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349 Peds Exam 4 > Chapter 29 The Child With Musculoskeletal Or Articular Dysfunction > Flashcards

Chapter 29 The Child With Musculoskeletal Or Articular Dysfunction Flashcards

1
Q

Which type of bone has the growth plates?

A

Long bone

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2
Q

Anytime there is a fracture in a growth plate, why are nurses so attentive with it?

A

Because it affects their growth

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3
Q

Anytime you have fracture or injuries what are you going to do?

A

Immobilize the child

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4
Q

What does Immobilized child mean?

A

When a child is simply put in a position where they do not move

Typically done to aid in the recovery of a bone injury

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5
Q

Why do we restrain a child?
Like what’s the number 1 reason?

A

Safety
Because we are trying to protect the child from further injuries to the current one, and or prevent future injuries

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6
Q

What’s the number one nursing consideration of restraining a child?

A

You must have an order and it must be updated

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7
Q

What’s the type of check we are going to be doing with these children in restrains?

A

Color
Movement
Sensation

CMS

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8
Q

What is a flexor restraint?

A

They prevent them from flexing

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9
Q

What is a procedural restraint?

A

A pupus

Looks like a burrito, like no other options

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10
Q

What is soft tissue injury? (4)

A

Contusions (bruise)
Dislocations
Sprains
Strains

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11
Q

What is a dislocation?

A

Displaced position of oppositing bone ends or bone end with socket

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12
Q

What is a sprain?

A

Partial or complete tear of ligament

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13
Q

What is a strain?
sTrain

A

Tear of musculotendinous unit

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14
Q

What’s the treatment for soft tissue injury? (4)

A

R
I
C
E

rest, ice, compression, elevation

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15
Q

For the elevation part of RICE in the treatment for any bone issue, what is the most important thing to note?

A

That the injury, like let’s say the leg
Is going to be elevated higher than the heart

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16
Q

How are we going to manage the ICE part in the RICE anagram for soft tissue injuries?

A

20mins
With a break in between each time
Don’t directly apply it on the skin

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17
Q

What does a fracture mean?

A

The breaking of a bone

  • resistance of bone against stress exerted yields to stress force
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18
Q

What’s our number one concern when regarding fractures?

A

Bone growth plate injuries
- which pretty prevents kids from growing

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19
Q

What is the main treatment behind fractures?

A

Immobilizing and promotion of RICE

then it will help with bone healing and remodeling

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20
Q

What two vitamins are so vital in healing a bone? And why do you think so?

A

Vitamin D - help the absorption of calcium

Calcium - literally help bone growth

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21
Q

What food would you suggest for fractures?

A

Daily products

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22
Q

What are the 4 types of fractures?

A

Compound-open
Complicated
Communited
Greenstick

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23
Q

What is a compound or open fracture?

A

Fractured bone protrudes through the skin

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24
Q

What is a complicated fracture?

A

Bone fragments have damaged other organs or tissues

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25
Q

What is comminuted fracture?

A

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

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26
Q

What is a greenstick fracture?

A

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

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27
Q

Buckle fracture
- the bone is still intact however it’s more so like a little bump and got swollen

Complete with periosteal hinge
- bone is long gone but we still have a small piece of hinge hanging on the

Complete fracture - completely snapped bone

A
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28
Q

What is a spiral fracture?

What’s super important about this?

A

Can happen in long bone
- needs to happen with great force
- usually by parents hitting the kids or by trampolines

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29
Q

What is a cast?

A

Constructed from gauze strips and bandages impregnated with plaster of Paris or synthetic

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30
Q

Casts are usually ___ to body part

A

Molded

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31
Q

The biggest thing for cast is we need to be checking for what 3 things?

A

CMS
color
Movement
Sensation

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32
Q

How can we assess for color?
How can we assess for movement?
How can we assess for sensation ?

A

Capillary refill & paleness

Moving their fingers and hands

Sharp & dull feelings
( they shouldn’t feel

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33
Q

What are the 5ps for cast care?

