An infant diagnosed with developmental hip dysplasia has shown inadequate response to a Pavlik harness, demonstrated by increased irritability, resistance during passive abduction, and asymmetry in thigh folds. What is the most appropriate nursing intervention following the decision to transition to a rigid abduction brace?

A) Educate the parents on the importance of performing daily skin assessments.

B) Advise the parents to discontinue all forms of hip support until the next follow-up.

C) Encourage the parents to increase the infant's tummy time to strengthen hip muscles.

D) Instruct the parents to only use the brace during daytime hours.

An infant diagnosed with developmental hip dysplasia has been using a Pavlik harness, but recent assessments indicate that the harness is not effective. During a follow-up, increased irritability, resistance during passive abduction, and a palpable clunk on the left hip were noted. What is the most appropriate nursing action to prioritize while awaiting further orthopedic consultation?

C) Monitor the infant for signs of neurovascular compromise in the affected limb.

A) Reinforce the correct application and positioning of the Pavlik harness to ensure proper usage.

B) Educate the parents about the potential need for surgical intervention to manage the condition.

C) Monitor the infant for signs of neurovascular compromise in the affected limb.

D) Suggest the parents use over-the-counter pain relief for the infant’s discomfort.

An infant with developmental dysplasia of the hip (DDH) is being monitored after transitioning from a Pavlik harness to a rigid abduction brace. The parents report improved comfort but reduced mobility. Which nursing intervention is most appropriate to support the infant's developmental needs while using the brace?

B) Recommend placing the infant in a prone position for tummy time under supervision

A) Educate parents on performing passive range-of-motion exercises for the legs

B) Recommend placing the infant in a prone position for tummy time under supervision

C) Suggest reducing the wearing time of the brace to allow for free movement

D) Encourage the use of a walker to promote mobility and strength building

An infant is being monitored after transitioning to a rigid abduction brace for hip dysplasia. The parents report improved comfort but concern about reduced mobility, and the healthcare team notes improved passive abduction and absence of the Ortolani clunk, while thigh fold asymmetry persists. A follow-up ultrasound shows slight increase in femoral head coverage but shallow acetabulum. Which nursing intervention is most appropriate to support the infant's developmental needs during this treatment phase?

A) Encourage parents to engage the infant in age-appropriate play activities that promote upper body strength and cognitive development.

B) Suggest increasing the duration the infant spends in the brace to maximize hip stability.

C) Advise the parents to limit the infant's time on their stomach to prevent discomfort and potential injury.

D) Instruct the parents to remove the brace during sleep to enhance the infant's mobility and comfort.

An infant with mild acetabular dysplasia is wearing a rigid abduction brace and shows delayed gross motor development due to restricted mobility. Which nursing intervention is most appropriate to support the infant's motor development while maintaining hip stability?

B) Schedule regular physical therapy sessions focusing on exercises that can be performed with the brace on

A) Encourage daily removal of the brace to allow the infant to move freely

B) Schedule regular physical therapy sessions focusing on exercises that can be performed with the brace on

C) Advise parents to frequently reposition the infant in the brace to prevent discomfort

D) Suggest increasing caloric intake to support overall growth and development

An infant diagnosed with mild acetabular dysplasia is wearing a rigid abduction brace. During a routine follow-up, the healthcare team notices that the infant's gross motor skills are not progressing as expected due to the mobility restrictions of the brace. What is the most appropriate nursing intervention to support the infant's motor development while maintaining hip stability?

B) Schedule more frequent physical therapy sessions to enhance motor development.

A) Discontinue the use of the brace to promote unrestricted movement.

B) Schedule more frequent physical therapy sessions to enhance motor development.

C) Recommend the parents limit the infant's physical activity to prevent further hip instability.

D) Suggest increasing the brace-wearing duration to ensure maximal hip joint stabilization.

An infant with developmental dysplasia of the hip (DDH) is experiencing increased irritability and asymmetry in leg length despite wearing a brace. Upon further assessment, the healthcare team notes decreased hip abduction and a persistent shallow acetabulum. What would be the most appropriate nursing intervention to support the infant's care plan while minimizing the risk of further joint damage?

