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Musculoskeletal Case Study
What other questions should the nurse ask?
Was the birth weight below normal
Questions about past medical history including significant past diseases/illnesses, surgery, including complications, trauma.
Is she Hypermobile?
Does she have Sleep disturbance (Connel, Bennett, & Eccleston, 2001)?
The social deprivation factor should be explored
Has the child undergone bereavements.
What techniques are helpful to incorporate in assessing a patient in this age group?
Establishing a rapport with both parents and the child is important when it comes to taking the history. The most important aspects of the examination are the Inspection and observation. Establishing the rapport and taking the history helps make relevant observations. For instance:
Take note of the behavior of the child and then awareness level and put these into consideration with the reports of the parents.
Take note of the child's appearance and note if it is unusual in any way.
Take note of the shape of the child's head, position of eyes, mode of ears, posture and body proportions.
Ascertain if there are any recognizable minor or major abnormalities.
What other assessments should the nurse make for this clinical presentation?
It is wrong to classify children as little...
In little babies, pay special attention to the sacrum region and take note of any hairy naevi or sinus. Notice normal variations (femoral anterversion, in-toeing, genu varus, genu valgus, etc.). Conduct specific hips and feet checks.
What are a few of the major differences in the musculoskeletal assessment of a child?
Children should not be seen as little adults and MSK assessment used in children is a whole lot different from that used in adults. Young children can sometimes have trouble in describing or localizing pain and the caregiver/parent always provide the history, which may not be clear with complaints that are non-specific like my child is limping. Symptoms like stiffness, pain, decreasing interest in activities or ebbing ability are the interpretations given by caregivers or parents and teachers who are concerned about character decadence (e.g. poor sleeping, irritability), motor skills (e.g. handwriting) or possessing good sporting skills. MSK problems or some neurological diseases may be indicated by a delay in serious motor milestones; drop of recorded milestones is possibly more important, e.g. a child who always delighted in walking without being aided but suddenly fears walking…
References
Clinch, J., & Eccleston, C. (2009). Chronic musculoskeletal pain in children: assessment and management. Rheumatology, 48(5), 466-474.
Connel, H., Bennett, S. M., & Eccleston, C. (2001). Chronic musculoskeletal and other idiopathic pain syndromes. Arch Dis Child, 84, 189-192.
Foster, H. E. (2008). Examination of the musculoskeletal system in children -- a simple approach. Paediatrics and Child Health.
Sometimes, studies show that elderly patients are perceived not to be in pain because they do not complain about pain, or that the perceive it differently than younger people. In both receptive and non-receptive patients, one can observe facial tics and/or grimaces, blood pressure (elevated blood pressure sometimes indicates more pain), body temperature, and even mobility. For the functional patient, assessment can be done by observation of body movement, gait,
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