Primary Nursing Diagnosis

Pain (acute) related to lack of the continuity of the bone to joint; edema and muscle spasms

OUTCOMES. Comfort level; Pain control behavior; Pain level; Symptom severity

INTERVENTIONS. Analgesic administration; Anxiety reduction; Environmental management: Comfort; Pain management; Medication management


If the joint remains unreduced (to reduce is to restore the components of the joint to their usual relationships), the patient is at greater risk for avascular necrosis. The primary goal for

294 Dislocation; Subluxation therapeutic management is to realign the bones of the joint to their normal anatomic position. With injuries or chronic conditions, the physician will generally use a closed reduction (manually placing the bone into the joint) after giving the patient a sedative or a local or general anesthetic. The decision for a closed reduction depends on the person's age, condition, and severity of the injury. If the same joint has repeatedly become dislocated or if the condition is severe, an open reduction is required. This procedure requires general anesthesia or an anesthetic block and involves surgical intervention for repositioning the bones and repairing ligaments. Once the proper position has been achieved, the physician may use pins or screws to maintain alignment.

After the open or closed reduction is accomplished, the physician immobilizes the joint to allow for healing through slings, taping, splints, casts, or traction devices. Treatment of subluxation is similar to that of a dislocation, but subluxation generally requires less healing time. Patients require a carefully regulated exercise program to restore the joint to its original range of motion without causing another dislocation.

The goal for treating DDH is the same as other dislocations or subluxations. However, the age of the child and the developmental nature of the condition alter the intervention. Treatment approaches vary, according to the child's age. Infants under 3 months of age may simply require a triple diapering technique. This procedure abducts (by use of the thick diapers) positioning the femoral head into the acetabulum as the baby grows. Skin traction such as Bryant's or spilt Russell's may be used for the baby over 3 months of age. These procedures relocate the femur to the acetabulum while gently stretching the ligaments and muscles around the joint. For the 3- to 6-year-old patient, serial casting (the placement of several casts over time as the child grows or as realignment is required) or open reduction with casting may be needed.

Pharmacologic Highlights

Medication or Drug Class





Naproxen, 500 mg

Analgesic, anti-inflammatory,

Uncertain mechanism of


PO followed by

and antipyretic activities

action; may inhibit


250 mg q 6-8 hr

Getting to Know Anxiety

Getting to Know Anxiety

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