B) Educate the parents on the importance of adhering to the updated brace adjustments and schedule regular follow-up visits.

A) Encourage the parents to increase the infant's physical activity to promote muscle strength around the hip joint.

B) Educate the parents on the importance of adhering to the updated brace adjustments and schedule regular follow-up visits.

C) Suggest discontinuing the use of the brace to allow the infant more freedom of movement and reduce irritability.

D) Recommend immediate surgical intervention to correct the hip displacement and prevent future complications.

An infant with developmental dysplasia of the hip (DDH) is showing signs of subluxation despite wearing a brace. The healthcare team notes mild asymmetry in leg length and decreased hip abduction. Which nursing intervention is most appropriate to support the infant's developmental needs while addressing the orthopedic complications?

A) Educate the parents on the importance of consistent brace wear and schedule additional check-ups with the orthopedic specialist.

B) Encourage the parents to perform passive range of motion exercises with the infant's legs to improve hip mobility.

C) Suggest reducing the frequency of brace wear to allow for more natural movement and developmental play.

D) Advise the parents to limit the infant's movement to prevent further joint displacement.

An infant is being closely monitored for improved hip development while also managing discomfort and potential skin breakdown from brace use. What is the most appropriate nursing intervention to address the infant's skin integrity while ensuring continued orthopedic management?

A) Increase the frequency of skin assessments and apply a moisture barrier cream to prevent breakdown.

B) Discontinue the use of the brace entirely until the skin fully heals to prevent further irritation.

C) Apply additional padding to the brace without altering the frequency of diaper changes.

D) Focus solely on increasing the frequency of therapy sessions to improve hip development, disregarding skin issues.

An infant with developmental dysplasia of the hip is experiencing skin irritation and erythema due to the use of a corrective brace. Which nursing intervention is most appropriate to address the skin integrity issue while maintaining the effectiveness of the orthopedic treatment?

C) Adjust the fit of the brace and apply a protective barrier cream to the affected area.

A) Increase the duration of brace-free periods to allow the skin to breathe.

B) Apply a thick layer of moisturizing lotion under the brace to prevent dryness.

C) Adjust the fit of the brace and apply a protective barrier cream to the affected area.

D) Discontinue the use of the brace until the skin heals completely.

infant developmental hip dysplasia - Nursing Case Study

Pathophysiology

• Primary mechanism: Developmental hip dysplasia occurs when the acetabulum (hip socket) is shallow or improperly formed, leading to insufficient coverage of the femoral head. This anatomical abnormality can result in joint instability and subluxation or dislocation of the hip, particularly as the infant grows and begins to move.

• Secondary mechanism: Ligamentous laxity, often influenced by hormonal, genetic, or environmental factors, contributes to the instability of the hip joint. This laxity allows more movement than normal within the joint, exacerbating the risk of dislocation and improper joint development.

• Key complication: If left untreated, developmental dysplasia of the hip can lead to early-onset osteoarthritis, gait abnormalities, and chronic pain due to improper joint alignment and wear over time. Early diagnosis and intervention are crucial to prevent these outcomes and ensure normal hip development.

Patient Profile

Demographics:

6-month-old female, not applicable

History:

• Key past medical history: Diagnosed with developmental hip dysplasia at 2 months of age

• Current medications: Vitamin D supplement

• Allergies: No known allergies

Current Presentation:

• Chief complaint: Limited mobility and discomfort in the left hip

• Key symptoms: Asymmetrical thigh folds, limited range of motion in the left leg, and occasional irritability

• Vital signs: Temperature 99.1°F, Heart rate 160 bpm, Respiratory rate 45 breaths per minute, Oxygen saturation 98% on room air

Section 1

In the following weeks after the initial diagnosis of developmental hip dysplasia, the infant was placed in a Pavlik harness to promote proper positioning of the femoral head within the acetabulum. However, during a follow-up appointment, the parents reported increased irritability and persistent discomfort, particularly during diaper changes and when placing the infant in the harness. Upon initial assessment, the healthcare team noted that the infant's left leg exhibited increased resistance during passive abduction of the hip, and there was a palpable clunk noted during the Ortolani maneuver, suggesting possible subluxation or worsening of the hip dysplasia. Additionally, the asymmetry in thigh folds appeared more pronounced, indicating a potential progression in the severity of the condition.

