Chapter 29 additional information Flashcards by Brina Quintanilla Reyes

Discuss the factors that should make the nurse suspicious of an intentional or abuse injury in a child

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What are some factors that can make a nurse suspicious of an intentional abuse injury in a child?

when a child injury is not congruent with the parents description of the incident

the child’s behaviors
- fearful, lack of crying

radiographs show multiple healed fractures

for example; a 6 month old infant cannot climb out of the crib and break her leg

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Discuss nursing care considerations in managing primary and secondary effects of immobilization in order to prevent complications in the muscular, skeletal, cardiovascular, respiratory, gastrointestinal, renal, metabolism, integumentary, and neurosensory systems along with behavioral effects.

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Before we discuss the nursing consideration of managing primary and secondary effects of immboilization, what is immobilization?

restraining a child

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what are some causes or reasons in to why we immobilize a child?

prevention of illness or injury
- mainly think of safety when it comes to immboliziing a child

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What is the muscular system nursing consideration regarding immobilizing a patient? (1)
and why?(1)

what might be the treatment for this or more so the prevention of this occurring? (1)

muscle atrophy
- because child will have a limited mobility and usually this results in patients having muscle loss

passive or active range of motion exercises and proper positioning can help prevent this

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What is the skeletal system nursing consideration regarding immobilizing a patient?
and why?

what might be the treatment for this or more so the prevention of this occurring?

the balance of bone formation and bone resorption is ruined

because if they are placed under stressed, they will not properly heal the patient

usually this results in the demineralization of the bone, so we want to make sure the patient is always in a good state of healing by promoting vitamins like D and calcium

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What is the cardiovascular system nursing consideration regarding immobilizing a patient?

and why?

what might be the treatment for this or more so the prevention of this occurring?

DVT
- because the patient is not really moving that limb so lack of circulation can result in a patient developing a blood clot

anticoagulants & ambulation like range of motion exercises

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What is the respiratory system nursing consideration regarding immobilizing a patient?
and why?
what might be the treatment for this or more so the prevention of this occurring?

pneumonia
- because the child tends to have a slower and more shallow breathing because they are not moving as much, resulting in secretions to not fully be breathed out, so these creations can build up and get an infection like pneumonia

treatment would be the usage of incentive spirometer

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What is the gastrointestinal system nursing consideration regarding immobilizing a patient?
and why?
what might be the treatment for this or more so the prevention of this occurring?

Fecal impaction
- just like every other reason, they are not moving, resulting the stool in the colon to slow down and get hard

treatment would be ambulation and stool softener

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What is the renal system nursing consideration regarding immobilizing a patient?
and why?
what might be the treatment for this or more so the prevention of this occurring?

renal calculi ( kidney stones )
- again, they are not moving, everything is slowed down and will build up over time

treatment
- ambulation and monitoring I&O’s

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What is the metabolism nursing consideration regarding immobilizing a patient?

since immobility or severe restriction of activity is usually the result of many patients developing problems, the main issue is that they will have a decrease metabolism, resulting them in being more fatigue

really you’re going to want to treat them and make sure they don’t develop hypercalcium because of that bone catabolism that can occur

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What is the integumentary system nursing consideration regarding immobilizing a patient?
and why?
treatment?

skin breakdown
- again, not moving!

treatment, change position, move them around, encourage the usage of creams on the area

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What is the neurosensory system nursing consideration regarding immobilizing a patient?

when a patient may lose or have damage nerve

usually because improper body positioning and or not applying casts or restraints properly resulting in blood flow to be disrupted

treatment - range of motion or passive rom

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Describe the types of common fractures in children and the five Ps used to assess the extent of injury child with a fracture.

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what are the 5 ps to use when we are assessing a patient with a fracture or any bone injury?

pain
pulse
paleness
paraesthesia
paralysis

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what are the most common fractures a kid can have ? (4)

compound ( open )
complicated
communited
greenstick

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what is compound (open)
what is complicated
what is communited
what is greenstick

open fracture, like outside the skin
bone fragments hit another organs
bone fragments are in a tissue
split right in half of the bone ( most common )

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Discuss the nursing care management for a child in a cast.

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why might we place a child in a cast?

treatment for fracture or surgery to help maintain alignment

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what is a cast made out of?

constructed from gauze bandage impregnanted with plaster of Paris or more commonly synthetic lighter weight and water resistant materials

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Usually when we are putting a cast on a child, what might be something we need to consider before putting the cast on?

The child development status ; you may want to distract them because they are scared
you mold it onto them

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Describe nursing considerations in caring for a child who is in traction, including the proper maintenance of traction and alignment, pin and skin care, and pain control measures.

