Care for Child w/MSK Condition & Maltreatment Flashcards
Several different methods to immobilize an extermity
Splinting Devices
Boots
Casts
Skin traction
Skeletal traction
Distraction devices
Splinting devices and boots can be done in outpatient setting or ER; easily removed
6 P’s of Neurovascular Assessment
Pain unrelieved by narcotics
Pallor
Paralysis
Paresthesia
Pulselessness
Poikilothermia
Main principles of traction is to
reduce dislocations and immobilize fractures
Skin traction
Force is applied over a large area of skin (DDH, femur fractures)
Skeletal traction
Force is applied directly to the bone (pin or wire, often for multiple injuries sustained)
What head shape abnormality?
Most often positional (Back to Sleep)
Cranial sutures are overriding
Facial abnormalities
Treated with corrective helmet
Plagiocephaly
What head shape abnormality?
Premature fusion of one or more of the cranial sutures
Most need craniotomy
Craniosynostosis
Common foot deformity diagnosed in newborns
May be associated with spina bifida or other anomalies, can be idiopathic
CONGENITAL TALIPES EQUINOVARUS (CLUBFOOT)
S/sx of clubfoot
Foot is:
Plantar-flexed
Inverted heel
Adducted forefoot
Rigid and cannot be manipulated into a neutral position
Risk factors for clubfoot
maternal obesity, maternal smoking, amniocentesis before 20 weeks, CVS
Treatment for clubfoot
-Serial casting
Provide cast care education, ADL’s- bathing, diapering
-Severe cases of clubfoot may require surgery
Post-op care & monitoring
Abnormal development of the hip (subluxation or dislocation of acetabulum)
Can result in abnormal gait, decreased strength, and hip & knee joint disease if untreated
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
S/sx of DDH
+ Ortolani or Barlow sign (first 3 months of age)
+ Galeazzi sign
Unequal gluteal folds
In older children, + Galeazzi, unequal leg length
Treatment for DDH
-Abduction brace (Pavlik harness 23 hours a day)
-If Pavlik fails, closed reduction and hip spica casting
-If after 18 months, open reduction and hip reconstruction
interrupted blood supply to the femoral head avascular necrosis of femoral head
Can be genetic or environmental
LEGG-CALVE-PERTHES DISEASE
S/sx of Legg-Calve-Perthes disease
-Hip or knee soreness or stiffness
-Pain that increases with activity and decreases with rest
-Painful limp
-Quadriceps muscle atrophy
-Joint dysfunction
-Limited ROM
Capital femoral epiphysis (top of femur) slips through epiphysis (growth plate) in a posterior direction
Cause unknown, genetic/obesity
8-15 years old
Treated with surgery (pinning)
SLIPPED Femoral Capital Epiphysis (SCFE)
S/sx of Slipped Femoral Capital Epiphysis
Pain in groin or referred pain to thigh or knee
Pain during internal rotation of hip
Hip does not fully rotate externally
Abduction is Limited
Affected leg may be shorter in moderate or severe slip
Sprains and strains are
soft tissue injuries
Connect muscle to bone
tendons
Connect bone to bone
ligaments
Sprain stretches or incomplete tears of a __________.
Causing Pain, Swelling, Bruising, Instability, & Loss of ability to move and use joint
ligament
__________ or muscles are stretched in a strain.
Causing Pain, Swelling, Limited motion, Muscle spasms, Muscle weakness, & Cramping
tendons
Patellar ligament irritation at the prominence of the tibial tubercle
Overuse in active school age children or adolescents
S/sx: pain below kneecap, pain when squatting or extending knee against resistance
Osgood-Schlatter Disease
What is it: Bone undergoes more stress than it can absorb
Cause: Most common are falls, MVA’s & bicycle accidents
S/S: Pain, swelling around area, immovable limb
Diagnosed w/ imaging
Fractures
How are fractures treated?
Closed reduction
Open reduction (surgery)- pins, screws, plates, rods
Elevate & cold packs
What it is: Non-painful lateral curvature of the spine.
