing management of a child with the above disorders

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Osteomyelitis

An infection of the bone (may be acute or chronic). More common in the long bones of the body, but may affect any bone.
Occurs in children of any age, but more common in premature infants and newborns born with complications.

Medlineplus, 2022

Children Hospital of Philadelphia, n.d

Contact info: info@nursesinternational.org

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Osteomyelitis: Causes

Most often caused by bacteria (Staphylococcus aureus)
Fungi may cause it too
Portal of Entry:

Infected wounds
Open fractures (broken bones penetrate through the skin)
Infected joints
Infection from another source inside the body (ear infections)
Trauma

Medlineplus, 2022

Children Hospital of Philadelphia, n.d

Contact info: info@nursesinternational.org

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Osteomyelitis: Risk Factors

Premature birth or delivery complications in newborns
Diabetes
Poor blood supply
Recent injury
Sickle cell disease
Infection due to a foreign body
Pressure ulcers
Human bites or animal bites
Weak immune system

Medlineplus, 2022

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Critical Thinking Question

Osteomyelitis is most common in ___________infants.

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Osteomyelitis: Symptoms

Localised bone pain
Limited or painful movement
Swelling in the infected area
Redness in the infected area
Warmth around the infected area
Fever
Chills
Sweating

Children Hospital of Philadelphia, n.d

Better Health, 2013

Contact info: info@nursesinternational.org

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Osteomyelitis: Diagnosis

Medical history
Physical Examination
X-rays
Bone scans
Blood tests
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Bone tissue biopsy

Children Hospital of Philadelphia, n.d

Better Health, 2013

Contact info: info@nursesinternational.org

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Osteomyelitis: Treatment

Antibiotics for infection

Pain medications

Surgery to clean out the infected area in and around the bone

Children Hospital of Philadelphia, n.d

Better Health, 2013

Contact info: info@nursesinternational.org

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Osteomyelitis: Nursing Management

Keep in comfortable position with the affected limb supported
Promote bed rest
Careful and gentle turning and moving
Assess and maintenance of nutritional needs
Administer antibiotics, analgesics as prescribed
Monitor and dress wound as prescribed
Encourage out of bed activity
Provide deep venous thrombosis and pressure sore prophylaxis
Parental education about medication compliance

Momodu, Savaliya, & Doerr, 2022

Hockenberry and Wilson, 2007

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

A child with acute osteomyelitis of the left femur is hospitalized for the treatment.

Which intervention will be included in the initial plan of care?

Immobilization of the left leg
Positioning the left leg in flexion
Assisted weight-bearing ambulation
Quadriceps-setting exercise repetitions

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Rickets

A bone disease where bones are too soft, causing them to warp, bend and break more easily
Child’s growing bones fail to develop properly due to a lack of vitamin D

Better Health, 2014

Cleveland Clinic, 2022

Contact info: info@nursesinternational.org

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Rickets: Symptoms

Bowing of leg bones
Widening of knees (children who can walk)
Widening of wrists (infants who can crawl)
Bone pain
Swelling of the ends of ribs, known as rachitic rosary
Pigeon chest
Growth and development delays
Unusual curving of the spine or shape of the skull
Teeth problems, such as cavities
Seizures (where calcium levels are critically low)

Better Health, 2014

Cleveland Clinic, 2022

Contact info: info@nursesinternational.org

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Critical Thinking Question

The nurse is caring for a child admitted to the nursing unit with Rickets.

