Chapter 29 additional information Flashcards
Discuss the factors that should make the nurse suspicious of an intentional or abuse injury in a child
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
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.
Before we discuss the nursing consideration of managing primary and secondary effects of immboilization, what is immobilization?
restraining a child
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
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
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
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
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
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
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
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
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
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
Describe the types of common fractures in children and the five Ps used to assess the extent of injury child with a fracture.
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
what are the most common fractures a kid can have ? (4)
compound ( open )
complicated
communited
greenstick
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 )
Discuss the nursing care management for a child in a cast.
why might we place a child in a cast?
treatment for fracture or surgery to help maintain alignment
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
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
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.
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
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
- sports with high risk
- medical problems
- 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
