ch 33 musculoskeletal dysfunction Flashcards
how to assess LOC in child
AVPU:
Alert
Verbal stimulus (responds to)
Painful stimulus (responds to)
Unresponsive to any stimulus
mnemonic for consideration of intentional physical abuse
5 Bs
bumps
bruises
breaks
burns
anything that happens in bathroom
spinal cord injury immobilization child v infant
child: c collar and flat board
infant: carseat
behavioral changes in immobilized child
-restlessness
-depression
-regression
-egocentrism
-hallucinations
-dependency
max kgs used in bucks traction
4.5 kgs
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
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
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
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
5 Ps for assessing fractures
Pain + point of tenderness
Pulse
Pallor
Paresthesia
Paralysis
female athlete triad for health considerations
amenorrhea
osteoporosis
eating disorders
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
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
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
5 stages of bone healing from fracture
- hematoma formation
- cellular proliferation
- callus formation
- ossification
- consolidation and remodeling
S+S heat cramps
-profuse sweating
-normal LOC
-elevated temp
Tx heat cramps
-rest
-replacement fluid and electrolytes
S+S heat exhaustion/stress
-thirst
-headache
-fatigue
-dizziness
-N/V
-profuse sweating
-tachycardia
-postural hypoTN
-syncope, some confusion
Tx heat exhaustion/stress
-cool environment
-rest
-replace fluid volume (maybe IV)
S+S heat stroke
-headache
-weakness
-disorientation
-agitation, confusion
-loss of consciousness
-nuchal rigidity
-possible seizures
-temp 104+
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
long term affects untreated torticollis
-permanent limitation of neck movement
-facial asymmetry
Tx torticollis
-PT and stretching
-if PT unsuccessful, surgical release
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
