cheo final Flashcards

Question 1

Q

Airway assesment
patent vs obstructed

Answer

A

Patent
- active, alert
- Air entry heard equally, bilaterally
- good colour
- Normal, easy respirations

Obstructed
- panic to unresponsive
- Floppy to rigid muscle tone
- Silent Chest
- no air entry heard
- no adventitious sounds
- No chest movement
- pale to cyanotic
- No respiratory effort

Question 2

Q

partially obstructed airway

Answer

A

Partially
- Normal to agitated/drowsy
- pink, pale, cyanotic
- Tripod/sniffing positioning

Upper Airway
- Stridor (Inspiratory) on exertion (mild obstruction)
- at rest + respiratory distress (moderate obstruction)
- + exhaustion (severe obstruction)
- Drooling; gurgling

Lower Airway
- Wheezes (musical, high pitched)
- End expiratory(mild)
- Expiratory(moderate)
- Inspiratory and expiratory (severe)

Decreased air entry
Increased respiratory effort

Question 3

Q

breathing assessement

Answer

A

Effort
- rate and depth
- chest symmetry
- adventitious breath sounds (wheeze,
stridor, crackles)
- cough
- retractions, tracheal tug, nasal flaring
accessory muscle use/head bobbing
grunting
- positioning → tripod
- gasping

efficacy
How effective is gas exchange?
- LOC, behaviour, agitation to exhaustion
- muscle tone

Colour
- mucous membrane
- cyanosis, or history of?

hypoxia (low O2) or hypercapoena (high CO2)

Question 4

Q

circulation assessement

Answer

A

Circulation
- Assessments includes inspection and hands on palpation
- Perfusion
- Heart rate & rhythm

rate
- Cardiac rhythms are usually regular in children
- common arrhythmias are subtle and require auscultation for at least 1 minute
are heart sounds S1,S2 normal?

Question 5

Q

perfusion

Answer

A

Central
- LOC, agitation/irritable
- Muscle tone
- Colour (pale;mottled)
- Urine out put
- Pulses; Apical (auscultate), Brachial,femoral,carotid(palpate)

Peripheral
- Capillary refill <3sec
- CWSM–compare bilaterally
- Pulses(palpate): Radial,dorsalis pedis

Question 6

Q

disability

Answer

A

Pediatric Neuroassessment
- LOC AVPU
- Modified GCS
- to determine severity of injury/insult identify trends over time, subtle changes are most important indicators,
- Posture, muscle strength, tone
- Behaviour, activity, response to stimulation, agitation, weak cry
- Pupil size and reaction

A. Alert
V. responds to Voice
P. responds to Pain
U. Unresponsive

Question 7

Q

childrens differences with fluids

Answer

A

anatomical & physiological differences
- Ratio of body surface area to body mass
- Higher Metabolic Rate – H20, O2, glucose
- Renal tubular immaturity –> Concentrated urine

weak Immune system

Dependence on caregivers

Different composition of total body water
- Higher extracellular water: intracellular water
- This means we can lose it faster

Question 8

Q

intake and output

Answer

A

Intake and output
- Normal fluid requirements based on size, smaller have higher needs
- Dependency, breastfeeding
- Serum electrolytes

Output
- > 0.5-3 cc/kg/hr
- 1ml/kg/hr minimum for infants and small children or > 4 wet nappies/24hrs
- Stools, emesis, blood loss
- Frequency, type, amount, consistency, colour, odour

Question 9

Q

conditions to increase vs decrease fluids

Answer

A

Increase fluid
- Child with respiratory problems need to increase fluid (loosens)
- Fever

Decrease
- Respiratory overload
- congenital heart issues
- Renal impairment
- Head injuries (cerebral edema)

Question 10

Q

glucose

Answer

A

Hypoglycemia (is more common)
- Trembling or ‘jitteriness’
- Pounding heart
- Cold sweating
- Pallor

