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