ch 33 musculoskeletal dysfunction Flashcards by McKenna Michael

how to assess LOC in child

AVPU:
Alert
Verbal stimulus (responds to)
Painful stimulus (responds to)
Unresponsive to any stimulus

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mnemonic for consideration of intentional physical abuse

5 Bs
bumps
bruises
breaks
burns
anything that happens in bathroom

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spinal cord injury immobilization child v infant

child: c collar and flat board
infant: carseat

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behavioral changes in immobilized child

-restlessness
-depression
-regression
-egocentrism
-hallucinations
-dependency

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max kgs used in bucks traction

4.5 kgs

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important principles of traction

TRACTION
-Temp of extremity (and oral temp)
-Ropes hang freely
-Alignment of extremity
-Circulation checks for 6 Ps
-Trapeze (frequently part of traction)
-Increase fluid intake
-Overhead trapeze (increases independence and muscle strength)
-No weights on bed or floor

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cast care teaching for child and family

-elevate on pillows for first day
-observe fingers/toes for swelling/discoloration
-check movement and sensation of fingers/toes
-don’t allow limb to hang in dependent position for 30+ minutes
-keep injured hand/arm elevated (pillows, sling)
-don’t put anything inside cast
-don’t put in water
-protect cast with plastic and tape if child is incontinent

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types of fractures

-complete v incomplete
-simple v compound
-complicated: bone fragments damaged other tissues/organs
-open: protrudes through skin
-transverse
-oblique
-spiral
-comminuted: fragments of bone in surrounding tissue
-greenstick: bend and crack

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how long does bone healing take for:
-neonatal period
-early childhood
-late childhood
-adolescence

neonatal: 2-3 wks
early childhood: 4 wks
late childhood: 6-8 wks
adolescence: 8-12 wks

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5 Ps for assessing fractures

Pain + point of tenderness
Pulse
Pallor
Paresthesia
Paralysis

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female athlete triad for health considerations

amenorrhea
osteoporosis
eating disorders

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what to do for traumatically amputated body part

-rinse limb with normal saline
-loosely wrap limb in sterile gauze
-place amputated part in ziplock bag
-place bag in bowl of ice water (don’t put directly in ice)
-label bag with name, date and time and transport with pt to hospital

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why is a figure eight compression bandaid used after amputation

-decreases stump edema
-controls hemorrhage
-aids in desired contour so it can be weight bearing in future

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how long should stump be elevated after amputation, and when do you stop elevating

24 hours elevation postop
then stop because contractures will develop and hinder mobility

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5 stages of bone healing from fracture

hematoma formation
cellular proliferation
callus formation
ossification
consolidation and remodeling

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S+S heat cramps

-profuse sweating
-normal LOC
-elevated temp

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Tx heat cramps

-rest
-replacement fluid and electrolytes

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S+S heat exhaustion/stress

-thirst
-headache
-fatigue
-dizziness
-N/V
-profuse sweating
-tachycardia
-postural hypoTN
-syncope, some confusion

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Tx heat exhaustion/stress

-cool environment
-rest
-replace fluid volume (maybe IV)

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S+S heat stroke

-headache
-weakness
-disorientation
-agitation, confusion
-loss of consciousness
-nuchal rigidity
-possible seizures
-temp 104+

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Tx heat stroke

-cool environment
-removal of clothing
-application of cool water (wet towels)
-fans
-oxygen
-cautious fluid and electrolyte replacement
*don’t use antipyretics because liver isn’t functioning well

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long term affects untreated torticollis

-permanent limitation of neck movement
-facial asymmetry

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Tx torticollis

-PT and stretching
-if PT unsuccessful, surgical release

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causes kyphosis

-TB
-arthritis
-osteodystrophy
-copmression fracture

causes lordosis

-obesity -flexion contractures of hip -congenital dislocated hip

cause of developmental dysplasia of hip (DDH)

breech birth

Dx of DDH

-ortolani and barlow tests at 1-4 wks -galeazzi sign (shortening of thigh, unequal gluteal folds) -older children with limp, leg discrepancy -x-ray

