Care Of A Child With Musculo Skelet Disorder Flashcards
In a neuro vascular check what do we look for
Pain Pallor Parasthesia Paralysis Bilateral pulse Polar Capillary refill
What do we do to children prior to
MRI and ct scan to make compliance easier?
Sedate patient
What is a contusion
Tearing of subcutaneous tissue
Blood in the soft tissue
Hematoma
What is a sprain
Torn ligaments
What is a strain
Small tear in muscle or tendon
Treatment for soft tissue injury
Rest (non weight bearing)
Ice
Compression
Elevation
Two common fractures in children
Green stick and buckle fracture (wrist)
What is Bryant’s traction
Skin traction used for children under 3 years old or 30 lbs
Used for dislocated hip or femur fracture
Buttocks is kept off bed
Risk for aspiration
Risk for volkmans ischemia
What is Russell’s traction
Weight pulls in two directions
Vertical and horizontal
Body acts as counter weight
Responsibility for traction
Applied and removed by MD Weights hang freely Pin care NV checks Observe for infection, compliance, and constipation
What is osteomyelitis
Inflammation of the bone caused by staph
What is Duchenne’s muscular dystrophy?
Progressive neuromuscular disease. Hereditary recessive, occurs in males. Fatty infiltration of muscle cells (breakdown)
Signs and symptoms of DMD
Delayed walking Decrease muscle strength Clumsiness (no fine motor skills) Increase lordosis Gowers sign Over developed calve muscles
What is Gowers sign
Difficulty getting up from sitting position. Holding calves to get up
What is the prognosis with DMD and what care do we provide for patients with the disease?
Poor prognosis life expectancy is early 30s. Prevention of complications is main goal.
When is DMD usually diagnosed
4-5 years of age
What is another name for legg-calve-perthes disease
Coxaplana
What is Coxaplana
Lack of circulation to the femoral head - slips out of acetabulum
What is the cause of Coxaplana and how does it develop?
Unknown cause - results from trauma or synovitis prior
What test is done to diagnose Coxaplana?
X-Ray
How long is treatment for Coxaplana?
1-2 years
What is the treatments for Coxaplana?
Bucks traction
Hip bracing to ABDUCT hips/legs
Maintain ROM
Limit activity during treatment
What is the prognosis for Coxaplana?
Good however there’s a potential for hip degeneration in later years
Where do bone rumors usually develop?
In the long bones
What is Ewing’s sarcoma?
Tumor growth in the marrow of long bones
What is the problem with Ewing’s sarcoma?
It can metastasize to the lungs and other bones
S&S of Ewing’s sarcoma
Pain
Possible mass at site
Possible fracture
What is osteosarcoma?
Primary malignant tumor of long bones. Also mets to lungs
Signs and symptoms of osteosarcoma
Pain, limited mobility, obvious tumor mass
What is the treatment for osteosarcoma
Amputation and chemo
What is given after amputation of affected limb in osteosarcoma for patient to return to a normal life
Possible prosthesis
What can cause juvenile rheumatoid arthritis?
Chronic strep infection
Systemic RA
Fever for 10 days, internal organs affected
Polyarticular
Arthritis in 5 or more joints
Pauciarticular
Arthritis in 4 or less joints
S&S of JRA
Swollen joints
Enlarged liver & spleen
Anemia, anorexia, rash
Pericarditis, myocarditis, uveitis (inflammation of anterior chamber in eye)
What test would be elevated in JRA?
