4 Congenital Hip Dysplasia Nursing Care Plans

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Congenital hip dysplasia (also known as developmental hip dysplasia) is related to abnormal hip development that may arise during the fetal life. The abnormalities include hip instability, shallow acetabulum (preluxation), incomplete dislocation of the hip (subluxation), and femoral head not in contact with the acetabulum (dislocation). Involvement of the hip is unilateral but may appear on both. It predominantly occurs in females than in males. It is usually recognized during newborn and responds to treatment best if started before two (2) months of age.

Hip dysplasia treatment is dependent on the age of the child and the severity of the condition and ranges from application of a reduction device to traction and casting, to surgical open reduction. Casting and splinting with correction is usually unfeasible after six (6) years of age.

Nursing Care Plans

Nursing care planning goals for a child with congenital hip dysplasia include improving physical mobility, providing appropriate family and social supports, educating and involving parents in ADL’s, and avoiding complications (e.g., compartment syndrome).

Here are four (4) nursing care plans (NCP) for congenital hip dysplasia:

1. Impaired Physical Mobility

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Impaired Physical Mobility: Limitation in independent, purposeful physical movement of the body or of one or more extremities.

May be related to

• - Musculoskeletal impairment (hip defect)

Possibly evidenced by

• - Imposed movement restriction by splint, harness, cast, or traction
• - Inability to purposefully move within the physical environment including bed mobility; ambulation

Desired Outcomes

• - Child will move self in bed with traction bar; walk the length of the hallway and back twice a day.

Nursing Interventions	Rationale
Assess muscle mass, strength, tone; ability to move and activity level in performing ADL.	Provides data about the condition and function of the musculoskeletal system.
Assess sensory and motor function of extremities; presence of surgical correction of musculoskeletal abnormalities.	Provides data about conditions or treatments that affect mobility.
Assess activity restrictions, bed rest status, imposed immobility by braces, casts, traction, splints.	Keep rest during acute stages to promote healing and restoration of health.
Allow all age-appropriate activities that promote mobility, encourage the infant to crawl.	Facilitates mobility based on the constraints of illness and provides an opportunity to vent frustration due to imposed immobility.
Discourage activity restrictions unless ordered; allow and assist if possible in performing daily activities; administer pain medication prior activity.	Supports mobility and activity compatible with health and life; allows for independence and control for normal development.
Provide and apply harness, splint; use of aids including wheelchair, crutches, supportive reading, eating, and other aids for ADL as needed.	Promotes autonomy and support in mobility and activities.
Keep body alignment during bed rest, do position changes every two (2) hours or as needed; provide a drawing for the child to follow for position and area to lie in bed.	Avoids contractures and physical deformity.
Encourage and assist the child in muscle strengthening exercises, passive stretching exercises as appropriate.	Conserves muscle strength or prepares for use of mobility aids.
Facilitates rest with periods of mobility.	Avoids fatigue and maintains energy.
Teach parents and child about complications brought about by immobility.	Promotes compliance with the program to maintain mobility and understanding of effects of immobility.
Teach parents and child to utilize devices or aids for mobility and ADL.	Helps safe use of aids and equipment and increased protection.

2. Impaired Social Interaction

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Impaired Social Interaction: The state in which an individual participates in an insufficient or excessive quantity or ineffective quality of social exchange.

May be related to

• - Physical mobility restrictions

Possibly evidenced by

• - Boredom
• - Change in pattern of interaction
• - Environment that lacks diversion
• - Inability to engage in usual activities for the age group
• - Lengthy treatment and immobilization

Desired Outcomes

• - Parent will stay with the infant and renders social interaction.
• - Infant will respond positively to parental interaction.
• - Infant will be included in family activities.

Nursing Interventions	Rationale
Assess infant’s social interaction with parents.	Provides data about infant stimulation.
Allow significant others to visit or stay with the child.	Facilitates social interaction with others during prolonged treatment and decreases boredom.
Provide exposure to other children by moving bed near areas of activity or near a window; wheel on a stretcher, wheelchair, or stroller; allow to walk with cast or brace if permitted.	Promotes environmental stimulation and social interaction; fosters social interaction with others during long-term treatment and lessens boredom.
Encourage age-appropriate toys to be used in bed while in a prone or sitting position depending on the type of treatment and degree of immobilization.	Promotes social and developmental activities and decreases boredom during prolonged treatment.
Position toys and other items within the reach of the child.	Gives access to diversion activities when needed.
Encourage parents to allow as much independence if self-care by the child as possible.	Promotes independence and allows some control over the situation.
Teach parents to incorporate infant/child in the family activities.	Promotes a feeling of acceptance and well-being as part of the family.
Assist parents with devices available or methods of converting aids used for mobility to satisfy needs of the child with a cast or appliance.	Promotes exposure to a variety of activities and changes of environmental stimuli.

3. Constipation

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Constipation: A decrease in a person’s normal frequency of defecation, accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool.

May be related to

• - Musculoskeletal impairment
• - Inadequate physical activity or immobility.

Possibly evidenced by

• - Frequency less than usual
• - Decreased bowel sounds
• - Hard formed stool
• - Straining at defecation.

Desired Outcomes

• - Child will maintain passage of soft, formed stool every 1 to 3 days without straining.

