Pediatric Musculoskeletal Disorders — Orthopedic Nursing Interventions and NCLEX Strategies | Chapter 36: Saunders NCLEX-PN Review

Chapter 36 of Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri delivers a detailed review of pediatric musculoskeletal disorders, equipping nursing students with the knowledge to manage developmental conditions, deformities, fractures, and orthopedic interventions. This guide emphasizes NCLEX-priority safety protocols, family teaching, and evidence-based nursing care for optimal patient outcomes.

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Developmental Dysplasia of the Hip (DDH)

DDH is identified through assessment techniques such as the Ortolani and Barlow maneuvers and the Trendelenburg sign. Early intervention is critical, with the Pavlik harness used in infants and spica casting for older children. Nursing care focuses on skin assessment, harness adjustment, and caregiver education.

Clubfoot (Talipes)

Clubfoot management includes serial casting, gentle manipulation, and sometimes surgical correction. Parents must be taught cast care, skin checks, and the importance of follow-up to prevent recurrence.

Scoliosis

Screening with Adam’s forward bend test identifies spinal curvature. Bracing (worn 16–23 hours per day) can slow progression, while severe cases may require spinal fusion. Postoperative nursing care includes logrolling, infection monitoring, incentive spirometry, and psychosocial support for body image changes.

Juvenile Idiopathic Arthritis (JIA)

This chronic condition presents with joint swelling, stiffness, and pain. Treatment may include NSAIDs, corticosteroids, and DMARDs such as methotrexate. Nursing priorities include encouraging ROM exercises, maintaining joint function, and monitoring for medication side effects.

Marfan Syndrome

A connective tissue disorder characterized by tall stature, long limbs, and cardiovascular risks. Nursing interventions include cardiac monitoring, vision screening, spine assessment, and advising activity restrictions to prevent injury.

Legg-Calvé-Perthes Disease

This condition involves avascular necrosis of the femoral head. Management may include crutches, casting, traction, or surgery. Nursing care focuses on mobility support, pain control, and promoting healing.

Pediatric Fractures & Cast Care

Fracture assessment follows the 5 Ps of neurovascular status: pain, pallor, pulse, paresthesia, and paralysis. Immediate care includes immobilization, elevation, and monitoring for compartment syndrome. Cast care involves petaling rough edges, assessing skin integrity, and preventing muscle atrophy.

Traction Methods

• Russell Traction: Combines skin traction and sling support.
• Balanced Suspension: Allows alignment and mobility for certain fractures.
• 90–90 Traction: Used for femur fractures, maintaining hip and knee flexion.

Nursing care for traction includes ensuring correct weight alignment, rope function, pin site care, and sensory stimulation for the child.

Post-Op Spinal Fusion

After spinal fusion, nurses must maintain spinal alignment with logrolling, monitor for signs of infection, encourage respiratory exercises, and assess bowel function. Emotional support is essential for coping with long recovery periods.

Family Teaching

Education is critical for home care. Families should understand cast care, brace maintenance, safe mobility techniques, medication administration, and the importance of physical therapy for recovery.

Conclusion

Pediatric musculoskeletal disorders require thorough assessment skills, a solid understanding of orthopedic interventions, and compassionate family education. Mastery of these topics is essential for NCLEX-PN success and for providing safe, effective patient care in the clinical setting.

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