Coxa Plana (Legg-Calve-Perthes Disease) Ischemic necrosis leading to eventual flattening of the head of the femur due to vascular

r interruption. Pathopysiology - Synovial inflammation is the first stage which leads to vascular interruption leading to the second stage which is necrosis of the ossification center of the femoral head which in turn permits the 3rd stage to revascularize, causing bone reformation which then lead to the 4th stage which is healing and regeneration, there may or may not be residual deformity. Clinical Manifestation Muscle atrophy, Slight shortening of the affected leg, restricted hip abduction, Adductor muscle spasm in the affected hip. Diagnosis Hip and Antero Posterior X-rays, MRI, Physical examination Medical management Analgesics, Osteomy and subtrochanteric derotation, Spica cast Nursing management Provide cast care, Give prescribed analgesics, Provide emotional support.

Guillain Barre Syndrome A form of polyneuritis which often occurs after a procedure, initially affects the peripheral nervous system. Pathopysiology Segmeneted demyelination of periphearal nerve occurs prevemting normal transmission of electrical impulses; sensorimotor nerve roots are affected. Clinical Manifestation Muscle weakness, sensory loss, Difficulty chewing, talking and swallowing, Paralysis of ocular, facial and oropharyngeal muscles. Diagnosis CSF analysis may show normal WBC count an elevated protein count and increased CSF pressure. Medical management I.V beta adrenergic blockers, I.V immune globulin, tracheostomy, gastrostomy or jejunostomy feeding tube insertion. Nursing management Encourage DBE, Provide eye and mouth care, Provide passive ROM exercises.

Ewings Sarcoma Is a malignant round-cell tumour. It is a rare disease in which cancer cells are found in the bone or in soft tissue. Pathopysiology Originates in bone marrow then invades shafts of long and flat bones, usually affects lower extremities and may metastasize to lungs Clinical Manifestation Palpable mass, cachectic appearance, Abnormal gait

Diagnosis Serum alkaline phosphatase, Bone X-rays, CT scan, Radioisotope bone scan, Incision and aspiration Biopsy. Medical management Chemotherapy, Analgesics, Excision of tumor, Hemipelvectomy or Interscapulothoracic amputation Nursing management Encourage communication, and help patient set realistic goals, Give I.V meds.

Muscular Dystrophy Hereditary disorder characterized by progressive symmetrical wasting of skeletal muscles. Pathopysiology Muscle fibers necrotize and regenerate, regeneration slows and degeneration dominates, Connective tissue replaces muscle fibers, weakness and wasting result. Clinical Manifestation Wide stance and waddling gait, Lordosis and protuberant abdomen, posture changes, Scapular flairing Diagnosis Urine creatinine, Serum Creatinine kinase, lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase levels are elevated. Biopsy comfirms diagnosis Medical management Stool softeners, possible steroids, Surgery to correct contractures and Spinal fusion. Nursing management Encourage DBE, Use splints, braces and overhead slings, Provide low calorie, high protein and high fiber diet.

Erb Duchennes dystrophy Is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the upper trunk C5-C6 is severed. Pathopysiology Dystrophy mainly starts with dystocia then muscle fibers necrotize and regenerate, regeneration slows and degeneration dominates, Connective tissue replaces muscle fibers, weakness and wasting result. Clinical Manifestation Gowers sign, muscle hypertrophy and atrophy, Calves enlarged because of fat infiltration into muscle, Posture changes. Diagnosis - Urine creatinine, Serum Creatinine kinase, lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase levels are elevated, Amniocentesis, Electromyogram. Medical management - Stool softeners, possible steroids, Surgery to correct contractures and Spinal fusion.

Nursing management - Encourage DBE, Use splints, braces and overhead slings, Provide low calorie, high protein and high fiber diet.

Congenital Hip dislocation Occurs when the ballshaped head of the femur comes out of the cupshaped acetabulum set in the pelvis. Pathopysiology Clinical Manifestation Legs of varying length, uneven thigh skin folds, less mobility or flexibility on one side. Diagnosis Physical examination (Barlow Method), X-ray. Medical management Casts, Replacement of the head of the femur to the acetabulum, Analgesics. Nursing management Cast care, Skin care, Encourage DBE.