Neurological signs/symptoms
- Difficulty concentrating/confusion
- Blurred/doublevision
- Difficulty hearing
- Slurred speech
- Dizziness and unsteady gait
- Loss of consciousness/seizure

Hyperglycemia Signs
- Increased urine output
- Excessive thirst
- Weight loss

** Note: If any alterations in LOC -always check BG!***

Question 11

Q

who pain ladder

Answer

A

Step 1 mild, pain score 1-3
- Tylenol
- NSAID (Ketorolac, Ibuprofen, Celebrex)

Step 2 moderate, pain score 4-6
- Tylenol and NSAID
- Opioid (i.e. Tramadol, Morphine/ Dilaudid at the low end of range)

Step 3 severe, pain score >7
Tylenol and NSAID
- Opioid (i.e. Morphine / Hydromorphone Dilaudid® / Fentanyl) orals at higher end of range or infusion
- May require supplemental Ketamine or Lidocaine
- PCA, NCA or Epidural
- Gabapentinoids / Antidepressants

Question 12

Q

what is asthma? S/S

Answer

A

What is asthma
- Hypersensitive lungs (obstructive)
- Chronic inflamation of the airway
- Excess in mucus production
- Tightening of the airway muscles (around the bronchioles → broncocontrsitcion)

What does asthma look like on the outside
- Wheezing → too narrow space so it forcefully tries to pass through → noisie
- Flared nostrils
- Pale skin
- Rapid “belly breathing”
- Tracheal tug (skin pulling on neck and chest)
- Accessory muscle use
- Rapid shallow breathing

Question 13

Q

PRAM scores

Answer

A

P. pediatric
R. respiratory
A. assessment
M. measure

mild 0-3
moderate 4-7
severe 8-12

Question 14

Q

asthma control medications

Answer

A

Controller medications (inhaled corticosteroid → reducing inflammation)

RED PUFFERS
- Flovent ® (fluticasone)
- Alvesco ® (cicloconide)
- Pulmicort ® (budesonide)
- Qvar ® (beclomethasone)
- Asthmanex ® (mometasone)

Oral vs inhaled corticosteroid
- Inhaled steroids are localised
- Inhaled must be used everyday
- Oral only for emergency

Question 15

Q

asthma reliver medications

Answer

A

Reliever medications BLUE PUFFERS
- Ventolin® (salbutamol)
- Aeromir® (salbutamol)
- Atrovent® (ipratropium)
- Bricanyl® (terbutaline)

How its used
- Noticing symptoms of an asthma trigger
- Last in our body for 4 hours
- 2 puffs for it to be effects as needed → PRN

Question 16

Q

asthma combination medications

Answer

A

Combination medications
- Controller + reliever (long acting→ lasts abt 12 hours)
- Still want to brush teeth and stuff to avoid thrush

Types
- Advair® (fluticasone and salmeterol)
- Symbicort® (budesonide and formoterol )
- Zenhale ® (mometasone + formoterol ) - zenhale is also blue so check if its ventolin first

Question 17

Q

nursing care resp infections

Answer

A

Nursing Care: Plan & Management
- goal: Decrease respiratory effort, prevent exhaustion and/or Increase efficacy

Interventions:
- Frequent assessment, close observation depending on presentation position
- clear airway (suction) offer O2
- humidified high flow NP
- Bronchodilators (if bronchiospams)
- Corticosteroids? Antibiotics? Epi?
- Promote rest and comfort– limit disruptions → limit what is taking their energy
- Promote hydration and nutrition (anemia → hemoglobin and O2)
- Manage temperature → hyperthermic OR hypothermic

Question 18

Q

resp diagnostics

Answer

A

Blood Gases
- Arterial/Capillary/Venous
- PaO2, pH, PaCO2,HCO3

Pulse Oximetry

XRay

PFT’s
- Expiratory flow rate
- Vital capacity

CT Scan/MRI Scopes

C&S

Question 19

Q

Croup patho and s/s

Answer

A

Pathophysiology
- Mucosal inflammation/edema in the : Larynx, trachea, epiglottis
- Airway obstruction, hypoxia

Symptoms
- Respiratory distress mild-severe
- Sudden onset of harsh, barky cough
- inspiratory stridor → sounds like they are barking
- Accessory muscle use
- Retractions
- cyanosis
- Worse at night!!

