Chapter 50: The Child with a Musculoskeletal Alteration Flashcards
when caring for a patient with osteomyelitis on IV antibiotic therapy, the nurse should monitor for these two side effects
renal toxicity
hepatotoxicity
fractures in infants are _____ because bones are mostly ________________
rare, cartilaginous
soft tissue injuries are seen most often in _____________ population and are related to _________ injuries
adolescent, sports
Before applying any immobilizing device, always assess for ______________ about the procedure, _______ for the device, and any _____________, _________, or ________ areas of skin that may be covered by the device.
knowledge, care, bruising, scrapes, open
the Ponseti and French methods are most effective when the infant is __________; ______________ should be planned to coincide with therapy along with a ______, _________, and _____ environment
relaxed, feeding, quiet, warm, dim
this medication is added if child does not improve within 4-6 weeks of NSAID therapy (juvenile idiopathic arthritis)
methotrexate
this risk factor of Duchenne Muscular Dystrophy (DMD) increases the chance of child having the disease
family history
initial treatment for Legg-Calve-Perthes disease includes these three things
anti-inflammatory medications, range of motion exercises, bed rest
complication that occurs when swelling increases the pressure within the fascial compartments and compromising the neurovascular system
compartment syndrome
fiberglass casts are (heavier, lighter) than plaster casts
lighter
type of reduction that is a surgical intervention in which the bones are reset and held in place with screws, pins, wires, or plates
open reduction
Increasing disability and deformity are present with Duchenne Muscular Dystrophy (DMD) and will result in ________________
contractures
infants with developmental dysplasia of the hip should have car seats with ______________
wide leg spread
complications of scoliosis fusion surgery include ______________ injury, lack of _______________, __________ failure, progression of __________, and __________.
spinal cord, solid fusion, implant, deformity, infection
the child with osteomyelitis will need a diet with _____________ and _______________
high protein, high calories
these three differences in the child’s gait may be noted with developmental dysplasia of the hip
toe walking
limping
waddling
if compartment syndrome is suspected the nurse should immediately ____________, ___________ the extremity, ____________ any restrictive bandages, _____ the cast (if able), administer _______________, and keep the patient _______
call the provider, elevate, loosen, split, medication, NPO
pediatric bones have a (weaker, stronger) periosteum, making complete fractures (less, more) likely and preventing ______________ of fractures.
stronger, less, displacement
if a female patient with scoliosis is postmenarchal, there is a slowed growth and (lower, higher) chance for curve progression
lower
scoliosis fusion surgery has significant ___________ and therefore the nurse will need to _____________ in the postoperative period
blood loss, transfuse blood
to treat developmental dysplasia of the hip, infants less than 6 months will be placed in this device, which will be initially worn continuously to help promote normal femoral head development
Pavlik harness
before losing ability to walk, patients with Duchenne Muscular Dystrophy (DMD) walk with a(n) _____________ or _______ gait
waddling, wide
pediatric bones have a (higher, lower) collagen to bone ratio, resulting in the bones being (more, less) brittle and make incomplete fracture (more, less) likely
higher, less, more
infants with developmental dysplasia of the hip and beyond the newborn period will show asymmetry of the ______________ when legs are extended
gluteal fold
these three lab work tests help show signs of inflammation with juvenile idiopathic arthritis
CBC (rules out infection)
increased ESR
increased CRP
complete soft tissue ruptures may require _________ to prevent ________________, which can pose long-term _______ problems
surgery, scar formation, joint
when caring for the wound site in osteomyelitis, _____________ precautions must be observed
standard
type of fracture in which the break or fracture line occurs at right angles to the long axis of the bone
transverse fracture
this can be helpful to help “wake up” joints in the mornings (juvenile idiopathic arthritis)
warm shower or bath
Duchenne Muscular Dystrophy (DMD) manifests between ages _______ but degeneration of cells begins before age _____
