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Chapter 33: child w/ musculoskeletal dysfxn Flashcards

1
Q

Skeletal development

A

-Not fully ossified by birth
-Ossification completes at adolescence
-Flexible and porous (allow for greater shock absorption, bones will bend not break)

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2
Q

Epidemiology of trauma

A

-Trauma is leading cause of death in kids > 1 y
-Unintentional injuries are leading cause of death in kids 1-19 yrs

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3
Q

Physiologic effects of immobilization

A

-Muscular: decreased strength, atrophy, less joint mobility
-Skeletal: bone demineralization, neg Ca balance
-CV: orthostatic intolerance, more heart workload, thrombus
-Respiratory: decreased effort, less mvmt of secretions
-GI: decreased motility, risk for aspiration
-Renal: renal stasis, renal calculi
-Metabolism: decreased rate and stress hormones
-Skin: decreased circulation, risk for ischemia
-Urinary: difficulty voiding, retention
-Neuro: loss of innervation
-Psych: diminished stimuli, altered perception of self, increased neg feelings, developmental regression

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4
Q

Immobility nursing mgmt

A

-Use of devices: orthotics, prosthetics, crutches, canes, wheelchairs
-Pressure reduction mattresses, position changes, ROM exercises
-Braden Q scale
-Child life, visitors, school activities

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5
Q

Traumatic injury

A

-Soft tissue injury includes muscles, ligaments, tendons
-D/t sports injuries or mishaps during play

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6
Q

Contusions

A

-Bruise or damage to soft tissue, subq tissue, muscle
-Blood leaks into tissue (ecchymosis)
-Swelling, pain, disability
-Myositis ossificans: deep contusions to biceps or quadriceps
-Crush injuries: extremities or digits crushed, can involve bone

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7
Q

Dislocations

A

-Stress on ligaments displaces normal position of opposing bone ends or bone ends to socket
-Hip dislocation –> loss of blood supply to femoral head
-Pain is main symptom: increases w/ mvmt
-Nursemaid’s elbow: common, subluxation or partial dislocation of radial head

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8
Q

Sprains

A

-Trauma to joint from a torn or stretched ligament
-Damage to blood vessels, muscles, tendons, nerves
-Presence of joint laxity is indicator of severity (pt feels joint is loose or hears snap
-Rapid onset of swelling

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9
Q

Strains

A

-Microscopic tears to muscle or tendon
-Swollen and painful to touch
-Incurs over time

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10
Q

Mgmt of soft tissue injuries

A

-RICE
-Ice max of 30 min at time
-Immobilization and support (often w/ torn ligaments)
-Rest is primary therapy

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11
Q

Mobilization devices

A

-Orthotics: braces, types include AFO, KAFO, HKAFO (hips, knees, ankles, foot, orthotics)
-Prosthetics: artificial limbs
-Crutches, canes, walkers, wheelchairs

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12
Q

Frxs

A

-Rare in infants, expect in MVCs, always considered child abuse
-In school-age children –> bike, sports, playground falls
-Children heal faster than adults
-Radius/ulna and clavicle most common

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13
Q

Types of frxs

A

-Complete vs incomplete
-Simple vs compound
-Compound or open: fractured bone protrudes thru skin
-Complicated: bone fragments damaged other organs or tissue
-Greenstick: compressed side of bone bends but tension side of bone breaks, causing an incomplete frx

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14
Q

Growth plate (physeal) injuries

A

-Weakest point of long bones is cartilage growth plate (epiphyseal plate)
-May affect future bone growth
-Tx includes open reduction and internal fixation

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15
Q

Bone healing and remodeling

A

-Phases: inflammatory, restorative, remodeling
-Healing time for femoral frx: neonatal 2-3 weeks, early childhood 4 weeks, later childhood 6-8 weeks, adolescence 8-12 weeks

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16
Q

s/s of frxs

A

-Swelling
-Pain or tenderness
-Deformity
-Diminished fxnal use
-Bruising
-Severe muscular rigidity
-Crepitus (grating sensation at frx site

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17
Q

Dx of frxs

A

-Obtain info from injured person
-X-ray most useful

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18
Q

Assessment of frxs

A

-Pain and point of tenderness
-Pulse (distal to frx site)
-Pallor
-Paresthesia (sensation distal to frx site)
-Paralysis (mvmt distal to frx site)
-Poikilothermia: inability to regulate core body temp
-Eval compartment syndrome

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19
Q

Frx complications

A

-Circulatory impairment
-Nerve compression syndrome
-Compartment syndrome
-Physeal damage
-Nonunion
-Malunion
-Osteomyelitis
-Kidney stones
-PE

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20
Q

Assessment prior to casting

A

-Color (cyanosis)
-Mvmt (mvmt of digits)
-Sensation (loss of sensation)
-Edema
-Quality of pulses

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21
Q

Casting

A

-Plaster or fiberglass material
-Assess neurovascular status pre and post
-Pre medicate for pain
-Skin impairment as cast edges
-Protect from moisture
-Don’t put anything in cast
-Persistent pain may indicate skin impairment under cast