Question 20

Q

acute LTB croup characteristics

Answer

A

Acute Laryngotracheobronchitis: croup
- Most common croup syndrome
- Mainly affects children < 5 years
- Mainly viral
- Usually follows an URTI

Characterized by:
- Gradual onset of low grade fever
- Barky brassy seal-like cough worse at night
- Inspiratory stridor
- Hoarseness

Question 21

Q

nursing plan for croup

Answer

A

Goal: Decrease respiratory effort, prevent exhaustion and/ or Increase efficacy

Interventions:
- Frequent assessment, close observation
- Environment calm &quiet; avoid unnecessary impingements (airway can be obstructed by stress response)
- Emergency airway/intubation equipment on hand
- administer humidified O2 prn
- Promote hydration (po/iv) and nutrition
- Prevent spread of infection, isolate,PPE

Administer medications:
- dexamethasone,
- antipyretics,
- epinephrine inhalations
- antibiotics if epiglottis type

Concern is agitation and low sats

Question 22

Q

acute epiglottitis

Answer

A

Acute Epiglottitis
- organism: H.influenzae type b
- Most Serious – high risk of airway obstruction
- Most common age 2-8 years

Clinical manifestations
- Usually abrupt onset
- retractions, fever, Inspiratory stridor
- Frog-like croaking sound on inspiration
- 4 D’s - drooling, dysphonia, dysphagia, distress (agitation)
- Tripod position

Question 23

Q

croup score

Answer

A

0-2 mild
3-7 moderate
8-11 severe
12-17 impending respiratory failure

Question 24

Q

foreign body aspiration

Answer

A

Can aspirate anything and Symptoms depend on location of obstruction
- Initial: coughing, gagging, wheezing, dyspnea
- Treat with abdominal thrusts and back blows if full obstructions occurs
- Laryngotracheal: stridor, hoarseness, drooling → sign they cant swallow, coughing
- Diagnosed by history and xray, removed by endoscopy
- Can lead to aspiration pneumonia if not removed quickly

Question 25

Q

influenza

Answer

A

Types A and B
- Spread by droplet/contact
- Severe in infants

Symptoms:
- dry throat, dry cough, photophobia, myalgia, lack of energy, fever/chills
- Can lead to viral pneumonia, encephalitis, secondary bacterial infections
- Lasts 4-5 days
- In mild cases supportive management at home
- no asprin (reye syndrome)

In severe cases:
- Tamiflu (oseltamivir) 48hrs

Prevention:
- flu shot!

Question 26

Q

pertussis

Answer

A

Caused by:
- Bordetella pertussis
- Primarily occurs in children under 4 and not immunized
- High morbidity and high risk of mortality
- PREVENTION is the key - Immunization
- Life-long immunity after infection

nsg care:
- droplet precaution (nasal swab)

Management:
- Supportive care
- erthyromicin

Question 27

Q

pneumonia

Answer

A

Pneumonia
- inflammation of the lungs –> alveoli fill w fluid

Etiology In children,usually:
- Viral (RSV, influenzas)
- Bacterial
- Aspiration

Pneumonia: Nursing Care Plan
- Goal; Decrease respiratory effort, prevent exhaustion and/or Increas eefficacy

Interventions:
- chest xray
- Frequent assessment, close observation depending on presentation
- Position, clear airway (suction), offer O2 - Humidified highflow NP
- Antibiotics
- Promote hydration and nutrition