3-7, 3
if the impairment persists after initial treatment, patients with Legg-Calve-Perthes disease may need __________ or ___________
braces, traction
In Duchenne Muscular Dystrophy (DMD), progressive weakness and muscle wasting occur without loss of ______________
sensation
pain management for postop scoliosis fusion surgery changes to oral by postoperative day ____
2-3
this maneuver is characterized by putting the hands on the knees and moving them up to the thigh to help stand
Gower maneuver
after placing an immobilizing device, perform this assessment at least every ___________ during the first ___________
neurovascular assessment, 2 hours, 48 hours
most effective way to properly diagnose fractures
X-ray
parents need to be taught proper use of a Pavlik harness to prevent improper placement, which can result in this
vascular necrosis (decreased blood flow to the joint)
In Duchenne Muscular Dystrophy (DMD), calves will be _____________ but ________
hypertrophied, weak
main and possible only manifestation of Legg-Calve-Perthes disease
pain or limp that is exacerbated with activity
diagnosis of soft tissue injuries is primarily made based on a(n) ___________________
physical exam
casts can be made from these three materials
fiberglass
semirigid nonfiberglass (soft cast)
plaster of Paris
type of traction that is preferred for patients subject to bleeding (ex. hemarthrosis in patient with hemophilia)
skin traction
skin traction has a risk of ______________ of the joint, which can lead to neurovascular compromise
hyperextension
skin traction is not appropriate if child has known skin ___________, _____________, ___________ damage, or altered ____________
infection, open wound, tissue, sensation
_______________ may be needed to release contractures with Duchenne Muscular Dystrophy (DMD)
Surgery
condition in which an avascular event affects the epiphyseal plate of the femur, ultimately resulting in decreased growth
Legg-Calve-Perthes disease
death from Duchenne Muscular Dystrophy (DMD) occurs in ______________ from _______________ or __________ failure
late teenage years, respiratory, heart
manifestations in infants include fever, irritability, lethargy, and feeding difficulties
osteomyelitis
older children with developmental dysplasia of the hip can use this while riding in the car
car vest restraint
in treating soft tissue injuries, ____________ movement is beneficial for healing
passive
soft tissue injury in which soft tissue or muscles are damaged
contusion
when caring for the wound site in osteomyelitis, note these four characteristics of drainage
color, odor, consistency, amount (COCA)
the Pavlik harness should be placed and tightened so that there is space for ____ finger(s) under the chest strap and _____ finger(s) under the shoulder straps. The feet are placed in the __________ and then attached to the ______ strap.
2, 1, stirrups, chest
osteomyelitis pain that radiates to a local joint should raise the suspicion of this
septic joint
Prevention and treatment of ______________ is important in Duchenne Muscular Dystrophy (DMD) because these can spread ____________ in a child with decreased mobility
infection, quickly
treatment for scoliosis curves >25 degrees
brace if skeletally immature
soft tissue injury which involves pulls, tears, or ruptures
strains
In a patient with juvenile idiopathic arthritis, exercise should be ___________ and include _________________ motion and _________________ exercises
gentle, active and passive, strengthening
treatment for clubfoot is aimed at reducing _______ and ___________ of the foot and correcting __________ and returning _____________ to the foot.
pain, deformity, structure, function
developmental dysplasia of the hip may involve partially or fully displaced ____________________
femoral head
fractures are common in children due to these two things
immature motor ability
risk taking behaviors
treatment of juvenile idiopathic arthritis focuses on supporting _________________ and minimizing impact on ______________
joint function, development
slipped capital femoral epiphysis affects patients who are ____________, which is a significant risk factor. this means that ______________ teaching and ____________ management may need to be addressed.
overweight, nutritional, weight
the epiphyseal plates of bones are _______ in children and can bear a large brunt of children’s injuries
open
the patient with slipped capital femoral epiphysis is discharged from the hospital with __________________________, which means that he/she will need proper _____________ teaching.
