Ch 44: Peds Musculoskeletal Flashcards
Developmental Dysplasia of the Hip
head of the femur is seated improperly in the acetabulum of the pelvis
Acetabular Dysplasia (preluxation) (DDoH)
mildest form
neither subluxation nor dislocation
delay in acetabular development occurs
femoral head remains in acetabulum
Subluxation (DDoH)
incomplete dislocation of the hip
femoral head remains in acetabulum
stretched capsule and ligamentum teres causes head of the femur to be partially displaced
dislocation (DDoH)
femoral head loses contact with acetabulum and is displaced posteriorly and superiorly over fibrocartilaginous rim
ligamentum teres is elongated and taut
Galeazzi’s sign, Allis’ sign
shortening of the limb on the affected side (DDoH)
Ortolani’s test (DDoH)
meaneuver is a test to assess for hip instability. examiner abducts the thigh and applies gentle pressureforward over the greater trochanter. a “clunking” sensation indicated a dislocated femoral head moving into the acetabulum.
Barlow’s test (DDoH)
examiner adducts the hips and applies gentle pressure down and back with the thumbs. in hip dysplasia, the examiner can feel the femoral head move out of the acetabulum.
Trendelenburg’s sign (DDoH)
child stands on one foot and then the other foot, holding onto a support and bearing weight on the affected hip; the pelvis tilts downward on the normal side instead of upward, as it would with normal stability.
Pavlik harness
DDoH: birth to 6 mo
worn continuously until ~3-6mo
hip spica cast
DDoH: 6-18 mo
following reduction under general anesthesia
worn for 2-4 mo until hip is stable
then flexion abduction brace for ~3mo
CF: talipes varus
inversion or bending inward
CF: talipes valgus
eversion or bending outward
CF: talipes equinus
plantar flexion in which the toes are lower than the heel
CF: talipes calcaneus
dorsiflexion in which the toes are higher than the heel
clubfoot treatment
manipulation an dcasting are performed weekly for about 8-12 wks
splint is then applied if casting and manipulation are succesful
surgical intervention may be necessary if normal alignment is not achieved by ~6-12 wks of age
Adam’s test
(scoliosis)
asymmetry of the ribs and flanks is noted when the child bends forward at the waist and hangs the arms down toward the feet
scoliosis post op
monitor for superior mesenteric artery syndrome:
caused by mechanical changes in the position of the child’s abdominal contents during surgery
superior mesenteric artery syndrome symptoms
emesis and abdominal distention similar to what occurs with intestinal obstruction or paralytic ileus
Marfan Syndrome
disorder of connective tissue that affects the skeletal system, CV system, eyes, and skin
Marfan Syndrome caused by -
defects in the fibrillin -1 gene, which serves as a building block for elastic tissue in the body.
disorder may be inherited.
no cure.
Marfan Syndrome symptoms
tall and thin body structure: slender fingers, long arms and legs, curvature of spine
visual problems
cardiac problems
Juvenile Idiopathic Arthritis meds
NSAIDS Methotrexate Corticosteroids Tumor Necrosis Factor Receptor Inhibitors Slower Acting Antirheumatic Drugs
(JIA meds) NSAIDS
first meds used
GI irritation and easy bruising
(JIA meds) Methotrexate
used is NSAIDS ineffective
CBC and LFTs monitored closely
(JIA meds) Corticosteroids
potent immunosuppressives used for life threatenign complication, incapacitating arthritis, and uveitis. Lowest possible dose admin-ed. Prolonged use = Cushing’s syn, osteoporosis, up infection risk, glucose intolerance, hypokalemia, cataracts, growth suppression.
(JIA meds) Tumor Necrosis Factor Receptor Inhibitors
Etanercept (Enbrel)
Infliximab (Remicade)
adverse effects: allergic rxn at inj site, up risk for infection, demyelinating disease, pancytopenia
(JIA meds) Slower Acting Antirheumatic Drugs
usually prescribed in combo w/ NSAIDS Sulfasalazine *Azulfidine) hydroxychloroquine (Plaquenil) gold sodium thiomalate (Myochrysine) penicillamine
Priority Nursing Actions of Extremity Fracture
- Assess extent of injury and immobilize
- compound fracture - cover wound w/ sterile dressing
- elevate the injured extremity
- apply cold to injured area
- monitor neurovascular status
- transport to nearest ED
five “P’s” of fracture assessment
pain and point of tenderness pulses distal to fracture site pallor paresthesia (sensation distal to the fracture) paralysis (mvmt distal to site)
Russell skin traction
stabilizes a femur fracture pre op
double pull (knee and foot) using a knee sling
similar to Buck’s traction
Balanced suspension
skin or skeletal traction
approximates fracture of femur, tibia, or fibula
90 degree 90 degree traction
lower leg supported by boot cast or calf sling
skeletal Steinmann pin or Kirschner wire is placed in distal fragment of femur
allows 90 degree flexion at hip and knee
simple fracture
fracture of the bone across its entire shaft w/ some possible displacement but w/o breaking the skin
greenstick fracture
incomplete fracture that occurs through only a part of the cross section of the bone; one side of the bone is fractured and the other side is bent.
comminuted fracture
complete fracture across the shaft of the bone w/ splintering of the bone fragments.
compound fracture
aka open / complex fracture
the skin or mucous membrane has been broken and the wound extends to the depth of the fractured bone.
JIA
a complication of JIA is iridocyclitis (uveatis)
JIA most often occurs before the age of 16
JIA is twice as likely to occur in girls than in boys
clinical manifestations of JIA include morning stiffness and painful, stiff, swollen joints
spiral fracture
a fracture that has a twisted or circular break.
affects the length rather than the width.
seen frequently in child abuse.
