Nursing Care Plan

Group 1
(3rd)

Patient’s name: Jeremy Farmer

Chief Complain:
"He looks funny. Could he have brain damage?"
Assessment
Subjective data:

Mother concerned something is wrong with baby because he was born breech; points to stiffness of legs
as indication that some neurological problem must be present.

Objective data:

-Infant was born breech

-Unable to flex and abduct hips to assess for subluxated hip.

-Lower extremities are positioned sharply bent at the hip with extended knees.

-Knees flex but with difficulty.

Diagnosis
Dysplasia; Risk for Injury

May be related to untreated or incorrect treatment for the dislocation.

Planning
Jeremy will maintain his traction; Pavlik harness will be applied properly; skin will be free of irritation in
spica cast.

Implementation
-Assessed infant for frank breech 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.

-Maintained skin traction in presence of abduction contracture in the infant and spica cast as applied
following the traction; maintained skin traction for gradual reduction of the hip adductor and flexor
muscles with a spica cast application for immobilization.

- Applied Pavlik harness splinting device to infant up worn continuously for 3 to 6 months to ensure hip
stability; apply double or triple diapers or Frejka pillow if this is treatment ordered.

-Provided traction care including correct alignment of extremity, right number of weights, free hang of
weights, perfectly functioning pulleys with secure knots, neurologic and circulatory assessment every 2
hours for warmth, color, sensation.
-Provided diaper change frequently; used disposable diapers or plastic protection over a diaper.

-Educated parents about the type and extent of deformity and cause and treatment plan for correction
and prognosis by reinforcing physician information

-Educated 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.

Evaluation
After applying the nursing interventions, Jeremy maintains his traction; Pavlik harness is applied
properly; skin is free of irritation in spica cast.