partial weight bearing, crutch
never leave infants in this device unattended (developmental dysplasia of the hip)
spica cast
this treatment method for clubfoot is performed by a trained physical therapist while patient is inpatient and includes stretching and taping of the foot daily
French method
if a female patient with scoliosis is premenarchal, there is a large amount of growth left and therefore a (lower, higher) chance for curve progression
higher
realignment of bones or repositioning of bone fragments into normal alignment is also called
reduction
after reduction is complete, the bones must be ___________ to prevent redisplacement
stabilized
this treatment method for clubfoot requires frequent, often weekly, casting of the foot to help stretch and manipulate the bones, ligaments, and tendons back into proper alignment
Ponseti method
exogenous routes of osteomyelitis include these two
injury
surgical procedures
manifestations include neurovascular impairments and extreme or worsening pain not relieved by medication or worsening pain when trying to move fingers/toes
compartment syndrome
these need to be removed from cast padding prior to applying hardened portion to prevent skin breakdown
wrinkles
the nurse should always assume that traction is (intermittent, continuous) unless the physician states otherwise
continuous
type of fracture in which the bone is splintered into pieces; occurs rarely in children
comminuted fracture
After application of the cast, patients often report that the cast feels _______
warm
although the cause of slipped capital femoral epiphysis is unknown, the increase in ____________ is related to weakening of the epiphyseal plate as it completes one last growth and closes
hormones
fracture complications are most common in child with _____________________ or has __________________
multiple fractures, long bone fractures
treatment for soft tissue injuries is mainly __________ therapy
RICE
Once identified, the patient with slipped capital femoral epiphysis is admitted to the hospital for strict _____________ and _________________ with a plate or screw.
bed rest, internal fixation
manifestations include axillary petechiae, hypoxemia, pulmonary infiltrates on imaging
fat embolism
four highest risk factors for developmental dysplasia of the hips
first born
female
breech position
low amniotic fluid in utero
a child with Duchenne Muscular Dystrophy (DMD) typically loses walking ability between ages _____
9-12
rare complication of fractures that occurs in <0.1% of children
deep vein thrombosis
plaster casts set within ____________ but will fully dry within ____________
10-15 minutes, 48 hours
characteristic manifestation of slipped capital femoral epiphysis involves a(n) _______ or ________ with activity in the __________, ____________, or ________
limp, pain, groin, thigh, knee
When caring for a patient with osteomyelitis on IV antibiotic therapy, the nurse should care for the _______ and pay attention to _______ and _________ levels
site, peak, trough
severe strains are more easily identified via a(n) __________
MRI
fiberglass casts set within ____________ but are less forgiving if ____________ is suspected
30 minutes, swelling
these injections can be given in selective joints in children with juvenile idiopathic arthritis
local corticosteroid injections
if severe vertebrae rotation is present with scoliosis, it can cause ____________ compromise
respiratory
when osteomyelitis is present, lab work will show these three levels
elevated ESR
elevated CRP
elevated WBC
these two tests aid in diagnosis of Duchenne Muscular Dystrophy (DMD)
electromyography, muscle biopsy
as Duchenne Muscular Dystrophy (DMD) progresses, these three manifestations appear
obesity
cognitive disability
cardiomyopathy
soft devices fabricated from a variety of materials (fiberglass, plaster, metal, thermoplastic polymers) that are used to help aid in stabilization, rest, and pain relief of affected area
splints
these two maneuvers are used to identify any abnormalities in the hips
Barlow, Ortolani
after the French method fully corrects clubfoot, parents are taught ____________ techniques to use at home until the child reaches ______________
stretching, walking age
preventative measures for deep vein thrombosis include early _______________, ____________ of the extremity, and postop _____________.
