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peds > ch 33 musculoskeletal dysfunction > Flashcards

ch 33 musculoskeletal dysfunction Flashcards

1
Q

how to assess LOC in child

A

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

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2
Q

mnemonic for consideration of intentional physical abuse

A

5 Bs
bumps
bruises
breaks
burns
anything that happens in bathroom

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3
Q

spinal cord injury immobilization child v infant

A

child: c collar and flat board
infant: carseat

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4
Q

behavioral changes in immobilized child

A

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

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5
Q

max kgs used in bucks traction

A

4.5 kgs

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6
Q

important principles of traction

A

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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7
Q

cast care teaching for child and family

A

-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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8
Q

types of fractures

A

-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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9
Q

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

A

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

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10
Q

5 Ps for assessing fractures

A

Pain + point of tenderness
Pulse
Pallor
Paresthesia
Paralysis

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11
Q

female athlete triad for health considerations

A

amenorrhea
osteoporosis
eating disorders

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12
Q

what to do for traumatically amputated body part

A

-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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13
Q

why is a figure eight compression bandaid used after amputation

A

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

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14
Q

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

A

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

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15
Q

5 stages of bone healing from fracture

A
  1. hematoma formation
  2. cellular proliferation
  3. callus formation
  4. ossification
  5. consolidation and remodeling
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16
Q

S+S heat cramps

A

-profuse sweating
-normal LOC
-elevated temp

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17
Q

Tx heat cramps

A

-rest
-replacement fluid and electrolytes

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18
Q

S+S heat exhaustion/stress

A

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

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19
Q

Tx heat exhaustion/stress

A

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

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20
Q

S+S heat stroke

A

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

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21
Q

Tx heat stroke

A

-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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22
Q

long term affects untreated torticollis

A

-permanent limitation of neck movement
-facial asymmetry

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23
Q

Tx torticollis

A

-PT and stretching
-if PT unsuccessful, surgical release

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24
Q

causes kyphosis

A

-TB
-arthritis
-osteodystrophy
-copmression fracture

25
Q

causes lordosis

A

-obesity
-flexion contractures of hip
-congenital dislocated hip

26
Q

cause of developmental dysplasia of hip (DDH)

A

breech birth

27
Q

Dx of DDH

A

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

28
Q

Tx DDH

A

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

29
Q

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

A

legg-calve-perthes disease

30
Q

Tx legg-calve-perthes disease

A

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

31
Q

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

A

slipped capital femoral epiphysis (SCFE)

32
Q

possible causes SCFE

A

-obesity
-puberty hormone changes
-bone changes

33
Q

S+S SCFE

A

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

34
Q

Tx SCFE

A

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

35
Q

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

A

osteomyelitis

36
Q

Dx osteomyelitis

A

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

37
Q

S+S osteomyelitis

A

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

38
Q

Tx osteomyelitis

A

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

39
Q

S+S septic arthritis

A

-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

40
Q

Dx septic arthritis

A

-blood culture
-joint fluid aspirate
-x-ray

41
Q

Tx septic arthritis

A

-surgery
-IV Abx

42
Q

A group of heterogeneous inherited disorders of connective tissue

A

osteogenesis imperfecta

43
Q

S+S osteogenesis imperfecta (OI)

A

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

44
Q

types OI

A

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

45
Q

meds for OI

A

bisphosphonates: end in -dronate

46
Q

Tx OI

A

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

47
Q

peak ages juvenile idiopathic arthritis (JIA)

A

1-3 yo and 8-10 yo

48
Q

S+S JIA

A

-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

49
Q

Dx JIA

A

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

50
Q

meds for JIA

A

-NSAIDs
-SAARDs
-corticosteroids
-DMARDs (methotrexate)

51
Q

Tx JIA

A

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

52
Q

complication with JIA

A

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

53
Q

people most common to get lupus

A

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

54
Q

possible triggers SLE

A

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

55
Q

S+S SLE

A

-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

56
Q

SLE criteria for Dx (must have 4+)

A

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

57
Q

meds for Tx of SLE

A

-corticosteroids
-NSAIDs
-hydroxychloroquine (skin and joint issues)
-methotrexate (DMARD)
-cyclophosphamide

-low fat, low salt diet
-calcium and Vit D (prevent osteoporosis)

58
Q

teaching for pt taking DMARD/methotrexate

A

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

peds (28 decks)

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