Given these findings, a decision was made to perform an ultrasound of the infant's hips to assess the positioning of the femoral head and the depth of the acetabulum. The ultrasound results revealed that despite the use of the Pavlik harness, there was insufficient coverage of the left femoral head, indicating a failure of the harness to adequately stabilize the joint. The acetabulum remained shallow, and the femoral head was not consistently positioned within the socket, raising concerns about the risk of further dislocation and potential joint damage.

These findings necessitated a reevaluation of the current management plan. It was determined that the Pavlik harness was not effective for this infant, and orthopedic consultation was sought to discuss alternative treatment options. The possibility of transitioning to a rigid abduction brace or considering surgical intervention was introduced, depending on the infant's response to the next phase of treatment. This change in approach aimed to prevent long-term complications and ensure optimal hip joint development as the infant continues to grow. The healthcare team emphasized the importance of regular monitoring and follow-up to assess the effectiveness of the new interventions and to adjust the treatment plan as necessary.

Section 2

In the weeks following the transition to a rigid abduction brace, the healthcare team closely monitored the infant's progress through regular follow-up appointments. During these assessments, the parents reported a noticeable improvement in the infant's comfort levels, with reduced irritability and less resistance during diaper changes and daily handling. However, they expressed concern over the infant's reduced mobility, as the brace limited the infant's ability to move freely, which could potentially impact developmental milestones such as rolling over and crawling.

Upon initial assessment, the healthcare team observed that the infant's left leg showed improved passive abduction, with a reduction in the previously noted resistance. The palpable clunk during the Ortolani maneuver was no longer present, indicating that the rigid abduction brace was more successful in maintaining hip stability compared to the Pavlik harness. Despite these improvements, the thigh fold asymmetry remained evident, suggesting that while the brace was effective in stabilizing the hip joint, the acetabular development was still a concern.

To further evaluate the effectiveness of the new treatment approach, a follow-up ultrasound was performed. The results showed a slight increase in the coverage of the left femoral head, although the acetabulum remained shallow. These findings suggested that while progress was made, the infant was still at risk for potential complications if additional interventions were not considered. The orthopedic team discussed the possibility of a minimally invasive surgical procedure, such as an arthrogram-guided closed reduction, if significant improvements were not observed in subsequent evaluations. This decision highlighted the importance of balancing immediate treatment goals with the long-term developmental needs of the infant, ensuring both hip stability and overall growth and development. Regular monitoring and collaborative decision-making with the parents remained essential components of the ongoing care plan.

Section 3

Several weeks after the transition to the rigid abduction brace, the infant returned for a routine follow-up, during which new diagnostic results provided additional insights into the condition's progression. The ultrasound showed a marginal improvement in the acetabular index, indicating a slight deepening of the acetabulum, yet it remained below the expected developmental range for the infant's age. Additionally, the femoral head coverage had increased to 50%, suggesting some progress in stability but still leaving room for concern regarding full hip joint development. The radiologist noted mild signs of acetabular dysplasia, which warranted continued close monitoring to prevent potential degenerative changes or hip joint deformities as the infant grew.

During this visit, the parents reported that while the infant had adapted to the brace, they noticed increased frustration during attempts to initiate movement, such as rolling from back to front. The healthcare team observed that the infant's gross motor skills were not progressing at the expected pace, potentially due to the mobility restrictions imposed by the brace. Although the infant's weight gain and overall growth parameters remained within normal limits, these findings raised concerns about the potential impact on motor milestone achievement, highlighting the delicate balance between maintaining hip stability and promoting typical motor development.