ambulation, elevation, physiotherapy
The Ponseti method corrects all parts of deformity of clubfoot at the same time except for the __________, which is corrected before the final casting using a(n) ________________________ procedure
equinus, tendoachillis lengthening (TAL)
_____________ and ______________ help keep the child with Duchenne Muscular Dystrophy (DMD) mobile
Braces, splinting
five different types of imaging that might be done for osteomyelitis
X-ray, ultrasound, MRI, CT, bone scans
endogenous routes of osteomyelitis include these three
upper respiratory infections
abscessed tooth
acute otitis media
if the osteomyelitis is unresponsive to therapy or if an abscess is identified, this treatment may be indicated
surgery
this medication can be used as first line treatment for juvenile idiopathic arthritis because it slows progression and gives longer period of disease control
methotrexate
In a patient with juvenile idiopathic arthritis, frequent ______________ can help increase overall endurance and limit joint impact for the day
rest breaks
soft tissue injury in which ligaments are stretched or torn
sprains
these two methods might be done to obtain a culture when osteomyelitis is suspected
blood culture
culture from aspirated fluid (i.e., joint)
size and type of cast is dictated by _______, ____________ and _________ of injury
type, location, severity
four risk factors for deep vein thrombosis
prolonged central lines
obesity
infection
long bone trauma
in treating soft injuries, these medications are used to help alleviate pain and inflammation
NSAIDs
When treating osteomyelitis, _______________ antibiotics are used, and a _____________ may be needed for long-term therapy.
high-powered, PICC line
to be diagnosed with juvenile idiopathic arthritis, the child must meet these three criteria
- younger than 16
- swelling in at least 1 joint for at least 6 weeks
- 2 or more signs of the following: decreased ROM, increased warmth, discomfort on movement
with the French method, full correction is obtained within _____________
5 months
pull or force exerted on one part of the body that can be applied to either skin or bone to aid in alignment of bone or joint
traction
a child receiving scoliosis fusion surgery is ideally discharged on day ___ and will follow up with the surgeon up to ________ postoperatively.
5, 1 year
type of fracture in which the break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side; seen most frequently in forearm
greenstick fracture
treatment for Legg-Calve-Perthes disease is aimed at preserving ______________ and delaying __________
motion of the hip, arthritis
this type of traction is more invasive and applies greater force to keep bones within alignment
skeletal traction
slipped capital femoral epiphysis may be initially misinterpreted as ___________________, but a(n) _________ will show the slipped plate
growing pains, X-ray
while infants wear a Pavlik harness, parents should put a ______________ onesie underneath the harness to reduce skin breakdown
well-fitting
In treating Duchenne Muscular Dystrophy (DMD), monitor the skin for signs of ______________ and teach parents to reposition every __________
breakdown, 2 hours
first-line treatment for juvenile idiopathic arthritis
NSAIDs
complication of fractures which occurs when pieces of fat are dislodged from the fracture site and travel to the lungs where they become lodged
fat embolism
providers will choose (plaster, fiberglass) cast if they need more pressure to “mold” a deformity
plaster
in treating soft injuries, extremity should be elevated to be level with _________
the heart
treatment for scoliosis curves >40-50 degrees
surgery- fusion to correct curvature
the material used for the cast is placed in ______ to help harden it
water
these four lab work tests are useful in identifying the arthritis as autoimmune and the individual subclass of juvenile idiopathic arthritis
rheumatoid factor (RF)
antinuclear antibody (ANA)
human leukocyte antigen B27 (HLA-B27)
anticyclic citrullinated peptide (anti-CCP)
immune suppression may result when taking these drugs for juvenile idiopathic arthritis
methotrexate
biologics
when wearing a scoliosis brace, patients should be instructed to wear ___________ shirt underneath it to reduce skin breakdown
form fitting
school based screenings for scoliosis utilize the ______________ test and sometimes a(n) ______________
Adams forward bend, scoliometer
in treating soft tissue injuries, ice should be applied no longer than ____________
20 minutes
this drug class helps control the disease process of juvenile idiopathic arthritis
biologics (Enbrel, Humira, Remicade)
In muscular dystrophy, the muscle fibers start to leak ______________ and take on ___________, which is harmful to the fibers. Over time, the damaged muscle tissues are replaced by _____, and ___________ and __________ begin.