Question 28

Q

CF

Answer

A

Autosomal recessive trait
- CF gene inherited from both parents (both parents must be carriers) –
- Increased Viscosity of Mucous Gland Secretion
- Results in mechanical obstruction
- Thick mucus accumulates, dilates, precipitates, coagulates and blocks glands, ducts, passageways
- 90% have a blocked pancreatic duct
- Malnutrition
- Respiratory tract and pancreas are predominantly affected

Question 29

Q

Patho to dehydration

Answer

A

decreased fluid intale/increased fluid loss
rapid ecf loss (children have less ecf)
electrolyete imbalances
Icf loss
cellular dehydrations
hypovolemic shock
death

key ecf losses
- diarrhea and vomitting
- blood loss/ wound drainage
- insensible losses

Question 30

Q

types of dehydration

Answer

A

isotonic
- Na loss = water loss
- ecf losses
- V+D –> insensibble losses –> decreased PO intake
- most common type for children (ECF is high in sodium)

hyotonic loss
- Na loss > water
- ECF to IC space –> increases ECF loss
- edema
- V+D, burns, renal issues

hypertonic
- Na loss <water loss
- ICF to ECF
- V+D
- too much concentrated intake not enough free water

Question 31

Q

hypovolemic shock

s/s

Answer

A

CO = HR x SV

Compensation:
- ↓ Stroke Volume (SV) related to ECF losses causes ↑
- HR to maintain Cardiac Output (CO)
- ↓ BP a late sign of shock
- Hypotension is followed by rapid decompensation

Signs of Shock:
- ↑HR
- Altered LOC
- Poor perfusion

Question 32

Q

dehydration tx for mild moderate and severe

Answer

A

Mild (<5%)
- rehydrate with ORS (50ml/kg) over 4 hours
- replace ongoing with ORS

moderate (5-10%)
- rehydrate with ORS (100 ml/kg) over 4 hours
- replace ongoing with ORS

Severe (> 10%)
- IV recussitation with NS or LR (2-40ml/kg) for 1 hour
- reasses and repeat if neccessary
- begin ORT when pt is stable
- replace ongoing loss with ORS

Question 33

Q

Cardio assessement

Answer

A

Color
Nutritional status/Feeding/weight gain or loss (Infants)
imput/ output
Respiratory – rate and ease of breathing
Sweating?!!! (A sign of cardiac issues)
Presence of oedema
Size/shape of chest
Auscultation (Heart sounds/ Murmers Lung sounds – crackles, wheezes decreased/no air entry)
HR, BP, O2 saturations
Pulses and warmth of extremities
Presence of clubbing (Related to hypoxia // chronic resp issues like COPD )

Question 34

Q

PDA

Answer

A

Patent ductus arteriosis (PDA)
Etiology: prematurity –> the more preterm – the higher likelihood of PDA
- They will have mixing of blood → less effective oxygenation bc of that
- Wil be acyanotic

Clinical Signs:
- increasing respiratory distress due to pulmonary edema;
- apnea and bradycardia;
- bounding pulses

Management:
- fluids (furosemide)
- oxygen
- indomethacin (to help close it)
- Surgical ligation

Question 35

Q

CHD presentation after birth

Answer

A

Shock in the 1st hour after birth
- Severe respiratory distress
- Cyanosis
- Poor perfusion

Or nonspecific and difficult to differentiate from respiratory causes
- If cyanosed – and oxygen helps, this can rule out cyanotic heart disease.
- If cyanosed and oxygen does not help, this can indicate cyanotic heart disease.
- do not to give cyanotic heart issue babies very much oxygen its not gonan help and it shifts their circulation

Question 36

Q

VSD and ASD Patho

Answer

A

VSD
- shunt creation between the right and left ventricles
- It allows oxygen-rich blood to move back into the lungs instead of being pumped to the rest of the body.