Tx DDH

-pavlik harness (0-6 mos) -spica casting/surgery (6+ months)

avascular necrosis of femoral head, most common in males 4-8 yo

legg-calve-perthes disease

Tx legg-calve-perthes disease

-rest -NSAIDs -PT -maybe traction/bracing/casting -maybe surgical reconstruction

Spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction -occurs during accelerated growth/puberty

slipped capital femoral epiphysis (SCFE)

possible causes SCFE

-obesity -puberty hormone changes -bone changes

S+S SCFE

-episode of trauma w/ acute displacement -gradual displacement w/o definite injury -intermittent displacement -limp

Tx SCFE

emergency -non-weight bearing -surgery -sometimes home traction

inflammation and infection of bony tissue -can be caused by any organism -can be caused by exogenous or homogenous source

osteomyelitis

Dx osteomyelitis

-early x-rays look normal -bone scans -bone culture from biopsy/aspirate

S+S osteomyelitis

-abrupt onset symptoms -(resembles arthritis and leukemia) -marked leukocytosis -severe pain -fever -irritability

Tx osteomyelitis

-prompt IV Abx for extended period (maybe through PICC) -complete bed rest

S+S septic arthritis

-warm, tender, swollen, painful joint -fever -leukocytosis -frequently after traumatic injury -most often in hip, knee, shoulder -MRSA frequent cause, N. gonorrhea is frequent cause in teens

Dx septic arthritis

-blood culture -joint fluid aspirate -x-ray

Tx septic arthritis

-surgery -IV Abx

A group of heterogeneous inherited disorders of connective tissue

osteogenesis imperfecta

S+S osteogenesis imperfecta (OI)

-excessive fragility -bone defects -defective periosteal bone formation -reduced thickness of bones -hyperextensible joints

types OI

type 1: mild bone fragility, most common type 2: lethal, severe bone fragility type 3: severe bone fragility and progressive deformities type 4: mild to moderate bone fragility

meds for OI

bisphosphonates: end in -dronate

Tx OI

-meds (bisphosphonates) -splints and braces -mostly supportive -surgery -PT

peak ages juvenile idiopathic arthritis (JIA)

1-3 yo and 8-10 yo

S+S JIA

-systemic onset -high fever -rash -hepatosplenomegaly, pericarditis, pleuritis, lymphadenopathy -destruction of cartilage -stiffness -loss of mobility -warm to touch -growth retardation -symptoms increase with stressors

Dx JIA

based on american college of rheumatology criteria: -onset <16 yo -1+ affected joints -arthritis 6+ wks -exclusion of other forms of arthritis

meds for JIA

-NSAIDs -SAARDs -corticosteroids -DMARDs (methotrexate)

Tx JIA

-meds -PT, OT -splints at night -regular eye appts

complication with JIA

iridocyclitis/uveitis (inflammation if iris and ciliary body) can lead to blindness, glaucoma, cataracts

people most common to get lupus

-females 10-19 yo -black, asian, and hispanic children

possible triggers SLE

-hormonal imbalance -immune disorders -environmental exposure to drugs -infection -stress -chemical agents

S+S SLE

-cutaneous lesions -lymphadenopathy -N/V/D -abdominal pain -generalized weakness -arthritis, joint, and stiffness w/o deformity -forgetfulness -seizures -paralysis -pleurisy, pericarditis -proteinuria -renal failure

SLE criteria for Dx (must have 4+)

-butterfly rash -discoid rash -photosensitivity -oral ulcers -arthritis -serositis -renal disorder -neurological disorder -hematological disorder -immunological disorder -ANA+

meds for Tx of SLE

-corticosteroids -NSAIDs -hydroxychloroquine (skin and joint issues) -methotrexate (DMARD) -cyclophosphamide -low fat, low salt diet -calcium and Vit D (prevent osteoporosis)

teaching for pt taking DMARD/methotrexate

pregnancy results in birth defects regular use of birth control, pregnancy tests