Which symptom will the nurse most likely find on physical examination of the child? (Select all that apply)

Bowing of leg bones
Widening of knees
Teeth cavities
Seizures

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Rickets: Risk Factors

Breastfeeding newborns and infants (if the breastfeeding mother isn’t getting enough vitamin D)
Prematurity
Lack of enough sunlight to create vitamin D
Darker-skin (takes longer to absorb enough of the sun’s rays to create the needed amount of vitamin D)

Better Health, 2014

Cleveland Clinic, 2022

Contact info: info@nursesinternational.org

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Rickets: Causes

Nutritional rickets:

Caused by vitamin D deficiency (used to absorb calcium)
Causes:

Insufficient exposure to sunlight (helps body make its own vitamin D
Lack of vitamin D in child’s diet
A diet very low in calcium

Inherited rickets:

Genetic diseases interfere with ability absorb vitamin D

Better Health, 2014

Cleveland Clinic, 2022

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Critical Thinking Question

A four year child came to an orthopedic unit and was diagnosed with Rickets.

For which of the following vitamins is this child most likely deficient in?

Vitamin A
Vitamin B
Vitamin C
Vitamin D

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Rickets: Diagnosis

Physical examination
Blood tests (calcium, vitamin D, and phosphorus levels)
X-rays
Bone biopsy in rare cases
Genetic testing (for inherited Rickets)

Health Direct, 2020

Cleveland Clinic, 2022

Cafasso, 2019

Contact info: info@nursesinternational.org

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Rickets: Treatment

Adding calcium and vitamin D rich foods to diet
Daily calcium and vitamin D supplements
Sunlight exposure
May need braces to position growing bones
In severe cases, may need corrective surgery

Better Health, 2014

Cleveland Clinic, 2022

Cafasso, 2019

Contact info: info@nursesinternational.org

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Rickets: Prevention

Healthy and balanced diet (Good sources of vitamin D)
Spend time in the sun
Vitamin D supplement

NHS, 2021

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Rickets: Prevention (Supplements)

Pregnant Women:

At least 600 IUs of vitamin D daily

From birth to 1 year of age (exclusively or partially breastfed)

8.5 to 10mcg of vitamin D daily

Children aged 1 to 4 years old: 10mcg of vitamin D daily
Infant formula fed babies do not need a vitamin D supplement until they are consuming less than 500ml a day

NHS, 2021

Cleveland Clinic, 2022

Contact info: info@nursesinternational.org

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Rickets: Nurses Role

Recognize children at risk for rickets
Assessment of sign and symptoms
Health education:

Preventive measures
Encourage vitamin D and calcium intake and supplement
Good sun exposure
Vit D and calcium supplements during pregnancy

Psychological support

Momodu, Savaliya, & Doerr, 2022

Contact info: info@nursesinternational.org

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Critical Thinking Question

What are the preventive measures for Rickets in a child? (Select all that apply)

Vitamin D supplement during pregnancy
Good sun exposure
Vitamin D containing diet
Iron containing diet

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Red Flags

Seizures in a child with Rickets

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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References:

Better Health. (2014). Rickets. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rickets

Better Health. (2013). Osteomyelitis. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteomyelitis

Cafasso, J. (2019). Rickets. [Review of article ‘Rickets’ by, C. Justin]. Healthline. https://www.healthline.com/health/rickets

Children’s Hospital of Philadelphia. (n.d). Osteomyelitis in Children. https://www.chop.edu/conditions-diseases/osteomyelitis-children#:~:text=Osteomyelitis%20is%20an%20infection%20in,may%20not%20be%20fully%20developed

Cleveland Clinic. (2022). Rickets.https://my.clevelandclinic.org/health/diseases/22459-rickets

Contact info: info@nursesinternational.org

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References:

Hockenberry, M. J. & Wilson, D. (2007). WONG’S Nursing Care of Infants and Children. 8th edi. Mosby

Medlineplus. (2022). Osteomyelitis in Children. https://medlineplus.gov/ency/article/007697.htm

Momodu, II., Savaliya, V., & Doerr, C. (2022). Osteomyelitis (Nursing). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568766/

NHS. (2021). Rickets and Osteomalacia. https://www.nhs.uk/conditions/rickets-and-osteomalacia/

Health Direct. (2020). Rickets. https://www.healthdirect.gov.au/rickets

Contact info: info@nursesinternational.org

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