ASD
- a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart.

normal heart pressure and o2 sats
- pressures are higher in left

Question 37

Q

CoA and TOF

Answer

A

Coarctation of the aorta is a narrowing (constriction) in a part of the body’s main artery (aorta).
The heart must pump more forcefully to send blood through the aorta and on to the rest of the body

TOF
- Ventricular septal defect, overriding aorta, pulmonary stenosis and right ventricular hypertrophy.
- These problems result in cyanotic, or blue, skin on babies because of a lack of oxygen.

Question 38

Q

TGA

Answer

A

Aorta and pulmonary artery switched
oxygen-poor blood from the body enters the right side of the heart but the blood is pumped directly back out to the rest of the body through the aorta.
Oxygen-rich blood from the lungs entering the heart is pumped straight back to the lungs through the main pulmonary artery.
End up with very cyanotic picture because body can’t access the pulmonary system
PDA in this case would be important

Question 39

Q

infective endocaditis

Answer

A

Infection of valves/inner lining of heart

Causes:
- Altered blood flow and turbulence inside the heart
- Damage to valvular endothelium
- increases fibrin and deposition of platelets –> Microorganisms grow and form vegetation on the endocardium
- Lesion may invade adjacent tissues (valves and myocardium)
- Risk of emboli

Question 40

Q

nsg priorities for all CHDs

Answer

A

contractility (medications – eg digoxin)
vasodilaters (ACE inhibitors –> to reduce resistance - eg captopril)
Remove excess fluid and sodium (decrease pre-load) (medications – diuretics)
Rest
Nutrition without fatigue (NG feeds)
Comfort and positioning (+/- sedation)
Improve oxygenation & decrease oxygen consumption
Preparation for invasive procedures and surgery

Question 41

Q

rheumatic fever

Answer

A

Rheumatic Fever
- Inflammatory disease which occurs after group A β hemolytic streptococcal pharyngitis
- Rheumatic heart disease: most significant complication of Rheumatic Fever.
- Causes damage to heart valves; usually mitral valve

Question 42

Q

s/s of increased ICP in chold/infant

Answer

A

infant
- Change in feeding, vomiting
- Altered LOC (irritability, restlessness,
poor consolability, lethargy)
- Bulging fontanels
- High-pitched cry
- increased HC (head circumference)
- separation of cranial sutures

Child
- Nausea/Vomiting
- Altered LOC
- Diplopia/blurred vision
- Slurred speech
- Seizures

Question 43

Q

Late s/s of increased ICP

Answer

A

Alteration in pupil size and reactivity
Decreased motor or sensory response
Coma
Posturing (decerebrate/decorticate)
Papilledema
Projectile vomiting
Changes in Vital Signs
Bradycardia
Irregular or decreased respirations
Cheyne Stoke

Question 44

Q

Hr and increased temp on ICP

Answer

A

Decreased heart rate and resp rate which causes –> Decreased O2 and increased CO2 which causes –> Decebral vasodialation to increased O2 –> Causes increased ICP which further decreases resp rate

Increased Temp (or instability) which causes –> Increased metabolic needs of brain which causes –> Seizures related to increased ICP which causes –> Increased metabolic rate and thus increased ICP

Question 45

Q

bacterial meningitis

Answer

A

Patho
- organisms from the nasopharynx invade the underlying blood vessels, cross the blood–brain barrier, and multiply in the CSF)
- inflammation, exudation, white blood cell accumulation, and varying degrees of tissue damage.
- cerebral edema, purulent exudate, fibrin, or adhesions may occlude the narrow passages and obstruct the flow of CSF

Usually abrupt onset
- Fever/Chills/ Headache
- Vomiting
- Seizures (often the initial sign)
- bulging fontanelles
- infants may not have nuchal rigidity
- Nuchal rigidity: May progress to opisthotonos
- Positive Kernig and Brudzinski signs

Signs and symptoms peculiar to individual organisms:
- Petechial or purpuric rashes (meningococcal infection), especially when associated with a shocklike state
- Joint involvement (meningococcal and Haemophilus influenzae infection)
- Chronically draining ear (pneumococcal meningitis)