creatine kinase, calcium, fat, weakness, atrophy
Cast padding is placed ___________ on the skin with extra padding along __________________.
directly, bony prominences
in developmental dysplasia of the hip, the affected hip will have limited ________ and asymmetric _________
range of motion (ROM), abduction
manifestations may include pain or tenderness at site, decreased ROM, swelling, obvious deformity, crepitus, erythema, ecchymosis, inability to bear weight, muscle spasms
fracture
direct exposure to bacteria for osteomyelitis can occur after these three things
open fracture
external fixation
traction
used to stabilize an extremity to maintain anatomic position while the bone heals
casts
condition in which rapid growth during adolescence causes a shearing force that causes the femoral epiphysis to displace
slipped capital femoral epiphysis
Before placing a cast, ensure that the bone is in proper ______________
alignment
this imaging test is used to confirm presence of developmental dysplasia of the hip
ultrasound (X-ray not fully accurate in infants because ossification is not complete)
clubfoot is characterized by these four manifestations
C: rigid midfoot Cavus
A: forefoot Adduction
V: heel Varus
E: ankle Equinus
Due to weakness in Duchenne Muscular Dystrophy (DMD), _____________ is a concern. Encourage a(n) ______________________
obesity, well-balanced diet
injury in which joint is disrupted so articulating surfaces are no longer in contact
dislocation
manifestations in older children include redness, pain, warmth, swelling over affected site; favoring of extremity; fever; lethargy; limited ROM
osteomyelitis
soft tissue injury surgery patients will be discharged with these two items and may need ___________ therapy
cold compress cuff
continuous passive motion (CPM) machine
physical
in Duchenne Muscular Dystrophy (DMD), these levels are elevated in early stages but decline as muscles die
serum creatine kinase (CK)
type of fracture characterized by twisted or circular break that affects the length rather than the width; seen frequently in child abuse
spiral fracture
after a closed or open hip reduction procedure, patients will be discharged in a __________ to ensure immobilization for about _________ (time period).
spica cast, 3 months
type of reduction which is usually done under light sedation and does not require hospitalization
closed reduction
type of fracture that involves a diagonal or slanting break that occurs between the horizontal and perpendicular planes of the bone
oblique fracture
treatment for fat embolism is ______________, including _____________ support, _______________, and volume ______________; also aimed at ______________, including minimal _______________ of the affected extremity
supportive, respiratory, oxygenation, resuscitation, prevention, movement
treatment for scoliosis curves <25 degrees
watched and followed closely for progression
In juvenile idiopathic arthritis, stiffness in the joints is worse in the _____________, after prolonged _________, and on ______ days
mornings, rest, cold
scoliosis deformity is directly driven by and related to __________, so it is important to note __________________ using the ________________
growth, sexual development, Tanner stages
this activity helps promote physical activity and range of motion exercises in a child with Duchenne Muscular Dystrophy (DMD)
swimming
type of traction that is noninvasive and best for younger and small children (less than 15 kg)
skin traction
most severe complication of skeletal traction which manifests as redness, swelling, drainage, tenderness, and odor from pin site; this can be prevented with __________________________
osteomyelitis; meticulous pin site care
Legg-Calve-Perthes disease can be seen on ________ but further imaging with ______ or _________ can show more detailed irregularities to the bone and necrosis
X-rays, MRI, bone scan
clubfoot can be diagnosed during the ___________ period via ______________ or upon ___________________ at ________
prenatal, ultrasound, physical assessment, birth
for traction to be effective, a ___________________ is also in place
counter-traction
patients with juvenile idiopathic arthritis should choose _____________ activities such as ______________ and _________________
low-impact, swimming, bike riding
