many children and adolescents, sports are one way to build friendships, work in teams, engage in healthy competition, and earn scholarships—Tracy Yatsko was no exception. Tracy played on her high school’s basketball and track teams until suffering from a severe concussion. Initially, her concussion was thought to be mild. However, the dizziness and nausea lingered into the next evening when she collapsed in the locker room after another game. Tracy spent much of the remaining school year at home with migraines, nausea, vomiting, and difficulty concentrating. She was prescribed several different medications, was forced to stop playing sports, and lost many friends (Mishori, 2012). Sports injuries such as concussions are only one of several musculoskeletal and neurologic disorders that impact pediatric patients. Patients with these disorders often require extensive care, and as the advanced practice nurse, it is your role to provide this care, develop treatment strategies, and identify factors that impact adherence to care.

This week you explore musculoskeletal and neurologic disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

· Assess pediatric patients for musculoskeletal and neurologic disorders

· Evaluate differential diagnoses for pediatric musculoskeletal and neurologic disorders

· Analyze treatment and management plans for pediatric patients with musculoskeletal and neurologic disorders

· Analyze strategies for educating patients and families on the treatment and management of musculoskeletal and neurologic disorders

· Evaluate the impact of culture on the treatment and management of musculoskeletal and neurologic disorders

· Understand and apply key terms, principles, and concepts related to musculoskeletal and neurologic disorders in pediatric patients

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L.  (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.

· Chapter 28, “Neurologic Disorders” (pp. 660-702)

This chapter explores the anatomy and physiology of the nervous system. It also presents assessment and management strategies of degenerative and nondegenerative disorders in children.

· Chapter 37, “Musculoskeletal Disorders” (pp. 983-1041)

This chapter examines the anatomy and physiology of the musculoskeletal system. It also explores clinical findings, differential diagnoses, and management of musculoskeletal disorders specific to children including hip, knee, and foot problems.

Marsh, A.M.,  Fraser, D., Marsh, J.P., Serota, J.A., Giordano, B., & Hallas, D. (2013). Management of concussion in the pediatric patient. Journal of Pediatric Health Care, 27(6), 499-504.

Note: Retrieved from the Walden Library databases.

American Academy of Pediatrics, Subcommittee on Febrile Seizures. (2011). Febrile seizures: Guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics, 127(2), 389–394. Retrieved from http://pediatrics.aappublications.org/content/127/2/389.full.pdf+html?sid=e5cbf9c6-b05c-459a-9aff-5a9d83a37a07

This article provides evidence-based recommendations for the diagnosis and evaluation of simple febrile seizures in infants and young children. It also identifies the benefits and limitations of various treatment options for simple febrile seizures.

Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders

Musculoskeletal and neurologic disorders can present complications for pediatric patients from infancy to adolescence. These disorders affect patients physically and emotionally and often impact a patient’s ability to participate in or carry out everyday activities. Patients with these disorders frequently need long-term treatment and care requiring extensive patient management and education plans. Musculoskeletal and neurologic disorders present various symptoms because they affect multiple parts of a patient’s body. Consider treatment, management, and education plans for the patients in the following three case studies.

Case Study 2:

HPI: A 12-year-old girl presents with left knee pain during and after playing soccer. She’s been a member of an elite soccer team for the last 6 years. She has 2 hour practices 3 times a week. Does not recall any injuries.

PMH: asthma, eczema MS: Anterior/posterior drawer tests negative; negative ballottement; negative edema/erythema; bony tenderness, slight swelling at the left tibial tubercle.

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To prepare:

· Review “Neurologic Disorders” and “Musculoskeletal Disorders” in the Burns et al. text.

· Review and select one of the three provided case studies. Analyze the patient information.

· Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

· Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.

· Consider strategies for educating patients and families on the treatment and management of the musculoskeletal or neurologic disorder.

Post an analysis of your assigned case by responding to the following:

· What additional questions will you ask?

· Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).

· What additional examinations or diagnostic tests, if any will you conduct?

· What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.

· What is your most likely diagnosis and why?

· How will you treat this child?

· Provide medication treatment and symptomatic care.

· Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.

· Patient Education, Health Promotion & Anticipatory guidance:

· Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.

· Include any socio-cultural barriers that might impact the treatment and management plans.

· Health Promotion:

· What immunizations should this child have had?

· Based on the child’s age, when is the next well visit?

· At the next well visit, what are the next set of immunizations?

· What additional anticipatory guidance should be provided today?