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).
Risk for Injury
- Risk for Injury
May be related to
- Untreated or incorrect treatment for the dislocation
Possibly evidenced by
- [not applicable]
- Child will maintain his or her traction; Pavlik harness is applied properly; skin is free of irritation in spica cast.
|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|
(Trendelenburg 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.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for musculoskeletal disorders and conditions:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 11 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Laminectomy (Disc Surgery) | 8 Care Plans
- Osteoarthritis | 4 Care Plans
- Osteoporosis | 4 Care Plans
- Rheumatoid Arthritis | 6 Care Plans
- Scoliosis | 4 Care Plans
- Spinal Cord Injury | 12 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans