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Pediatric Nursing Care > Chapter 50: The Child with a Musculoskeletal Alteration > Flashcards

Chapter 50: The Child with a Musculoskeletal Alteration Flashcards

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1
Q

when caring for a patient with osteomyelitis on IV antibiotic therapy, the nurse should monitor for these two side effects

A

renal toxicity
hepatotoxicity

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2
Q

fractures in infants are _____ because bones are mostly ________________

A

rare, cartilaginous

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3
Q

soft tissue injuries are seen most often in _____________ population and are related to _________ injuries

A

adolescent, sports

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4
Q

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.

A

knowledge, care, bruising, scrapes, open

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5
Q

the Ponseti and French methods are most effective when the infant is __________; ______________ should be planned to coincide with therapy along with a ______, _________, and _____ environment

A

relaxed, feeding, quiet, warm, dim

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6
Q

this medication is added if child does not improve within 4-6 weeks of NSAID therapy (juvenile idiopathic arthritis)

A

methotrexate

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7
Q

this risk factor of Duchenne Muscular Dystrophy (DMD) increases the chance of child having the disease

A

family history

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8
Q

initial treatment for Legg-Calve-Perthes disease includes these three things

A

anti-inflammatory medications, range of motion exercises, bed rest

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9
Q

complication that occurs when swelling increases the pressure within the fascial compartments and compromising the neurovascular system

A

compartment syndrome

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10
Q

fiberglass casts are (heavier, lighter) than plaster casts

A

lighter

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11
Q

type of reduction that is a surgical intervention in which the bones are reset and held in place with screws, pins, wires, or plates

A

open reduction

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12
Q

Increasing disability and deformity are present with Duchenne Muscular Dystrophy (DMD) and will result in ________________

A

contractures

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13
Q

infants with developmental dysplasia of the hip should have car seats with ______________

A

wide leg spread

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14
Q

complications of scoliosis fusion surgery include ______________ injury, lack of _______________, __________ failure, progression of __________, and __________.

A

spinal cord, solid fusion, implant, deformity, infection

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15
Q

the child with osteomyelitis will need a diet with _____________ and _______________

A

high protein, high calories

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16
Q

these three differences in the child’s gait may be noted with developmental dysplasia of the hip

A

toe walking
limping
waddling

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17
Q

if compartment syndrome is suspected the nurse should immediately ____________, ___________ the extremity, ____________ any restrictive bandages, _____ the cast (if able), administer _______________, and keep the patient _______

A

call the provider, elevate, loosen, split, medication, NPO

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18
Q

pediatric bones have a (weaker, stronger) periosteum, making complete fractures (less, more) likely and preventing ______________ of fractures.

A

stronger, less, displacement

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19
Q

if a female patient with scoliosis is postmenarchal, there is a slowed growth and (lower, higher) chance for curve progression

A

lower

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20
Q

scoliosis fusion surgery has significant ___________ and therefore the nurse will need to _____________ in the postoperative period

A

blood loss, transfuse blood

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21
Q

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

A

Pavlik harness

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22
Q

before losing ability to walk, patients with Duchenne Muscular Dystrophy (DMD) walk with a(n) _____________ or _______ gait

A

waddling, wide

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23
Q

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

A

higher, less, more

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24
Q

infants with developmental dysplasia of the hip and beyond the newborn period will show asymmetry of the ______________ when legs are extended

A

gluteal fold

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25
Q

these three lab work tests help show signs of inflammation with juvenile idiopathic arthritis

A

CBC (rules out infection)
increased ESR
increased CRP

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26
Q

complete soft tissue ruptures may require _________ to prevent ________________, which can pose long-term _______ problems

A

surgery, scar formation, joint

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27
Q

when caring for the wound site in osteomyelitis, _____________ precautions must be observed

A

standard

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28
Q

type of fracture in which the break or fracture line occurs at right angles to the long axis of the bone

A

transverse fracture

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29
Q

this can be helpful to help “wake up” joints in the mornings (juvenile idiopathic arthritis)

A

warm shower or bath

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30
Q

Duchenne Muscular Dystrophy (DMD) manifests between ages _______ but degeneration of cells begins before age _____

A

3-7, 3

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31
Q

if the impairment persists after initial treatment, patients with Legg-Calve-Perthes disease may need __________ or ___________

A

braces, traction

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32
Q

In Duchenne Muscular Dystrophy (DMD), progressive weakness and muscle wasting occur without loss of ______________

A

sensation

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33
Q

pain management for postop scoliosis fusion surgery changes to oral by postoperative day ____

A

2-3

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34
Q

this maneuver is characterized by putting the hands on the knees and moving them up to the thigh to help stand

A

Gower maneuver

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35
Q

after placing an immobilizing device, perform this assessment at least every ___________ during the first ___________

A

neurovascular assessment, 2 hours, 48 hours

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36
Q

most effective way to properly diagnose fractures

A

X-ray

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37
Q

parents need to be taught proper use of a Pavlik harness to prevent improper placement, which can result in this

A

vascular necrosis (decreased blood flow to the joint)

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38
Q

In Duchenne Muscular Dystrophy (DMD), calves will be _____________ but ________

A

hypertrophied, weak

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39
Q

main and possible only manifestation of Legg-Calve-Perthes disease

A

pain or limp that is exacerbated with activity

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40
Q

diagnosis of soft tissue injuries is primarily made based on a(n) ___________________

A

physical exam

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41
Q

casts can be made from these three materials

A

fiberglass
semirigid nonfiberglass (soft cast)
plaster of Paris

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42
Q

type of traction that is preferred for patients subject to bleeding (ex. hemarthrosis in patient with hemophilia)

A

skin traction

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43
Q

skin traction has a risk of ______________ of the joint, which can lead to neurovascular compromise

A

hyperextension

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44
Q

skin traction is not appropriate if child has known skin ___________, _____________, ___________ damage, or altered ____________

A

infection, open wound, tissue, sensation

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45
Q

_______________ may be needed to release contractures with Duchenne Muscular Dystrophy (DMD)

A

Surgery

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46
Q

condition in which an avascular event affects the epiphyseal plate of the femur, ultimately resulting in decreased growth

A

Legg-Calve-Perthes disease

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47
Q

death from Duchenne Muscular Dystrophy (DMD) occurs in ______________ from _______________ or __________ failure

A

late teenage years, respiratory, heart

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48
Q

manifestations in infants include fever, irritability, lethargy, and feeding difficulties

A

osteomyelitis

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49
Q

older children with developmental dysplasia of the hip can use this while riding in the car

A

car vest restraint

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50
Q

in treating soft tissue injuries, ____________ movement is beneficial for healing

A

passive

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51
Q

soft tissue injury in which soft tissue or muscles are damaged

A

contusion

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52
Q

when caring for the wound site in osteomyelitis, note these four characteristics of drainage

A

color, odor, consistency, amount (COCA)

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53
Q

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.

A

2, 1, stirrups, chest

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54
Q

osteomyelitis pain that radiates to a local joint should raise the suspicion of this

A

septic joint

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55
Q

Prevention and treatment of ______________ is important in Duchenne Muscular Dystrophy (DMD) because these can spread ____________ in a child with decreased mobility

A

infection, quickly

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56
Q

treatment for scoliosis curves >25 degrees

A

brace if skeletally immature

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57
Q

soft tissue injury which involves pulls, tears, or ruptures

A

strains

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58
Q

In a patient with juvenile idiopathic arthritis, exercise should be ___________ and include _________________ motion and _________________ exercises

A

gentle, active and passive, strengthening

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59
Q

treatment for clubfoot is aimed at reducing _______ and ___________ of the foot and correcting __________ and returning _____________ to the foot.

A

pain, deformity, structure, function

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60
Q

developmental dysplasia of the hip may involve partially or fully displaced ____________________

A

femoral head

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61
Q

fractures are common in children due to these two things

A

immature motor ability
risk taking behaviors

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62
Q

treatment of juvenile idiopathic arthritis focuses on supporting _________________ and minimizing impact on ______________

A

joint function, development

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63
Q

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.

A

overweight, nutritional, weight

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64
Q

the epiphyseal plates of bones are _______ in children and can bear a large brunt of children’s injuries

A

open

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65
Q

the patient with slipped capital femoral epiphysis is discharged from the hospital with __________________________, which means that he/she will need proper _____________ teaching.

A

partial weight bearing, crutch

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66
Q

never leave infants in this device unattended (developmental dysplasia of the hip)

A

spica cast

67
Q

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

A

French method

68
Q

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

A

higher

69
Q

realignment of bones or repositioning of bone fragments into normal alignment is also called

A

reduction

70
Q

after reduction is complete, the bones must be ___________ to prevent redisplacement

A

stabilized

71
Q

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

A

Ponseti method

72
Q

exogenous routes of osteomyelitis include these two

A

injury
surgical procedures

73
Q

manifestations include neurovascular impairments and extreme or worsening pain not relieved by medication or worsening pain when trying to move fingers/toes

A

compartment syndrome

74
Q

these need to be removed from cast padding prior to applying hardened portion to prevent skin breakdown

A

wrinkles

75
Q

the nurse should always assume that traction is (intermittent, continuous) unless the physician states otherwise

A

continuous

76
Q

type of fracture in which the bone is splintered into pieces; occurs rarely in children

A

comminuted fracture

77
Q

After application of the cast, patients often report that the cast feels _______

A

warm

78
Q

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

A

hormones

79
Q

fracture complications are most common in child with _____________________ or has __________________

A

multiple fractures, long bone fractures

80
Q

treatment for soft tissue injuries is mainly __________ therapy

A

RICE

81
Q

Once identified, the patient with slipped capital femoral epiphysis is admitted to the hospital for strict _____________ and _________________ with a plate or screw.

A

bed rest, internal fixation

82
Q

manifestations include axillary petechiae, hypoxemia, pulmonary infiltrates on imaging

A

fat embolism

83
Q

four highest risk factors for developmental dysplasia of the hips

A

first born
female
breech position
low amniotic fluid in utero

84
Q

a child with Duchenne Muscular Dystrophy (DMD) typically loses walking ability between ages _____

A

9-12

85
Q

rare complication of fractures that occurs in <0.1% of children

A

deep vein thrombosis

86
Q

plaster casts set within ____________ but will fully dry within ____________

A

10-15 minutes, 48 hours

87
Q

characteristic manifestation of slipped capital femoral epiphysis involves a(n) _______ or ________ with activity in the __________, ____________, or ________

A

limp, pain, groin, thigh, knee

88
Q

When caring for a patient with osteomyelitis on IV antibiotic therapy, the nurse should care for the _______ and pay attention to _______ and _________ levels

A

site, peak, trough

89
Q

severe strains are more easily identified via a(n) __________

A

MRI

90
Q

fiberglass casts set within ____________ but are less forgiving if ____________ is suspected

A

30 minutes, swelling

91
Q

these injections can be given in selective joints in children with juvenile idiopathic arthritis

A

local corticosteroid injections

92
Q

if severe vertebrae rotation is present with scoliosis, it can cause ____________ compromise

A

respiratory

93
Q

when osteomyelitis is present, lab work will show these three levels

A

elevated ESR
elevated CRP
elevated WBC

94
Q

these two tests aid in diagnosis of Duchenne Muscular Dystrophy (DMD)

A

electromyography, muscle biopsy

95
Q

as Duchenne Muscular Dystrophy (DMD) progresses, these three manifestations appear

A

obesity
cognitive disability
cardiomyopathy

96
Q

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

A

splints

97
Q

these two maneuvers are used to identify any abnormalities in the hips

A

Barlow, Ortolani

98
Q

after the French method fully corrects clubfoot, parents are taught ____________ techniques to use at home until the child reaches ______________

A

stretching, walking age

99
Q

preventative measures for deep vein thrombosis include early _______________, ____________ of the extremity, and postop _____________.

A

ambulation, elevation, physiotherapy

100
Q

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

A

equinus, tendoachillis lengthening (TAL)

101
Q

_____________ and ______________ help keep the child with Duchenne Muscular Dystrophy (DMD) mobile

A

Braces, splinting

102
Q

five different types of imaging that might be done for osteomyelitis

A

X-ray, ultrasound, MRI, CT, bone scans

103
Q

endogenous routes of osteomyelitis include these three

A

upper respiratory infections
abscessed tooth
acute otitis media

104
Q

if the osteomyelitis is unresponsive to therapy or if an abscess is identified, this treatment may be indicated

A

surgery

105
Q

this medication can be used as first line treatment for juvenile idiopathic arthritis because it slows progression and gives longer period of disease control

A

methotrexate

106
Q

In a patient with juvenile idiopathic arthritis, frequent ______________ can help increase overall endurance and limit joint impact for the day

A

rest breaks

107
Q

soft tissue injury in which ligaments are stretched or torn

A

sprains

108
Q

these two methods might be done to obtain a culture when osteomyelitis is suspected

A

blood culture
culture from aspirated fluid (i.e., joint)

109
Q

size and type of cast is dictated by _______, ____________ and _________ of injury

A

type, location, severity

110
Q

four risk factors for deep vein thrombosis

A

prolonged central lines
obesity
infection
long bone trauma

111
Q

in treating soft injuries, these medications are used to help alleviate pain and inflammation

A

NSAIDs

112
Q

When treating osteomyelitis, _______________ antibiotics are used, and a _____________ may be needed for long-term therapy.

A

high-powered, PICC line

113
Q

to be diagnosed with juvenile idiopathic arthritis, the child must meet these three criteria

A
  1. younger than 16
  2. swelling in at least 1 joint for at least 6 weeks
  3. 2 or more signs of the following: decreased ROM, increased warmth, discomfort on movement
114
Q

with the French method, full correction is obtained within _____________

A

5 months

115
Q

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

A

traction

116
Q

a child receiving scoliosis fusion surgery is ideally discharged on day ___ and will follow up with the surgeon up to ________ postoperatively.

A

5, 1 year

117
Q

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

A

greenstick fracture

118
Q

treatment for Legg-Calve-Perthes disease is aimed at preserving ______________ and delaying __________

A

motion of the hip, arthritis

119
Q

this type of traction is more invasive and applies greater force to keep bones within alignment

A

skeletal traction

120
Q

slipped capital femoral epiphysis may be initially misinterpreted as ___________________, but a(n) _________ will show the slipped plate

A

growing pains, X-ray

121
Q

while infants wear a Pavlik harness, parents should put a ______________ onesie underneath the harness to reduce skin breakdown

A

well-fitting

122
Q

In treating Duchenne Muscular Dystrophy (DMD), monitor the skin for signs of ______________ and teach parents to reposition every __________

A

breakdown, 2 hours

123
Q

first-line treatment for juvenile idiopathic arthritis

A

NSAIDs

124
Q

complication of fractures which occurs when pieces of fat are dislodged from the fracture site and travel to the lungs where they become lodged

A

fat embolism

125
Q

providers will choose (plaster, fiberglass) cast if they need more pressure to “mold” a deformity

A

plaster

126
Q

in treating soft injuries, extremity should be elevated to be level with _________

A

the heart

127
Q

treatment for scoliosis curves >40-50 degrees

A

surgery- fusion to correct curvature

128
Q

the material used for the cast is placed in ______ to help harden it

A

water

129
Q

these four lab work tests are useful in identifying the arthritis as autoimmune and the individual subclass of juvenile idiopathic arthritis

A

rheumatoid factor (RF)
antinuclear antibody (ANA)
human leukocyte antigen B27 (HLA-B27)
anticyclic citrullinated peptide (anti-CCP)

130
Q

immune suppression may result when taking these drugs for juvenile idiopathic arthritis

A

methotrexate
biologics

131
Q

when wearing a scoliosis brace, patients should be instructed to wear ___________ shirt underneath it to reduce skin breakdown

A

form fitting

132
Q

school based screenings for scoliosis utilize the ______________ test and sometimes a(n) ______________

A

Adams forward bend, scoliometer

133
Q

in treating soft tissue injuries, ice should be applied no longer than ____________

A

20 minutes

134
Q

this drug class helps control the disease process of juvenile idiopathic arthritis

A

biologics (Enbrel, Humira, Remicade)

135
Q

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.