Question 46

Q

Care for meningitis

Answer

A

A medical emergency (and ICU care)
Isolation precautions
Initiation of antimicrobial therapy
Maintenance of hydration
Maintenance of ventilation
Reduction of increased ICP
Management of systemic shock
Control of seizures
Control of temperature
Treatment of complications

Question 47

Q

hydrocephalus

Answer

A

caused by an abnormal buildup of cerebrospinal fluid in the ventricles (cavities) deep within the brain
Ventricles engorged with CSF → infants can compensate well
Can be congenital or acquired

Management
- For congenital they will place a shunt to drain inside body → can get blocked or infected
- Relieve, prevent ICP r/t hydrocephalus
- Monitoring and early intervention for problems related to surgery

Question 48

Q

scoliosis

what is it? Angle? Types?

Answer

A

What
- Lateralcurvature of the spine that usually involves spinal rotation (Structural or Non-Structural).
- Curves with Cobb angle > 10 degrees = scoliosis.
- Curves with Cobb angle < 10 degrees = spinal asymmetry and have no long-term significance.

Classification of Scoliosis
A. Early Onset Scoliosis
B. Late Onset Scoliosis
- Congenital Scoliosis
- Neuromuscular Scoliosis
- Idiopathic Scoliosis

Question 49

Q

neuromuscular scoliosis

Answer

A

Neuromuscular Scoliosis
- Result of muscle imbalance and lack of trunk control
- Early detection is important as early intervention may help improve function and delay progression
- Lots are wheelchair ambulators (ie dont walk most of the time) → we want to help them with their posture until we must operate
- Function can include: ambulation, positioning in wheel chairs, prevention of pressure ulcers, and cardio-pulmonary function

Question 50

Q

idiopathic scoliosis

Answer

A

3 subcategories:
- Infantile: 0 to 3 years
- Juvenile: 4 to 9 years
- Adolescent: ≥ 10 years

Adolescent Idiopathic Scoliosis (AIS)
- most common form; 80 – 85% of cases.
- The primary concerns regarding scoliosis often involve activities of daily living, as well as aesthetic appearance
- When the scoliosis angle increases over 70 degrees, other organ systems can be affected (Heart/lungs)

Question 51

Q

AIS assesments

Answer

A

Inspection
- Shoulder height asymmetry
- Pelvic/hip asymmetry
- Head in line with center of sacrum

Adam’s forward-bending test (AFBT)
- Assess degree of rotation and deformity
- Patient bends forward at waist with knees straight and palms together
- Thoracic or lumbar prominence noted

Scoliometer (optional)
- Measures angle of trunk rotation: run along spine from top to bottom during forward bend test

more signs
- Cafe au lait spors

Question 52

Q

diagnostic evaluation +cobb angle and risser signs

Answer

A

Xray required to confirm diagnosis and is indicated if:
- Clinically evident scoliosis based on physical exam
- Thoracic or lumbar asymmetry on physical exam
- Family history of scoliosis

3 Foot Spine Xray (PA/LAT) identifies:
- site of deformity (thoracic or lumbar) and curve pattern
- Magnitude of curve (Cobb angle)
- Skeletal maturity (Risser sign + Sanders)
- Spondylolysis/Spondylolisthesis

Cobb Angle
- Degree of curvature measured according to Cobb method.
- Gold standard for assessing degree of curve.
- Essential to determine management of scoliosis and risk of progression.

risser sign (pelvis)
- Degree of ossification and fusion of iliac crest/apophysis.
- Used to assess skeletal maturity using xray.
- Maturity occurs in a stepwise fashion from lateral to medial.

Question 53

Q

Management of AIS

Answer

A

Monitor patients if…
- Cobb angle <25 ° & still growing at time of presentation
- Curve more than 45° and finished spinal growth.