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notes
purpose of traction
1. to realign bone fragments
2. to provide rest for an extremity
3. to help prevent or improve contracture deformity
4. to correct a joint deformity
5. to treat a dislocation
6. to allow preoperative or postoperative positioning and alignment
7. to provide immobilization specific areas of the body
8. to reduce muscle spams

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what is traction? and how it interacts with the body?

attaching weight to the distal bone fragment the body will have counetrtraction, in order to align the bones together

what is the nursing care management behind treating kids who are in traction? remember traction is when we are using weights in order to pull and push a bone together in place

always assessing for signs of redness, pain, infection, cleaning

what type of medications might a child be on when having traction?

opioids muscle relaxants analgesics

Discuss clinical manifestations of and nursing care indications for the following complications of fractures: circulatory impairment, nerve compression syndromes, compartment syndrome, epiphyseal damage, nonunion, malunion, infection, kidney stones, and pulmonary emboli.

Fracture complications circulatory impairment what is our main concern?

the lack of blood flow, resulting in delayed healing and the potential to clot up & additionally lack of oxygen

what is nerve compression syndrome?

a broad spectrum term to identify when a nerve is being pressured and causing pain and potential nerve damage, to like touch and or certain sensations

what is the main treatment of most nerve compression syndromes ?

alleviation of pressure ( surgery ) elevate the extremity

what is compartment syndrome ? how does it happen? is it a medical emergency ? what does it have to do with the 5ps? what's the treatment?

when too much pressure is within a certain muscle and nerves resulting in patients to have this very tight feeling mainly from tight dressing, skin traction, trauma, burns etc it is a medical emergency, we need to do surgery to relieve the pressure it stops all the 5ps, so like extreme pain, very pale, absent pulse, paresthesia feeling, and potential to cause paralysis surgery, fasciotomy, which cuts the skin right open and allows the pressure to be relieved

what is physeal damage? what is the treatment?

when the growth plates dont grow at the same rate, so think of how one limb might be shorter than the other surgery, lengthen surgery

what is nonunion vs malunion

nonunion -when bone fragments dont allow for proper healing malunion - fracture union with increased angulation or deformity the fracture site

what is our main worry behind infection when it comes to fractures or any bone injury?

osteomyelitis, so infection of the bone and poses a risk for severe fevers

what is our worry behind kidney stones and pulmonary emboli ? remember the most important thing about these patients, they are moving so ?

since they arent moving, the risk of kidney stones and a PE developing is 100% more higher than an average person, so we want to monitor and encourage ambulation ( compression devices or socks might help prevent things and fluids ! )

Discuss incidence of, risk factors, and causes of sudden death in children and adolescents participating in sports activities.

what are you going to tell children who just got an injury and or fracture about their status of playing sports? dont over think it

they should not engage in the sport until the doctor has said otherwise, however range of motion and light exercise may be allowed

Sudden death in children or instatnaeous death are applied to death that occurs within minutes of the onset of the cause of death or within 24 hours of the episode what are some causes that can increase the risk of sudden death? treatment? dont over think it

1. sports with high risk 2. medical problems 3. sport environment ( rules ) education about signs and symptoms, prevention methods, and support groups

Discuss the etiology, treatment, and nursing care management of the following pediatric musculoskeletal conditions: torticollis, Legg-Calvé-Perthes disease, and slipped femoral capital epiphysis.

what is torticollis or wry neck? etiology? nursing care treatment

condition of limited neck motion - its a condition characterized by the beck being in a flexed position and the head drawn or tilted laterally to the affected side, while the chin is pointed towards the opposite side can be congenital or acquired ; mainly resulting in birthing positioning nursing care is that nurses should be alert about the possible limited head movement and should educate parents on the stretching exercise in order to increase rom and position the head for better feedings and playing treatment Is gentle stretching exercises

what is kyphosis what is lordosis treatment ? its the same for both by the way

hump back pregnant body spine brace in order to aid with proper growth and surgery correction if it is severe

what is idiopathic scoliosis? when do we normally see this? like at what age group? treatment ?

the S curve we see in the spine when children usually stand straight and or bend down preadolescents growth spurt brace, Boston ands Wilmington braces are most famous

What is legg-calve perthes disease? I won't go into this as much, just the general idea of what it is

self limiting disease in which there is necrosis of the femoral head ( so on the leg there is necrosis )

what is slipped capital femoral epiphysis ? SUFE when does it normally happen? clinical manifestations ? treatment?

spontaneous displacement of the proximal femoral epiphysis in relationship to the femoral neck and shaft ( so the hip ball ends up going down ) using in accelerated growth or onset of puberty limping, continuous pain that radiates from the hip down to the foot surgery, in order to help with the displacement

what is skeletal limb deficiency?

congenital limb defiiciencies are characterized by underdevelopment of skeletal elements of the extremities

what is some examples of skeletal limb deficiency ? dont over think it, think about what could happen?

a child could be missing a limb, or the potential of having an additional limb

what is the therapeutic management or nursing care management of these children with skeletal limb deficiency?

usually the education and need of prosthetic devices

what is the developmental dysphasia of the hip? (DDH) also known as congenital hip dysplasia or congenital dislocation of the hip

describes an abnormal development of the hip that may occur at any time during fetal life, infancy and childhood

what are the 2 maneuvers we will use to help assess a child who may have DDH?