ANA & the tests associated with Lupus
Treatment for JRA
NSAIDs, heat packs/hot showers
Good nutrition
Immunizations
Corticosteroids
What does uveitis lead to
Blindness
How can we do range of motion for a child with JRA
Play with child (catch, dance, etc)
Drug of choice for JRA
NSAIDS
What is the problem with NSAIDS
They are gastrotoxic therefore take with food/milk
What medication is acceptable to use in children with JRA that would otherwise not be acceptable
Aspirin
What is ankylosis and how is it prevented
Joint deformity and ROM will prevent it
What will affect immunizations in JRA
The steroid therapy the patient is on
What is wax & wane in JRA
On and off symptoms (exacerbations)
What is scoliosis
S like curvature of spine
What is functional scoliosis
Poor posture
What is structural scoliosis
Congenital
Neuromuscular
Idiopathic
How is scoliosis tested for
Patient bends over - dr feels spine
X ray
What is treatment for curves under 20 degrees
Good posture
backpack safety
Treatment for curves 20-40 degrees
Boston brace
Milwaukee brace
Daily exercise
Treatment for curves greater than 40 degrees
Harrington rods
Spinal fusion
How long does patient wear back brace
23 hours a day for 2-3 years
How do we protect skin integrity when patient with scoliosis wears brace
Light tee shirt under brace
How long patient in hospital after surgery for scoliosis
48-72 hours
When does physical therapy start for back surgery in scoliosis
4-6 weeks after surgery
What do we do directly after sport injury
Ice 20 min on and off for first 24 hours
Inflammation of middle ear secondary to upper respiratory infection
Otitis media
Another name for otitis media
Ear infection
What can also cause an ear infection
Communicable disease complication
Haemophilus influenzae (flu)
Baby w/ bottle in bed
Second hand smoke
How does second hand smoke cause ear infection
Smoke damages cilia in ear
Signs and symptoms of OM (otitis media)
Pain in ear (pulling on ear) Irritability Diminished hearing Fever Headache Vomiting & diarrhea Potential for rupture of eardrum
Treatment for OM
Broad spectrum antibiotic if throat culture is positive
Analgesics
Ear drops
How do you administer ear drops in a child under 3 years old
Ear lobe down and back
How do you administer ear drops in a child over 3 years of age
Pinna up & back
Why do we not put cotton in the ear after administering ear drops in ear infections
The cotton will absorb all of the medication - ineffective treatment
Nursing care for ear infection
Meds as ordered - anti biotics and Tylenol No cotton in ear Place child on side if drum is ruptured Cold compress for pain relief Check temp Avoid water in ears
If ear drum ruptured what do we do
Put patient on affected side to drain ear
How do you get swimmers ear
Going under water
How do we tell Difference between ear infection and swimmers ear
When you press on ear, pain with swimmers ear
What is a myringotomy
Procedure to drain fluid from straight eutstachian tube
What age is a myringotomy
Children under 5
How do the tubes come out after a myringotomy
They fall out on their own
What causes hearing impairment in newborns
Pre natal viral infection or German measles (rubella)
How do you get acquired deafness
Measles, mumps, meningitis, exposure to loud noise
Temporary due to wax build up
Chronic ear infections
Neurological deficit
What kind of delays can we expect to see in hearing impaired child
Speech, relationship and developmental delays
What kind of communication adaptation is available for the hearing impaired
ASL (American sign language)
Nursing interventions for hearing impairement
Safety concerns
Gain child attention before speaking
Face child at eye level
Proper care of hearing device
What is hyphema
Bleeding into the anterior chamber of the eye usually caused by blunt or penetrating trauma
A tearing of the subcutaneous tissue that results in hemorrhage, edema, or pain
Contusion
Blood in soft tissue
Hematoma
Torn ligament or ligaments stretched. Swelling pain and immobility occurs
Sprain
Small tear in muscle or tednon occuring overtime, pain and edema occur
Strain
Break in bone
Fracture
What type of fracture is Bone broken but not through skin
Simple
Fracture that is broken bone through skin, at great risk for infection
Compund
Fracture that is incomplete, one side is broken other side is bent
Greenstick
Fracture that is caused by forceful twisting motion
Spiral
With a spiral fracture what must we not rule out
child abuse
A non-displaced fracture is when
Bones are still in alignment