Nursing Interventions	Rationale
Assess child’s stool including color, consistency, frequency and amount.	Normal consistency, frequency, and amount of stools vary with children’s age, and diet.
Encourage increased fluid intake as tolerated.	Adequate hydration is necessary for regular bowel movements.
Provide stool softener or mild laxative as needed.	May be prescribed to prevent fecal impaction.
Provide privacy during defecation.	Privacy allows the patient to relax, which can help promote defecation.
Provide regular exercise and activity as appropriate.	Movement promotes peristalsis. Abdominal exercises strengthen abdominal muscles that facilitate defecation.
Instruct parents to increase dietary fiver apple juice to milk formula for infants; fruits, vegetables, whole for older infants and children.	Provides bulk to the stool and makes defecation easier because it passes through the intestine essentially unchanged.

4. Risk for Injury

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Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

May be related to

• - Untreated or incorrect treatment for the dislocation

Possibly evidenced by

• [not applicable]

Desired Outcomes

• - Child will maintain his or her traction; Pavlik harness is applied properly; skin is free of irritation in spica cast.

Nursing Interventions	Rationale
Assess infant up to 2 months of age for frank breech birth, cesarean birth, hip joint laxity or dislocation (Ortolani or Barlow test), degree of dysplasia or dislocation, shortened limb on the affected side (telescoping), broadened perineum, asymmetry of thigh and gluteal folds with increased number of folds and flattened buttocks.	Provides information about the presence and degree of dysplasia; may be preluxation, subluxation, or dislocation (luxation) and involve a laxity of the capsule or an abnormal acetabulum; identification of the presence of the deformity at this age results in the highest success rate in complete correction.
Assess child’s shortened leg affected with telescoping; palpation of femur when thigh is extended and pushed toward the head and pulled in distal direction; delayed walking and a limp that causes lurching toward affected side; downward tilt of pelvis toward unaffected side if weight-bearing on affected side when standing (Trendelenberg sign); lordosis and waddling gait if both hips affected.	Provides information about the presence of deformity in one or both hips in the older infant or toddler and preschool age group; usually identified when the child begins to walk or stand, and limb is shortened and adductor and flexor muscle contracture has occurred; requires closed reduction (traction and cast) or open reduction (surgery, cast splint) to correct.
Maintain skin traction in presence of abduction contracture in the infant up to 6 months of age and spica cast if applied following the traction; maintain skin traction for gradual reduction of the hip adductor and flexor muscles with a spica cast application for immobilization in child 6 to 10 months of age.	Promotes hip abduction until stable; applies with a spica cast if unable to maintain stable reduction of the hip for 3 to 6 months; removal of the spica cast is followed by an abduction brace for protection.
Apply Pavlik harness splinting device to infant up to 6 months of age to be worn continuously for 3 to 6 months to ensure hip stability; apply double or triple diapers or Frejka pillow if this is treatment ordered.	Maintains abducted, reduced position for maintaining the femur in the acetabulum; other options to correct unstable hip may be applied to stretch legs and keep abducted position depending on the extent of the deformity.
Provide instruction on spica cast care including support of cast when moving, removing crumbs and small articles that may get into cast, petal cast edges, avoiding insertion of anything into cast to scratch, clean cast when needed, allow to dry completely, protect cast from soiling and dampness from elimination or bathing; neurologic and circulatory assessment every 2 hours for color, warmth, sensation, peripheral pulse, capillary refill; nausea and vomiting resulting from cast syndrome.	Maintains safe, effective immobilization to guarantee the permanent stability of the hip with child’s response to cast monitored for cast syndrome as a result from tight spica cast compressing the superior mesenteric artery of the duodenum.
Provide traction care including correct alignment of extremity, right amount of weights, free hang of weights, perfectly functioning pulleys with secure knots, neurologic and circulatory assessment every 2 hours for warmth, color, sensation.	Maintains safe, effective traction to affected hip(s) with child’s response to traction monitored.
Provide diaper change frequently and as needed; use disposable diapers or plastic protection over a diaper.	Maintains clean harness brace, or cast.
Educate parents about the type and extent of deformity and cause and treatment plan for correction and prognosis by reinforcing physician information; inform of suggested surgical reduction in an older child or if obstruction of joint development by soft tissue is present in the young child.	Provides information about the deformity, its classification, pharmacological or surgical regimen that is determined based on age and severity of the deformity.
Educate parents to apply splint or harness properly over the diaper and shirt, utilize disposable diapers or waterproof undergarment to protect appliance; on removal of harness for bathing if allowed or sponge bathing child with harness in place, padding shoulder straps, changing position every 2 hours; to prevent adjusting the harness.	Promotes and maintains hip reduction to correct the deformity.
Educate parents about traction care including reason and purpose for traction, amount of allowable movement, doing a neurovascular assessment and what to report, exact weight for amount and hanging with pulleys and knots if present, maintaining body alignment.	Assures accurate traction for the gradual reduction of the hip and/or preoperative if surgery is expected.
Educate parents about spica cast care including reason and purpose; keeping the cast clean and dry and shielding it from stool and urine using waterproof tape or plastic cover; providing cast support during movement; padding cast edges; doing lifting through crossbar; forbidding small objects or crumbs to enter cast; cast signatures without leaving white space between writing; Provide instruction in diapering or bedpan/toilet use; use of a diaper tucked into the perineal opening on cast; feeding infant in a supine position with head elevated or while being held in upright position on lap or in a car seat; notify parents that specially made car seats for infants with casts/harness are available and must be applied if the child rides in a car; refer to a social worker if financial constraints prevent access to the seats.	Guarantees correct cast care for immobilization of hip following a surgical hip reduction; traction or surgical correction may be used for acetabulum reduction or reconstruction.
Refer parents to community agencies supporting disabled children.	Provides information and support services to the child and family.

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References and Sources : nurseslabs.com