Chapter 29 The Child With Musculoskeletal Or Articular Dysfunction Flashcards
Which type of bone has the growth plates?
Long bone
Anytime there is a fracture in a growth plate, why are nurses so attentive with it?
Because it affects their growth
Anytime you have fracture or injuries what are you going to do?
Immobilize the child
What does Immobilized child mean?
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
Why do we restrain a child?
Like what’s the number 1 reason?
Safety
Because we are trying to protect the child from further injuries to the current one, and or prevent future injuries
What’s the number one nursing consideration of restraining a child?
You must have an order and it must be updated
What’s the type of check we are going to be doing with these children in restrains?
Color
Movement
Sensation
CMS
What is a flexor restraint?
They prevent them from flexing
What is a procedural restraint?
A pupus
Looks like a burrito, like no other options
What is soft tissue injury? (4)
Contusions (bruise)
Dislocations
Sprains
Strains
What is a dislocation?
Displaced position of oppositing bone ends or bone end with socket
What is a sprain?
Partial or complete tear of ligament
What is a strain?
sTrain
Tear of musculotendinous unit
What’s the treatment for soft tissue injury? (4)
R
I
C
E
rest, ice, compression, elevation
For the elevation part of RICE in the treatment for any bone issue, what is the most important thing to note?
That the injury, like let’s say the leg
Is going to be elevated higher than the heart
How are we going to manage the ICE part in the RICE anagram for soft tissue injuries?
20mins
With a break in between each time
Don’t directly apply it on the skin
What does a fracture mean?
The breaking of a bone
- resistance of bone against stress exerted yields to stress force
What’s our number one concern when regarding fractures?
Bone growth plate injuries
- which pretty prevents kids from growing
What is the main treatment behind fractures?
Immobilizing and promotion of RICE
then it will help with bone healing and remodeling
What two vitamins are so vital in healing a bone? And why do you think so?
Vitamin D - help the absorption of calcium
Calcium - literally help bone growth
What food would you suggest for fractures?
Daily products
What are the 4 types of fractures?
Compound-open
Complicated
Communited
Greenstick
What is a compound or open fracture?
Fractured bone protrudes through the skin
What is a complicated fracture?
Bone fragments have damaged other organs or tissues
What is comminuted fracture?
Small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue
What is a greenstick fracture?
Compressed side of the bone bends but the tension side of the bone breaks, causing an imcomplete fracture
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
What is a spiral fracture?
What’s super important about this?
Can happen in long bone
- needs to happen with great force
- usually by parents hitting the kids or by trampolines
What is a cast?
Constructed from gauze strips and bandages impregnated with plaster of Paris or synthetic
Casts are usually ___ to body part
Molded
The biggest thing for cast is we need to be checking for what 3 things?
CMS
color
Movement
Sensation
How can we assess for color?
How can we assess for movement?
How can we assess for sensation ?
Capillary refill & paleness
Moving their fingers and hands
Sharp & dull feelings
( they shouldn’t feel
What are the 5ps for cast care?
Pain
Pulse
Pallor
Paresthesia
Paralysis
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?
Because we can cause compartment syndrome
Which affects those 5 ps
What is compartment syndrome?
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
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?
That their hand is above their elbow
Remember, always elevate above the heart
How are we going to provide hygiene to these patients with casts?
Don’t get the cast wet!
Remember don’t even put anything inside the cast either
Something I wanted to mention as well because I forgot
What’s our number one worry with patients with a compound or open fracture?
Infection
Educate parents about itching
How and what are we going to say?
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
The child in traction
What is a traction and the purpose behind it?
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
What’s our nursing action for traction?
Cleaning
Noticing any redness, swelling or pus
Avoiding infections
Careful with weights
What are distraction? And why do we use it with kids?
To help promote healing and growth
What is an external fixation?
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
What is amputation?
The removal of a limb
What is a nursing care for amputation? (2)
Stump shaping for prosthetic fit
Pain management ; phantom limb pain
What is congenital hip dysplasia?
Normally found in which babies?
Usually a hip is out of socket
Babies born breech
What are the clinical manifestation of development dysplasia of the hip? (3)
An additional gluteal / thigh fold
One hip will move forward more / usually you’re gonna hear a click/clunk sound
Asymmetry of thigh folds
What is a pavilk harness?
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
What is a spica cast?
Biggest issue?
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
What other condition can use you hip spica cast other than the hip dysplasia?
Spiral fracture
What is congenital club foot, proper name?
Talipes equinovarus
What is congenital clubfoot?
Where the foot curves inside
What is the treatment or thought process behind clubfoot?
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
What is skeletal limb deficiency?
Underdevelopment of skeletal elements of extremities
Reduction of malformation
Varying degrees of functional capacity loss
An example of skeletal limb deficiency are like?
Extra digits
Like polydactyly
- Extra finger
- extra toe
What is osteogenesis imperfecta?
Excessive fragility and bone defects
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
Osteogenesis imperfecta
What’s the main disease associated with this?
Brittle bone disease
When we think of brittle bone disease
What is the anagram to remember?
Blue sclera
Dental imperfections
( discolored and weak teeth )
Sensorineural hearing loss
Multiple fracture
BDSM
How do you get osteogenesis imperfecta?
Mutation in collagen
What is it Slipped capital femoral epiphysis? (SUFE)
Happens mainly in who?
Spontaneous displacement of promixal femoral epiphysis posteriorly and inferiorly
Adolescent because of rapid growth
What is the main clinical manifestation of SUFE?
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
What is kyphosis?
Lateral convex angulation in curvature of thoracic spine
“ Bow out to the king “
What is lordosis?
Lateral inward curve of cervical or lumbar curvature
Like the pregnant body
What is idiopathic scoliosis?
This S curve of the spine
How are you going to assess a back a spine in a kid?
Stand straight
Bend down forward
What is the main treatment for scoliosis?
A brace around the chest
Nice and snug!
What is osteomyelitis?
Infection of the bone
What is the treatment of osteomyelitis? (2)
long term treatment of IV antibiotics
Surgery
What is septic arthritis?
Inflammation - Bacterial infection in the joint
What is the clinical manifestion septic arthritis ? (3)
Swollen painful joint
Limp
Fevers
What is the diagnosis of septic arthritis?
You take fluid out of the joint
And usually cloudy infection
Tap the knee
- usually micro can confirm the infection
What is skeletal tuberculosis?
TB goes into the bone
What is juvenile idiopathic arthritis?
Chronic childhood arthritis causing inflammation in joint synovium and surrounding tissue
What is the difference between rheumatoid arthritis vs arthritis
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
What’s the treatment of juvenile idiopathic arthritis?
Corticosteroids
Helps with the inflammation
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
What is systemic Lupus erythematosus?
Who may you not see this in?
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
What is the clinical manifestation of lupus?
Main one!
Butterfly shaped rash!!!
Mouth ulcers
Fever
Fatigue
Chest pain
Kidney disease
Weight loss
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
What’s the main treatment for lupus?
Steroids
What do you need to watch out for steroids?
Growth suppression