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22
Q

s/s of casting complications

A

-Pain
-Edema
-Cyanosis
-Skin coolness
-Numbness or tingling
-Prolonged cap refill
-Absence of pulse
-Hot spots on cast surface
-Drainage

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23
Q

Compartment syndrome

A

-Pressure within 1+ muscle compartments –> ischemia-edema cycle
-Can lead to tissue necrosis and neuromsk damage in 4-6 hrs w/o tx
-Caused by tight cast
-Assess for pain unrelieved by elevation or pain meds, numbness or pallor
-Tx: fasciotomy

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24
Q

Overuse injury

A

-Repetitive microtrauma
-Inflammation of involved structure
-Complaint of pain, tenderness, swelling, disability
-Ex: tennis elbow, osgood-schlatter disease

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25
Crutch walking: non weight bearing
-Put crutches forward at 1 step's length -Push down on crutches, hold bad leg up from floor, squeeze top of crutches btwn chest and arm -Step on good leg
26
Crutch walking: partial weight bearing
-Put crutches forward at 1 step's length -Put bad leg froward, level w/ crush tips -Take most of weight by pushing down on hand grips, squeezing top btwn chest and arm -Take step w/ good leg
27
Traction
-Forward force produced by attaching weight to a distal bone fragment -Provides rest for extremity, immobilizes frx, reduces muscle spasms (rare in kids) -Countertraction: backward forced provided by bw -Frictional force: provided by pt's contact w/ bed -Skin traction: pulling mechanisms attached to skin w/ adhesive material or elastic bandage (buck's traction) -Skeletal traction: applied directly to skeletal structure by pin, wire, or tongs inserted into diameter of bone distal to frx -Halo/cervical traction: screws inserted into outer skull, halo is attached to bed or vest worn by pt, make sure pins are tight
28
Traction nursing mgmt
-Weight should hang free all the time -Maintain body alignment -Never released by nurse unless emergency -Inspect pin for infection, make sure they're not loose, monitor skin under vest
29
Distraction
-Separation of opposing bones to encourage regeneration of new bone in created space -Can be used when limbs unequal in length or to immobilize frxs -External fixator device -Educate on pin care
30
Amputation
-May be congenital absence, traumatic loss, surgically required d/t cancer -Elastic bandaging for compression -PT
31
Stress frxs
-Result of repeated muscle contractions -Seen in weight-bearing sports (gymnastics, running, basketball) -Tibial most common -Small crack
32
Torticollis
-Wry neck -Congenital or acquired limited neck ROM w/ neck flexed to affected site -Tight sternocleidomastoid muscle -PT first, surgery next if needed
33
Kyphyosis
-Increased convex angulation in thoracic spine -Most common form is postural -Can result from TB, arthritis, osteodystrophy, compression frx
34
Lordosis
-Accentuation of cervical or lumbar curvature -May occur w/ flexion contractions of hip or congenital dislocated hip -In obese children, abdominal fat alters COG
35
Scoliosis
-Most common spinal deformity -Can compress organs, affect breathing -Lateral curvature, spinal rotation causing rib asymmetry, thoracic hypokyphosis -May be congenital or acquired -Most causes idiopathic -Becomes noticeable after pre adolescent growth spurt -Complaint of ill-fitting clothes
36
Scoliosis dx
-Usually idiopathic -Radiographs -Asymmetry of shoulder height, scapular or flank shape, hip height -Primary curve and compensatory curve to align head w/ gluteal cleft -Cobb technique (uses X-ray) -Risser scale (measures maturity of bones)
37
Scoliosis nursing mgmt
-Bracing (TLSO) and exercise -TLSO has poor compliance, worn 23 hrs a day -Surgery if severe -Concerns of body image
38
DDH
-Congenital -Developmental dysplasia of the hip -High association w/ breech delivery -Dysplasia of hip joint: acetabulum is showing or sloping instead of cup shape -Subluxation: partial dislocation -Dislocation: no contact btwn femoral head and acetabulum -Tx: spica cast
39
DDH s/s
-Affected leg is shorter -Greater trochanter is prominent -Asymmetry of gluteal and thigh folds -Limited hip abduction in flexion -Shortening of femur as evidenced by level of knees -Ortolani clunk in infants < 4 weeks -Pos trendelenburg sign w/ lordosis if child is weight-bearing -Marked lordosis if bilateral dislocation -Waddling gait in bilateral dislocation
40
Pavlik harness
-For infants w/ DDH > 6 m -Worn until hip is stable (6-12 weeks) -Check skin irritation in folders and under straps -Avoid lotions and powders -Always place diaper under straps
41
Congenital clubfoot
