Ch 51 lecture musculoskeletal disorders

Question 1

A child’s bones differ from an adults in that they are:

Answer 1

1. More porous and pliable
2. Less dense
3. Child bone growth from epiphyseal plate
4. Long-bone growth continues until approximately age 20
   (Test Question: this is why a child who breaks a long bone will have serial surgeries as they grow because there is a risk for uneven height/length so must adjust pins, etc as they grow!)
5. Rapid bone growth facilitates healing of fractures, but may also lead to growing pains, as muscles are pulled

Question 2

matatarsus adducts

Answer 2

intoeing

This disorder is characterized by convexity (curvature) of the lateral border of the foot.

Question 3

Talipes equinovarus

Answer 3

clubfoot

Manipulation and serial casting should be begun as soon as possible after birth
(Surgery)

Nursing
Provide emotional support
Provide cast and brace care
Provide postsurgical care

Question 4

genu varum and genu valgum

Answer 4

varum- bowlegs,
valgus - knock knees

1. Often resolve spontaneously
2. Reassure parentes
3. Educate parents and the child
4. Provide guidelines for brace wear and maintenance

Question 5

hip deformities include:

Answer 5

Perthes disease and hip dysplasia

Question 6

Legg-Calvé-Perthes disease

Answer 6

Avascular necrosis of the femoral head

Suspect in any child (esp. boy) 2 to 12 who complains of hip discomfort with a limp
-Walks fine, then limp develops

Treatment involves immobility, usually more than 2 years

Although the Toronto brace may seem formidable for a child to wear, children adapt quite well to it.

Question 7

Hip dysplasia

Answer 7

Femoral head and the acetabulum are improperly aligned which causes:

1. hip instability
2. dislocation (displacement of the bone from its normal articulation with the joint)
3. subluxation (in this instance, a partial dislocation)
4. dysplasia (abnormal cellular or structural development leading to instability)

Treatment

1. The most common treatment for D D H in a child under 3 months is a Pavlik harness. A shirt should be worn under the harness to prevent skin irritation. (It was omitted for clarity in this photograph.)
2. A child should be examined by provider before any adjustments are made to the harness. See provider every 1-2 weeks!!

Question 8

Spine disorders such as scoliosis, kyphosis, and lordosis generally become noticeable __.

Answer 8

after the preadolescent growth spurt

Typically diagnosed around this time
Age 10-14

Question 9

tortilcollis

Answer 9

Tilt of the head caused by rotation of the cervical spine

Question 10

kyphosis

Answer 10

hunchback

spinal curvature is assessed by having the child bend 90 degrees. Diagnosis is confirmed by radiograph.

exercises are prescribed for mild condition; bracing is commonly used; surgery is performed in severe cases

nursing:
provide support
encourage exercises and diligent brace wear.
help the child to deal with the psychological stress of altered body image

Question 11

lordosis

Answer 11

swayback; excessive concave curvature of the lumbar spine with an angle of more than 60*; most common in prepubescent girls and african americans

spinal curvature is assessed by looking at the standing child from the side; confirmed by lateraled radiograph

treatment focuses on exercises and postural awareness. bracing and surgery are rarely prescribed.

nursing:
provide support
reassure the child and family that the condition is often outgrown as the child matures.
encourage physical conditioning exercises and follow-up exams on a yearly basis.

Question 12

Braces limit movement. What is nursing care of braces?

Answer 12

1. Snug but do not impair circulation
2. No direct contact with skin
3. Assess neurovascular and skin status. **Question about assessing neurovascular status on test!

Question 13

Teaching guidelines for brace wear

Answer 13

Braces should be as comfortable as possible and the child should have adequate mobility while wearing the brace.

Begin wearing the brace for periods of 1 to 2 hours and then progress to 2 to 4 hours.

Check the skin at 1-to 2-hour intervals initially, then every 4 hours once skin has been clear for several days.

1. If redness is apparent, leave the brace off and allow the skin to clear.
2. If breakdown has occurred, the brace cannot be replaced until healing is complete.

Always have the child wear a clean white sock, T-shirt, or other thin white liner beneath the brace.

1. Be sure the liner is wrinkle-free under the brace.
2. Avoid using powders or lotions that can cause skin to break down.
3. Toughen any sensitive areas using alcohol wipes 3 to 4 times daily.

Reapply the brace when the skin returns to its normal color.

Return to the orthotic specialist or other specified healthcare provider if discomfort or red areas persist or if the brace needs adjustment or repair or is outgrown.

Check the brace daily for rough edges.

Question 14

A life threatening condition of muscle degeneration and wasting is called __.

Answer 14

muscular dystrophy

Early signs - Weakness and hypotonia

Nursing management

1. Maintenance of body systems
2. Promote safety
3. Child and family support
4. Maximize independence
   * *For example, pt go to school
   * *If not moving, then will have respiratory problems!!
5. Assess for and treat infections
6. Perioperative care when surgery required

Question 15

Soft tissue injuries include:

Answer 15

contusions
dislocations
sprains
strains

Question 16

nursing care of soft tissue injuries:

Answer 16

Rest, ice, compression, and elevation (RICE) and ICES

• Rest the injured part
• Ice immediately (maximum 30 minutes at a time)
• Wet elastic bandage for compression
• Elevation of the extremity
• Immobilization and support (casts or splints as appropriate to the injury)

Question 17

The __ is the most frequently broken bone in childhood, especially in those younger than 10 years old.

Answer 17

clavicle

Fractures are rare in infants, except with motor vehicle crashes. They are common in children, and
in school-age children bicycle and sports injuries are the common cause.

Question 18

Compound or open fracture

Answer 18

Fractured bone protrudes through the skin

Question 19

complicated fracture

Answer 19

Bone fragments have damaged other organs or tissues

Question 20

comminuted frature

Answer 20

Small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue

Question 21

greenstick fracture

Answer 21

Compressed side of the bone bends but the tension side of the bone breaks, causing an incomplete fracture

Question 22

The weakest point of the long bone is the __.

Answer 22

cartilage growth plate (epiphyseal plate)

Frequent site of damage during trauma

May affect future bone growth so will need serial casts as they grow!

Question 23

6 P’s (Assessment of a fracture distal to the injury)

Answer 23

Pain, Pulse-lessness, Pallor, Parasthesia, Paralysis, Pain

Question 24

Traction

Answer 24

a. Extended pulling force may be used
b. To provide rest for an extremity
c. To position for bone healing
d. To immobilize a fracture until healing is sufficient to permit casting or splinting
e. To help prevent or improve contracture deformity
f. To provide immobilization
g. To reduce muscle spasms (rare in children)
h. Protect skin from pressure, wetness

Question 25

Nursing care of traction:

Answer 25

Role of Nurse is assessment!!

• Skin care issues
• Pain management and comfort

Skin traction - Assess skin
Skeletal traction - Pin care, Prevent infection
Cervical Traction - Halo brace or halo vest

Gardner-Wells tongs - a type of cervical traction

1. Inserted through burr holes in the skull with weights attached to the hyperextended head
2. As neck muscles fatigue, vertebral bodies gradually separate so the spinal cord is no longer pinched between the vertebrae