In response to these findings, the healthcare team decided to schedule more frequent physical therapy sessions to support the infant's motor development while ensuring hip stability. They emphasized the importance of a multidisciplinary approach, involving orthopedic specialists, pediatricians, and physical therapists, to tailor interventions that would address both the orthopedic and developmental needs of the infant. This approach aimed to enhance the infant's mobility within the constraints of the brace and potentially avoid the need for surgical intervention, ensuring a holistic path forward in the infant's care plan.

Section 4

As the multidisciplinary team continued to monitor the infant's condition, they noted a change in the patient’s status during a follow-up appointment. The parents reported that their child was increasingly irritable, especially during diaper changes and when attempting to engage in play activities. Upon examination, the healthcare team observed that the infant was now experiencing mild asymmetry in leg length when measured from the anterior superior iliac spine to the medial malleolus. The left leg appeared slightly shorter than the right, which raised concerns about potential subluxation. Additionally, there was a noticeable decrease in hip abduction on the affected side, with measurements showing only 30 degrees of abduction compared to 45 degrees on the opposite side. These findings suggested a possible progression in the dysplastic changes despite the use of the brace and necessitated further evaluation.

In response to these new complications, the team ordered an updated ultrasound and a pelvic X-ray to assess the structural status of the hip joint more comprehensively. The ultrasound indicated a persistent shallow acetabulum with an acetabular index of 30 degrees, a value that remained outside the normal range for the infant's age. The X-ray revealed a slight lateral displacement of the femoral head, supporting the findings of potential subluxation. These results prompted the team to re-evaluate the current management plan and consider adjustments to the brace or explore alternative interventions. This situation required careful clinical reasoning to weigh the risks and benefits of each potential intervention, particularly considering the infant's developmental needs and the goal of preventing long-term joint damage.

The healthcare team discussed these findings with the parents, emphasizing the need for continued close monitoring and the potential for increased intervention intensity. They outlined a plan to increase the frequency of orthopedic evaluations and physical therapy sessions, aiming to address both the orthopedic complications and support motor development. This approach underscored the importance of maintaining an adaptable care plan that could respond to changes in the infant's condition, ensuring that both immediate and future developmental needs were met while minimizing the risk of surgical intervention. The team remained committed to a collaborative, evidence-based practice, with the ultimate goal of achieving optimal outcomes for the infant's hip joint development and overall growth trajectory.

Section 5

In the weeks following the intensified management plan, the healthcare team observed the infant's response to the revised interventions. During a routine follow-up appointment, the physical therapist noted an improvement in the infant's range of motion during guided exercises. The left hip abduction increased to 35 degrees, indicating a modest but positive response to the increased frequency of therapy sessions. However, the parents reported that the infant continued to show signs of discomfort and irritability during diaper changes and prolonged periods in the brace. This discomfort raised concerns about potential skin irritation or pressure sores, prompting a thorough skin assessment.

Upon examination, the nurse identified erythema and slight breakdown over the left greater trochanter region, likely due to pressure from the brace. The team immediately adjusted the fit of the brace and applied a protective barrier cream to the affected area. The pediatrician also recommended alternating brace-free periods to reduce pressure while closely monitoring the hip's stability. Meanwhile, the infant's vital signs remained stable, with a heart rate of 120 beats per minute, respiratory rate of 30 breaths per minute, and temperature within normal limits at 98.6°F. These findings provided reassurance that the infant was otherwise stable, allowing the team to focus on addressing the localized skin complication.

Despite the initial improvements in range of motion, the multidisciplinary team remained vigilant about the potential risk of further subluxation. Consequently, they scheduled a follow-up ultrasound in two weeks to reassess the hip joint's status and ensure that the current interventions were effectively promoting acetabular development. This careful monitoring and adaptive approach highlighted the importance of balancing orthopedic management with the infant's comfort and overall well-being, ensuring that each aspect of care was addressed comprehensively. The collaborative efforts of the team aimed to prevent progression toward more invasive interventions while supporting the infant's growth and developmental milestones.