Ch. 28: Developmental Dysplasia of the Hip (DDH)

Question 1

What is acetabular dysplasia?

Answer 1

Delay in acetabular development

Question 2

What is subluxation ?

Answer 2

Incomplete dislocation of the hip

Question 3

What is dislocation?

Answer 3

Femoral head does not have contact with the acetabulum

Question 4

What are signs of DDH in an infant?

Answer 4

• Assymetry of gluteal and thigh folds
• Limited hip abduction
• Shortening of the femur
• Positive ortolani test
• Positive barlow test

Question 5

What is the ortolani test?

Answer 5

Hip is reduced by abduction (sign of DDH in infant)

Question 6

What is the barlow test?

Answer 6

Hip is dislocated by adduction (sign of DDH in infant)

Question 7

What are signs of DDH in the child?

Answer 7

• One leg shorter than the other
• Positive Trendelenburg sign
• Walking on toes on one foot
• Walk with a limp

Question 8

What is the trendelenbury sign?

Answer 8

While bearing weight on the affected side, the pelvis tilts downward (sign of DDH in child)

Question 9

In DDH patients, what should be done at 2 weeks of age? Why?

Answer 9

Ultrasound; to determine the cartilaginous head of the femur

Question 10

What can diagnose DDH in infants older than 4 months of age?

Answer 10

X ray

Question 11

What do DDH patients newborn-6 months wear?

Answer 11

Pavlik harness

• Maintain harness in place for 12 weeks
• Check straps every 1-2 weeks for adjustment
• Perform neuromuscular skin integrity checks

Question 12

What is client teaching about the Palvik harness (newborn-6 m)

Answer 12

• Teach fam not to adjust straps
• Teach fam how to place harness if removal is prescribed
• Teach fam about skin care (use an undershirt, knee socks, assess skin, massage skin under straps, avoid lotion and powder, place diaper UNDER straps)

Question 13

What cast is used when adduction contracture is present?

Answer 13

Bryant traction or hip spica cast

Question 14

What is the Bryant traction?

Answer 14

-Hips flexed at 90 degree angle with butt raised off bed

Question 15

What are nursing action for Bryant traction?

Answer 15

• Neurovascular checks
• Maintain traction (ropes, boots, pulleys, and weights)
• Ensure client maintains alignment
• Skin care

Question 16

What are nursing actions for the hip spica cast?

Answer 16

• Needs to be changed to accommodate growth
• Maintain cast
• Frequent neurovascular check
• ROM with unaffected extremities
• Skin integrity (especially diaper area)
• Assess pain
• Evaluate hydration
• Assess elimination status daily

Question 17

How should casts be positioned?

Answer 17

On pollows

Question 18

Keep casts elevated until __

Answer 18

Dry

Question 19

What helps allow for drying?

Answer 19

Encourage frequent position

Question 20

How do we handle the cast when it is still wet?

Answer 20

Handle casts with the palm of hand until dry

Question 21

Use a waterproof barrier around the genital opening of the ____ to prevent soiling with urine or feces

Answer 21

Spica cast

Question 22

What happens at 6 months-2 years?

Answer 22

Surgical closed reduction with placement of hip spica cast

Question 23

What are complications of post op?

Answer 23

Atelectasis
Ileus
Infection

Question 24

What are effects of immobilization complications?

Answer 24

Decreased muscle strength
Bone demineralization
Altered bowel motility

Question 25

What are effects of casting complications?

Answer 25

Skin breakdown

Neurovascular alterations

Question 26

Infection: What would be changes in neuromuscular status?

Answer 26

Numbness
Tingling
Decreased mobility
Sensation 
Cap refill

Question 27

Infection: What kind of diet helps promote adequate hydration?

Answer 27

High fiber

Question 28

Infection: Reposition the child ____

Answer 28

Frequently

Question 29

The nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child’s mother ass the nurse why a Pavlik harness is not being used. Which of the following responses by the nurse appropriately addresses the mothers question?

A. The Pavlik harness is used for children with scoliosis, not hip dysplasia.
B. The Pavlik harness is used for school-age children
C. The Pavlik harness cannot be used for your child b/c her condition is too severe
D. The Pavlik harness is used for infants less than 6 months of age

Answer 29

D

Question 30

A nurse is caring for a preschool-age child. Which of the following assessments should the nurse use to assess for development dysplasia of the hip?

A. Barlow test
B. Trendelenburg sign
C. Manipulation of foot and ankle
D. Ortolani test

Answer 30

B