Types:
C-curve: laterally in one direction
S-Curve: two opposite directions
Diagnosed initially with Adam’s position or the bend over test. Then, radiography at Cobb’s angle.
Scoliosis
S/sx of scoliosis
Unequal shoulder heights
Scapular prominences and heights
Rib prominences
Chest asymmetry
Unequal leg length
Treatment for scoliosis
Back Brace
-Brace worn 23 hours a day
-Skin care and monitoring
-PT
Halo Traction
-Will sometimes use before surgery
Spinal Surgery: Spinal Fusion, may delay to prevent issues with spinal growth, necessary if pulmonary function is compromised
Bacterial Infection of the bone and tissues around the bone and bone marrow. Infection spreads to ends of bones and can destroy epiphyseal plate.
Causes:
Open fracture or blunt trauma
Penetration of skin
Septic joint
Infected wound
Bacterial infection in body
Osteomyelitis
S/sx of Osteomyelitis
Pain
Fever
Irritability
Soft tissue swelling, redness, warmth, pain
How is osteomyelitis treated?
w/ antibiotics
Connective tissue disorder which can cause fractures with minimal or no trauma (decrease in synthesis of collagen)
Osteogenesis Imperfecta
AKA brittle bones disease
Blue sclera, deformed teeth, brittle bones
osteogenesis imperfecta
Group of muscle disorders that cause the gradual wasting and degeneration of symmetrical groups of skeletal muscle
MUSCULAR DYSTROPHIES
What are the three types of MD?
3 Types:
Duchenne’s (most common)
Congenital myotonic dystrophy
Facioscapulohumeral MD
Symptoms appear after child can walk (3-7 years of age)
Waddling, wide-based gait
Calf muscles become weak and hypertrophied
Leg, Pelvis, arm, shoulder, and cardiac muscles weak and hypertrophied
Gower’s maneuver to rise from floor
Duchenne’s MD
Risk factors for abuse
-Children < 1
-Children with disabilities/chronic illness
-Single parents
-Low socioeconomic level
-Caregivers with: Mental Illness, Substance use, Strict ideas of discipline, hx of generational abuse, &Marital discord
-Intentional injuries
-Injuries are inconsistent with story: Bruises, Burns, Fractures, &Changes in behavior
Physical abuse
-Any behavior, attitude, or failure to provide emotional or physical care
-Impairs a child’s socio-emotional development, mental health, and sense of self-worth
Emotional abuse
-Any sexually related act involving adult and a child
-Violation of bodily privacy
-Exposing to adult sexuality
-Exploiting through child pornography or prostitution
-Electronic sexual luring
-UTIs, changes in behavior, regression, running away, abnormal knowledge of sex
Sexual abuse
-Most common yet most difficult to prove
-Seen in families with mental illness and/or substance abuse
Neglect
Retinal hemorrhage can lead to
blindness
-Caregiver fabricates signs and symptoms of illness in child
-Child may undergo needless and painful procedures and treatments
-10% of cases may be fatal to the child
-Difficult to prove
Munchausen Syndrome by Proxy (MSBP)
Munchausen Syndrome by Proxy (MSBP) Perpetrators will
-Gain support of the health care team through skilled deceit, leading professionals to believe they are a devoted, loving caregiver.
-Doctor shops & hospital jumps so that tracking the child’s true medical history is virtually impossible
-Typically, the mother
-Often work in health care
-Reporting of signs and symptoms occurring only in the presence of the parent
-Reports that illness is unresponsive to treatments
-Marital discord is often present
-May have other children with complicated medical histories
Common Presentations and Methods of Deception of Munchausen Syndrome by Proxy
Apnea- suffocation, drugs, poisoning
Seizures- drugs, poisoning, asphyxiation
Vomiting- poisoning w/drugs that initiate vomiting
Diarrhea- poisoning w/drugs such as laxatives, mineral oil, or salt