A

creatine kinase, calcium, fat, weakness, atrophy

136
Q

Cast padding is placed ___________ on the skin with extra padding along __________________.

A

directly, bony prominences

137
Q

in developmental dysplasia of the hip, the affected hip will have limited ________ and asymmetric _________

A

range of motion (ROM), abduction

138
Q

manifestations may include pain or tenderness at site, decreased ROM, swelling, obvious deformity, crepitus, erythema, ecchymosis, inability to bear weight, muscle spasms

A

fracture

139
Q

direct exposure to bacteria for osteomyelitis can occur after these three things

A

open fracture
external fixation
traction

140
Q

used to stabilize an extremity to maintain anatomic position while the bone heals

A

casts

141
Q

condition in which rapid growth during adolescence causes a shearing force that causes the femoral epiphysis to displace

A

slipped capital femoral epiphysis

142
Q

Before placing a cast, ensure that the bone is in proper ______________

A

alignment

143
Q

this imaging test is used to confirm presence of developmental dysplasia of the hip

A

ultrasound (X-ray not fully accurate in infants because ossification is not complete)

144
Q

clubfoot is characterized by these four manifestations

A

C: rigid midfoot Cavus
A: forefoot Adduction
V: heel Varus
E: ankle Equinus

145
Q

Due to weakness in Duchenne Muscular Dystrophy (DMD), _____________ is a concern. Encourage a(n) ______________________

A

obesity, well-balanced diet

146
Q

injury in which joint is disrupted so articulating surfaces are no longer in contact

A

dislocation

147
Q

manifestations in older children include redness, pain, warmth, swelling over affected site; favoring of extremity; fever; lethargy; limited ROM

A

osteomyelitis

148
Q

soft tissue injury surgery patients will be discharged with these two items and may need ___________ therapy

A

cold compress cuff
continuous passive motion (CPM) machine
physical

149
Q

in Duchenne Muscular Dystrophy (DMD), these levels are elevated in early stages but decline as muscles die

A

serum creatine kinase (CK)

150
Q

type of fracture characterized by twisted or circular break that affects the length rather than the width; seen frequently in child abuse

A

spiral fracture

151
Q

after a closed or open hip reduction procedure, patients will be discharged in a __________ to ensure immobilization for about _________ (time period).

A

spica cast, 3 months

152
Q

type of reduction which is usually done under light sedation and does not require hospitalization

A

closed reduction

153
Q

type of fracture that involves a diagonal or slanting break that occurs between the horizontal and perpendicular planes of the bone

A

oblique fracture

154
Q

treatment for fat embolism is ______________, including _____________ support, _______________, and volume ______________; also aimed at ______________, including minimal _______________ of the affected extremity

A

supportive, respiratory, oxygenation, resuscitation, prevention, movement

155
Q

treatment for scoliosis curves <25 degrees

A

watched and followed closely for progression

156
Q

In juvenile idiopathic arthritis, stiffness in the joints is worse in the _____________, after prolonged _________, and on ______ days

A

mornings, rest, cold

157
Q

scoliosis deformity is directly driven by and related to __________, so it is important to note __________________ using the ________________

A

growth, sexual development, Tanner stages

158
Q

this activity helps promote physical activity and range of motion exercises in a child with Duchenne Muscular Dystrophy (DMD)

A

swimming

159
Q

type of traction that is noninvasive and best for younger and small children (less than 15 kg)

A

skin traction

160
Q

most severe complication of skeletal traction which manifests as redness, swelling, drainage, tenderness, and odor from pin site; this can be prevented with __________________________

A

osteomyelitis; meticulous pin site care

161
Q

Legg-Calve-Perthes disease can be seen on ________ but further imaging with ______ or _________ can show more detailed irregularities to the bone and necrosis

A

X-rays, MRI, bone scan

162
Q

clubfoot can be diagnosed during the ___________ period via ______________ or upon ___________________ at ________

A

prenatal, ultrasound, physical assessment, birth

163
Q

for traction to be effective, a ___________________ is also in place

A

counter-traction

164
Q

patients with juvenile idiopathic arthritis should choose _____________ activities such as ______________ and _________________

A

low-impact, swimming, bike riding

Pediatric Nursing Care (17 decks)

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