A

Pain
Pulse
Pallor
Paresthesia
Paralysis

34
Q

This is very important to note
If a patient were to get a fracture, let’s say the day before, they are going to develop swelling in 24-48 hours. Obviously we are going to monitor it, however why do you think we don’t put casts on these patients during the peak time of swelling?

A

Because we can cause compartment syndrome

Which affects those 5 ps

35
Q

What is compartment syndrome?

A

Medical emergency

It’s soo much swelling that the skin starts to split

What they do, cut the skin and release the pressure in the arm

36
Q

Let’s say a patient is going to be placed into a sling, what is the vital thing to note when it comes to patients with a sling when regarding the healing process?

A

That their hand is above their elbow

Remember, always elevate above the heart

37
Q

How are we going to provide hygiene to these patients with casts?

A

Don’t get the cast wet!

Remember don’t even put anything inside the cast either

38
Q

Something I wanted to mention as well because I forgot
What’s our number one worry with patients with a compound or open fracture?

A

Infection

39
Q

Educate parents about itching
How and what are we going to say?

A

Don’t put anything small in their arm

I believe if I remember from patho, recommend the usage of like a hair dryer on cool

40
Q

The child in traction
What is a traction and the purpose behind it?

A

To position distal and proximal bone ends
( pulling two bones together by pulling in an opposite force )

To fatigue involved muscle and reduced spams

To immobilize a fracture until healing is sufficient to permit casting or splinting

To help prevent or improve contracture deformity

41
Q

What’s our nursing action for traction?

A

Cleaning
Noticing any redness, swelling or pus
Avoiding infections
Careful with weights

42
Q

What are distraction? And why do we use it with kids?

A

To help promote healing and growth

43
Q

What is an external fixation?

A

Process of separating opposing bone to encourage regeneration of new bone in the created space

  • can be used when limbs are unequal in length and new bone is needed to elongate the shorter limb

Normally just helps kids move around

44
Q

What is amputation?

A

The removal of a limb

45
Q

What is a nursing care for amputation? (2)

A

Stump shaping for prosthetic fit
Pain management ; phantom limb pain

46
Q

What is congenital hip dysplasia?

Normally found in which babies?

A

Usually a hip is out of socket

Babies born breech

47
Q

What are the clinical manifestation of development dysplasia of the hip? (3)

A

An additional gluteal / thigh fold

One hip will move forward more / usually you’re gonna hear a click/clunk sound

Asymmetry of thigh folds

48
Q

What is a pavilk harness?

A

Holding a baby in a frog position
By having the legs be spread out, allowing the hip to kinda stay in the socket - promoting hip statment

49
Q

What is a spica cast?
Biggest issue?

A

A big cast around the hips up to the chest

Hygiene, because it only has one hole so trying to keep the skin clean is very tough

50
Q

What other condition can use you hip spica cast other than the hip dysplasia?

A

Spiral fracture

51
Q

What is congenital club foot, proper name?

A

Talipes equinovarus

52
Q

What is congenital clubfoot?

A

Where the foot curves inside

53
Q

What is the treatment or thought process behind clubfoot?

A

Since if you think about it, the foot is curved in, all the tendons are going to be tight

So we need surgery to loosen it up, usually multiple surgeries early in life

And then the cast molding each time to hold it in place and slowly reposition the foot

54
Q

What is skeletal limb deficiency?

A

Underdevelopment of skeletal elements of extremities

Reduction of malformation
Varying degrees of functional capacity loss

55
Q

An example of skeletal limb deficiency are like?

A

Extra digits
Like polydactyly
- Extra finger
- extra toe

56
Q

What is osteogenesis imperfecta?

A

Excessive fragility and bone defects

57
Q

Notes classification of osteogenesis imperfecta
Type 1 - most common and mildest
Type 2 - most severe and lethal in infancy
Type 3 - multiple fractures present at birth, short stature, severe bone deformity, disability

Type 4 : similar to type 1, but more severe and short stature

A
58
Q

Osteogenesis imperfecta
What’s the main disease associated with this?

