Musculoskeletal assessment techniques in pediatric nursing practice

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 adults and the MSK assessment technique employed for adults should not be used for assessing problems in kids.

Take note of any unusual curvature or abnormalities of the spine, especially towards the lower part. 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 might have acquired some MSK disease. Some fatal conditions like acute leukemia may come with non-specific muscle or joint pains and in children with pyrexia whose origins are unknown, MSK assessment is vital to eliminate joint or bone infection (Foster, 2008).

Idiopathic pain syndromes

Pain occurs mostly in a limb and can persist for over a month without identifying any disease. The coming of in DIP-diffuse idiopathic pain syndrome is mostly a gradual process. Most times, there is the possibility of an initial infection (insult) or hypermobility but there is mostly no obvious trigger, just a mere recollection of the initial stage. The pain is a generalized type of pain. There may be parts of hyperalgesia and allodynia but autonomic changes are present in more restricted pain conditions (Clinch & Eccleston, 2009).