A displaced fracture is when
Bones have shifted and need to be re-aligned
No surgery, bones are gently put back into place and cast or traction is applied
Closed reduction
Surgical procedure usually requiring pins, rods, or other devices
Open reduction
Used when the immobilization required is more that what could be obtained by casting
Traction
What are the 4 purposes of traction
Ensure alignment, Secure corrected position, prevent or treat contracture deformities, and to relieve muscle spasm and back pain
How do we check pulses during nuerovascular assessment
Distal to injury or cast, if it is difficult use a doppler
If the child cannot feel touch on the extremety what can we expect it to be
compartment syndrome
What are the excersies called that are used to prevent muscle atrophy and to strenghten muscle
isometric excersices
Weights in traction care should
hang freely and not touch the floor
Ropes in pulley for traction care should
Move freely, and not be obstructed
What is the last thing that child will develop, and when should it advance
Fine motor coordination, before 7 yo
By 18 months the child should be able to
Walk steady
By 6 years of age the child should be able to in reference to gait
walk like an adult
Muscle tone is developed
Cephalocaudal
What is psuedoparalysis
When child is afraid to move extremity because it is going to hurt
What are the 5 P’s in Neurovasuclar Assessment
Pain, Pallor, Parasthesia, Paralysis, Pulse
Tearing of subcutaneous tissue
Contusion
Blood in the soft tissue
Hematoma
What does RICE stand for and what is it used for
Rest, Ice, Compression, Elevation. Soft tissue injuires
When elevating for a soft tissue injury what must we elevate it by
Above level of heart
How do we wrap an Ace bandage
Wrap distal to proximal
A buckle fracture is also known as a
Greenstick fracture
If growth plate is involved what can happen
Permanent deformitiy
What are the two things we need to look for, in plaster cast - post op
Can dry unevenly, can cause pressure
Why is fiberglass preferred over Plaster (3)
Drys quicker, lighter, easier to remove
Spica body casts are from the
nipple line to ankles
Why is buttocks kept of bed
So no compression on sciatic nerve
What is Volkman’s ischemia
lack of blood flow
Skin traction is used for children (age,weight)
under 3 years old or under 30lbs
Describe Russels traction
Weight pulls in two direction, body acts ad counterweight
Skeletal fraction is
2 weights hanging from bed frame
What is patient at risk for in skeletal tracrtion
risk for infection and immobility
In skeletal traction, what bone does it go through
Femur
Halo traction is used for the
Neck
In Bryants traction what does the patient have a risk for
Volkman’s ischemia
Inflammation of the bone, staph aureus, and a blood borne infection is
Osteomyelitis
What are the 3 S&S of Osteomyelitis
Fever, Pain, Psuedoparalysis
With an elevated ESR, and Luekocytosis what can we expect
Osteomyelitis
For Osteomyeltiss it is important the the limb affected remains
immobile
Breakdown, deferioration of muscles, more common in males
Duchenne’s Muscular Dystrophy
Fatty infilration of muscle cells with tissue breakdown happens in
Duchenne’s Muscular Dystrophy
What are 4 S&S of Duchenne Muscular Dystropy
Delayed Walking, decreased muscle strength, Lordosis, Clumsiness
What is the name of the sign and what is it in Duchenne Muscular Dystrophy
Kids cant lift themselves off the floor, grabbing when lifting GOWERS SIGN
What is the life extpectancy for Duchenne Muscular Dystrophy
early 30s
Also known as Coxaploma, it is a Degenerative Hip disease
Legg-Calve-Perthes Disease
Lack of circulation to femoral head
Legg-Calve-Perthes Disease
Can have 4-8 years with limp, cause is unknown,
Legg-Calve-Perthes Disease
What usually comec before a diagnosis of Legg-Calve-Perthes Disease
Trauma or Synovitis
Bucks traction is mainly done to
Abduct legs
What are 3 tx. For Legg-Calve-Perthes Disease
Bucks traction, Hip bracing, Maintaining ROM but limiting activity
What is prognosis for Legg-Calve-Perthes Disease
Good-w/ potential for hip degeneration in later years
tumor that causes deformity and pain
Benign
tumor that had development of abnormal cells
Malignant
Growth in marrow of long bones. Mets to lungs and other bones, usually occurs after a fracture
Ewings Sarcoma
Primary malignant tumor of long bones
Osteosarcoma
What is one thing patient does not want to hear that has Osteosarcoma
Success stories
What are 3 things we can do for patient post op Osteosarcoma surgery