A

Brittle bone disease

59
Q

When we think of brittle bone disease
What is the anagram to remember?

A

Blue sclera
Dental imperfections
( discolored and weak teeth )
Sensorineural hearing loss
Multiple fracture

BDSM

60
Q

How do you get osteogenesis imperfecta?

A

Mutation in collagen

61
Q

What is it Slipped capital femoral epiphysis? (SUFE)

Happens mainly in who?

A

Spontaneous displacement of promixal femoral epiphysis posteriorly and inferiorly

Adolescent because of rapid growth

62
Q

What is the main clinical manifestation of SUFE?

A

Radiating pain from the hip down to the legs

Remember the ball and socket in our hip, these kids are growing so much that the ball just popped out, and then proceeds to just go down instead
- so when the ball goes down, think of how the ball started at the hip and rolls all the way down your leg

63
Q

What is kyphosis?

A

Lateral convex angulation in curvature of thoracic spine

“ Bow out to the king “

64
Q

What is lordosis?

A

Lateral inward curve of cervical or lumbar curvature

Like the pregnant body

65
Q

What is idiopathic scoliosis?

A

This S curve of the spine

66
Q

How are you going to assess a back a spine in a kid?

A

Stand straight
Bend down forward

67
Q

What is the main treatment for scoliosis?

A

A brace around the chest

Nice and snug!

68
Q

What is osteomyelitis?

A

Infection of the bone

69
Q

What is the treatment of osteomyelitis? (2)

A

long term treatment of IV antibiotics
Surgery

70
Q

What is septic arthritis?

A

Inflammation - Bacterial infection in the joint

71
Q

What is the clinical manifestion septic arthritis ? (3)

A

Swollen painful joint
Limp
Fevers

72
Q

What is the diagnosis of septic arthritis?

A

You take fluid out of the joint
And usually cloudy infection

Tap the knee
- usually micro can confirm the infection

73
Q

What is skeletal tuberculosis?

A

TB goes into the bone

74
Q

What is juvenile idiopathic arthritis?

A

Chronic childhood arthritis causing inflammation in joint synovium and surrounding tissue

75
Q

What is the difference between rheumatoid arthritis vs arthritis

A

Older people
- pain have end of the day
- pain when using Joints a lot

Rheumatoid
- wake up in pain
- as they get moving the joints, pain goes away

76
Q

What’s the treatment of juvenile idiopathic arthritis?

A

Corticosteroids

Helps with the inflammation

77
Q

Classification of JIA
systemic arthritis
- involves one or more joints with at least 2 weeks of fever, rash, lymphadenopathy, hepatospelnomegaly, and serositis

Oligoarthritis
- one to four joints for the first 6 months

Polyarthritis rheumatoid factor negative
- five or more joints in the first 6 months with negative rheumatoid factor

Polyarthritis rheumatoid factor positive
- five or more joints in the first 6 months with positive rheumatoid factor

A
78
Q

What is systemic Lupus erythematosus?

Who may you not see this in?

A

Autoimmune disease which we attack the connective tissues and blood vessels

In a baby, less likely because remember you need to have an immune system

79
Q

What is the clinical manifestation of lupus?
Main one!

A

Butterfly shaped rash!!!

Mouth ulcers
Fever
Fatigue
Chest pain
Kidney disease
Weight loss

80
Q

Cutaneous lesions
Lymphadenopathy
Nausea, vomit, diarrhea, pain
Generalized weakness, arthritis, joint pain and stiffness without deformity

Forgetfulness
Seizures
Paralysis
Pleurisy
Pericarditis
Proteinuria
Reneal failure

Also other symptoms of lupus

A
81
Q

What’s the main treatment for lupus?

A

Steroids

82
Q

What do you need to watch out for steroids?

A

Growth suppression

349 Peds Exam 4 (7 decks)

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