-Talipes varus: inversion (bending inward) -Talipes valgus: eversion (bending outward) -Talipes equinovarus: plantar flexion w/ toes lower than heel -Talipes calcaneus: dorsiflexion w/ toes higher than heel -Males more affected -Bilateral in half of cases -Dx at birth or prenatally -Tx: staged correction, ponseti method (weekly serial casting)
42
Metatarsus adductus
-Most common congenital foot deformity -Results from abnormal position in uterus -Pigeon-toed gait -Tx: PT and braces
43
OI
-Osteogenesis imperfecta -Group of heterogeneous inherited disorders of connective tissue -Excessive fragility and bone defects --> multiple bone frxs -Hyperextensibility of ligaments -s/s: short height, blue sclerae, hearing loss, small and discolored teeth -Tx: PT, no meds, surgery w/ intramedullary rods, caution w/ handing to prevent frxs
44
Legg-calve-perthes disease
-Interruption of blood supply (avascular necrosis) to femoral head --> loss in shape of femoral head -Most often when kid is 4-8 yrs -Over time revascularization occurs, femoral head reforms -Hip pain or immobility
45
JIA
-Juvenile idiopathic arthritis -RA, chronic arthritis, or idiopathic arthritis of childhood -Chronic inflammation of synovium of joints, wearing down of articular cartilage -Results in joint deformities -90% of cases are neg for rheumatoid factor
46
JIA s/s
-Stiffness, swelling, limp in morning -Warm, tender to touch w/o erythema -Delayed growth -Increases w/ stressors -Iridocyclitis: inflammation of iris and ciliary body (tx by eye doctor, unique to JIA) -Uveitis: inflammation of uvea (tx by eye doctor, unique to JIA)
47
JIA dx
-Before 16 yrs -1+ affected joints -Duration > 6 weeks -No definitive dx test -Elevated CRP and ESR -ANA common but not specific to JIA -Leukocytosis during exacerbations -X-rays are for baseline comparison
48
JIA tx
-No specific cure -NSAIDs, DMARDs, corticosteroids, cytotoxic agents, immunologic modulators -PT and OT -Exercise -Splinting -Surgery
49
SLE
-Systemic lupus erythematosus -Chronic multisystem autoimmune disease of connective tissues and blood vessels -Inflammation -Common in girls 10-19 yrs -Common in black, asian, latin children -Familial tendency -Triggered by hormonal imbalance, immune disorders, exposure to drugs, infection, stress, chemicals
50
SLE s/s
-Cutaneous lesions, lymphadenopathy -N/V/D, pain -Fatigue, arthritis, joint stiffness w/o deformity -Forgetfulness, seizures, paralysis -Pleurisy -Pericarditis -Proteinuria and renal failure
51
SLE dx
-Must have 4 of following -Butterfly rash -Discoid rash -Photosensitivity -Oral ulcers -Arthritis -Serositis -Renal, neuro, hematologic, immunologic disorders -ANA
52
SLE mgmt
-Hydroxychloroquine, NSAIDs, methotrexate, steroids -Body issues -Avoid sun exposure -Medical alert bracelet
53
SCFE
-Slipped capital femoral epiphysis -Spontaneous displacement of proximal femoral epiphysis in posterior and inferior direction -Occurs before or during growth spurts -Usually idiopathic but can be d/t obesity and puberty hormone changes
54
SCFE s/s
-Episodes of trauma w/ acute displacement -Gradual displacement w/o definite injury -Intermittent displacement
55
SCFE dx
-Physical exam -Radiographs
56
SCFE mgmt
-Keep head of femur in acetabulum -Use of devices -Rest, no weight bearing initially -Surgery -Home traction
57
Osteomyelitis
-Infection of bony tissue -Resemble s/s of arthritis and leukemia -Marked leukocytosis -Bone cultured obtained from biopsy or aspirate -Early x-rays appear normal -Bone scans for dx
58
Osteomyelitis types
-Exogenous: infectious agent invades bone following penetrating wound, open frx, contamination in surgery, or secondary extension from abscess or burn -Hematogenous: pre existing infection, source may be furuncles, skin infections, URI, abscessed teeth, pyelonephritis, any organism can be source, infective emboli travels to arteries in bone metaphysis
59
Osteomyelitis mgmt
-May have subacute presentation w/ walled-off abscess rather than a spreading infection -Prompt, vigorous IV abc for 3-4 weeks or months -Monitor hematolic, renal, hepatic response
60
Septic arthritis
-Also called suppurative, pyogenic, purulent arthritis -Results from extension of soft tissue infection -Usually involves hip, knee, shoulder -Usually only affects 1 joint -Neisseria gonorrhoeae is frequent cause in sexually active teens
61
Septic arthritis s/s
-Joint is warm, tender, swollen -Follows traumatic injury -Fever, leukocytosis, increased sedimentation rate
62
Septic arthritis dx
-Blood culture -Joint fluid aspirate -X-rays
63
Septic arthritis mgmt
-Prevent destruction of joint cartilage -Decompress joint -Eradicate infection -Prevent spread of infection -Abx and pain meds -Surgery

Pediatrics (24 decks)

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