Teach about phantom limb pain, PT to prothesis, emotional support
Arthirits children get that usually follows a strep infection
Juvenile Rheumathoid Arthritis
Fever that is x10 days, affects internal organs
Systemic Fever
Arthritis in 5 or more joints is called
Polyarticular
Arthriits in 4 or less joints is called
Pauciarticular
Inflammation of the eyes is called
Uveitis
What is the child at risk for who is taking NSAIDS
ulcers and gastric bleeding
For kids with juvenile rheumathoid arthritis, we want to prevent Ankylosis which is a
Joint deformity
What will excarbate symptoms in Juvenile Rhuemathoid Arthritis
Poor nutrition
What can we have child do for Juvenile Rheumathooid Arthritis that might help
Do alphabet with hands and feet
When do we usually screen for Scoliosis and how do we confirm
Between 9-13 confirmed with X-ray
What is maxiumum weight for a child to carry that has scoliosis
5 lbs
What is the tx for Curves under 20 degrees
Good posture, backpack safety
What is the tx. For 20-40 degrees (3)
Bostom Brace, Milwaukee Brace, Daily exercise
What are 2 tx. For Curves greater than 40 degrees
Harrington Rods, Spinal Fusion
How long should patient have brace on
23 hours a day
What can patient experience post op surgery for scoliosis
Constipation
When can we start p.t. for Scoliosis after surgery
Minimal pt after 3 days, Intense after 6 weeks
What do we do post op surgery scoliosis
Log roll
To help skin integrity what can we tell patient to do that has a brace
Tee shirt underneath brace
For sports injuries how long should we apply ice at a time
20 minutes on/off
Brusing in the peri-area is usually a sign of
Abuse
Otitis media simply is a
Ear infection
Second hand smoke can sometimes damage the ulna resulting in a
Otitis media
What are 3 ways to get Otitis media
Haemophilus Influenzae, Baby w/ bottle in bed, Second hand smoke
What are 4 things we see for children who develop Otitis media
Pulling on ear, Irritability, Fever, Vomiting/Diarhhea
After ear drops what must we have child do
Lay still for 5 min
What do we use in the ear for tx. Of Otitis Media
Broad Spectrum Antibiotic
How do we place eyedrops for children under 3 years
ear lobe down and back
How do we place eyedrops for children over 3 years
Pinna up and back
It is important that we do not place what in childs ear
cotton
Common procedure that we do to drain fluid from straight eustacian tube
Myringotomy
What are 4 things we must do/ look out for post Myringectomy
keep ears dry, ear plugs, no submerging head under water, monitor for tube falling out
A tearing of the subcutaneous tissue that results in hemorrhage, edema, or pain
Contusion
Blood in soft tissue
Hematoma
Torn ligament or ligaments stretched. Swelling pain and immobility occurs
Sprain
Small tear in muscle or tednon occuring overtime, pain and edema occur
Strain
Break in bone
Fracture
What type of fracture is Bone broken but not through skin
Simple
Fracture that is broken bone through skin, at great risk for infection
Compund
Fracture that is incomplete, one side is broken other side is bent
Greenstick
Fracture that is caused by forceful twisting motion
Spiral
With a spiral fracture what must we not rule out
child abuse
A non-displaced fracture is when
Bones are still in alignment
A displaced fracture is when
Bones have shifted and need to be re-aligned
No surgery, bones are gently put back into place and cast or traction is applied
Closed reduction
Surgical procedure usually requiring pins, rods, or other devices
Open reduction
Used when the immobilization required is more that what could be obtained by casting
Traction
What are the 4 purposes of traction
Ensure alignment, Secure corrected position, prevent or treat contracture deformities, and to relieve muscle spasm and back pain
How do we check pulses during nuerovascular assessment
Distal to injury or cast, if it is difficult use a doppler
If the child cannot feel touch on the extremety what can we expect it to be
compartment syndrome
What are the excersies called that are used to prevent muscle atrophy and to strenghten muscle
isometric excersices
Weights in traction care should
hang freely and not touch the floor
Ropes in pulley for traction care should
Move freely, and not be obstructed
What is the last thing that child will develop, and when should it advance
Fine motor coordination, before 7 yo
By 18 months the child should be able to
Walk steady
By 6 years of age the child should be able to in reference to gait
walk like an adult
Muscle tone is developed
Cephalocaudal