Barlow and ortolani maneuvers

what might we see on assessment of a child with DDH? think of the physical things

additional gluteal fold one leg can extend farther than the other one is higher than the other affected leg appears shorter than the other

what is the main treatment behind DDH? usually for infants and young children?

pavilik harness

what is a pavilk harness?

a harness that puts a child in a frog position that usually is trying to get the hip use to be in this certain position and not pop out

however we know that a pavilk harness isn't going to work for an older child, what might we do instead?

surgery is needed in order to help with the hip deformity

what is clubfoot? also known as congenital talipes equinovarus ?

complex deformity of the ankle and foot that includes forefoot adduction

what is the gold standard approach in the treatment of the clubfoot management ?

ponseti method - where we use several casting and slowly try to loosen those tight muscles and nerves and if it doesn't work, surgery

Discuss the therapeutic and nursing management of children undergoing treatment for idiopathic scoliosis and more severe spinal curvatures, including the use of braces and surgery with internal fixation devices.

as mentioned before, idiopathic scoliosis is the s curve in the spine we can test this by asking the child to stand up and bend over and we see this S formation of the spine in the back treatment usually is with a brace, we want it to be snug and not tight to where they find it difficulty to breath or potential block of blood flow if it is very severe and causes so much pain, surgery is indicated for these patients

iscuss the etiology, types, pathophysiology, clinical manifestations, and therapeutic management of a child with osteomyelitis.

What is osteomyelitis ?

infection of the bone

what is the pathophysiology behind osteomyelitis ?

bacteria will enter the bone

what is the clinical manifestation behind osteomyelitis ?

fever, inflammation, irritability, tenderness, pain, limping

what is the diagnosis of osteomyelitis ?

aspiration and drainage of the bone or joint ( fluid tap on the site of the bone )

what is the therapeutic management behind osteomyelitis ?

IV antibiotics and fluids

Discuss the etiology, therapeutic management, and nursing care for a child with septic arthritis, skeletal tuberculosis osteogenesis imperfecta (OI).

what is septic arthritis ? mainly affecting the knees, hips, ankles and elbows what are the clinical manifestations behind septic arthritis?

bacterial infection in the joint swelling, warmth, erythema, fever, malaise, headache, nausea, vomiting

what is the treatment for septic arthritis?

IV antibiotics therapy surgical intervention may be needed if there is a foreign object that can be causing an infection like issue

what is skeletal tuberculosis? Treatment? what type of precautions or isolation ?

tuberculous infection of the bones antibiotics for TB droplet and contact isolation

what is osteogenesis imperfecta (OI)?

excessive fractures and bone deformity

what are the 4 clinical manifestation anagram to remember when thinking of osteogenesis imperfecta, mainly brittle bone disease

BDSM blue scelare discolored teeth/dental issues sensory hearing loss multiple fractures

what is the main cause of OI or brittle bone disease?

mutation of collagen

what is the therapeutic management behind brittle bone disease or oi?

supportive, bone marrow transplant, rehab,

Discuss the etiology, pathophysiology, types, clinical manifestations, course, prognosis, therapeutic management, and nursing care of children with juvenile idiopathic arthritis or juvenile rheumatoid arthritis.

What is juvenile Idiopathic arthritis?

chronic autoimmune childhood arthritis

what are your clinical manifestations of juvenile idiopathic arthritis?

stiffness, swelling, loss of motion

juvenile idiopathic arthritis usually goes away during what?

movement

what are your main medications for juvenile idiopathic arthritis?

DMARDS, mainly NSAID though

something to note, with arthritis, what does it mainly affect?

synovium joints surrounding tissues

what is systemic lupus erthematosus?

chronic multisystem autoimmune disease of the blood vessels and connective tissue

what is the most famous clinical manifestation behind systemic lupus erythematous ? additional diagnosis can also help with this clinical manifestation

butterfly rash on the face

what is the main treatment of SLE?

corticosteroids

overall what do you need to watch out with a lot of steroid usage in these children ?

growth suppression

just something to review what is the anagram we use to help treat any bone injury ? and what do we do with the I? and what do we do with the E?

RICE rest ice compression elevation 20mins on, not directly on the skin, then take a break elevate above the heart

one last thing, what is the anagram we use to help remember to assess for any complications of having a cast?

CMS color - palness motion - can they move sensation - pricking or soft sensations