Treat patients if still growing and…
- Cobb angles >25° considered for bracing if skeletally immature (Risser 0-2).
- Cobb angles >45-50° at time of diagnosis will likely require surgery.

Question 54

Q

bracing for scoliosis

Answer

A

Bracing
- Does not correct curvature!!!
- Objective: Arrest curve progression.
- Reduces chance of progressing to surgery
- Must be skeletally immature (Risser 0-2)
- TLSO (thoraco-lumbar-sacral orthosis) or Providence (night- time) brace routinely used.
- Time in brace varies

Question 55

Q

post op teaching for scoliosis

Answer

A

VS & Neurovascular checks with ankle dorsiflexion
Monitoring effect of PCA and PO analgesia ( nausea, vomiting, pruritis)
Monitor respiratory status + leg paresthesias
Assessment of peripheral neurologic signs in extremities is essential after spinal surgery (changes can occur up to 48 hours post op)
In/Out monitoring: Fluids, Drains – hemovac + foley
Activity - POD#1: Standing at bedside BID
POD#2: Walking BID or more. essential to progress recovery and avoid complications
Dressing intact and clean until discharge day then changed –> check Q4H.

Question 56

Q

discharge teaching for spinal surgery

Answer

A

Follow up with surgeon 1-2 weeks post-op.
Activity restrictions – return to school 1 month post op, no contact sports x 6 months.
Frequent position changes
Monitor for signs of infection – fever, drainage, inc. pain
May shower 5-7 days post op, no baths or soaking for 6 weeks.

Medications:
- Narcotic PRN,
- Tylenol str x3D then PRN
- Celebrex x5D
- PEG 3350 and Baclofen x5D

Question 57

Q

DDH and 5 risks

Answer

A

DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)

Risk Factors
5 F’s:
- Family History
- Fetal position – Feet first/ Breech presentation more likely
- First born infant - increased risk with Females
- Fluid – history of oligohydramnios (low amniotic fluid levels)
- Family Hx of Breech position = Most Important RF

Question 58

Q

physicsal exam for DDH

Answer

A

Hip Exam:
- Asymmetrical creases (thigh or gluteal)
- Range of Motion (? Limited abduction)
- Barlow or Ortolani maneuver
- Galeazzi sign (knee level)

Neck:
- Preference to one side
- Plagiocephaly (flat back of head)
- Torticollis & strength (stiff neck)

Spine:
- Dysraphism (spina bifida)

Upper & Lower Extremities:
- Generalized motor assessment & reflexes
- Foot abnormalities (MA or club foot)

Question 59

Q

swaddling and pavlick tx

Answer

A

Cultures that keep the baby’s hips in an “M” style or wide position have lower rates of hip dysplasia
Hip-Safe swaddling methods are recommended for newborn infants.

Pavlik Harness Treatment
- Goal: To obtain and maintain concentric reduction of the hip and allow for healthy development of the acetabulum and hip joint.

Success of Pavlik treatment
- 80-95%

How does it help?
- Holds hips in a flexion position (>90-100 degrees) AND abduction position (optimal position for hip development)
- Prevents adduction of the hip

Question 60

Q

secondary tx for DDH

Answer

A

When?
- If the infant has failed the Pavlik harness treatment
- If the child is over 6-12 months at
diagnosis (grey area for Pavlik use)
- We will put them in a cast instead

types
- Fixed abduction brace
- Closed reduction under anesthesia & hip spica cast (can be tried up until 2 years of age)
- Open reduction +/- pelvic osteotomy & hip spica cast

Question 61

Q

spica cast

Answer

A

what
- A plaster cast from upper torso (nipple line) down tothe ankles

Types
- Bilateral full leg
- Unilateral
- Bilateral short leg (rare)
- A-Frame/Petrie (phasing out)

Objective: Immobilization of the hip, pelvis and/or femur

Question 62

Q

pain management for DDH surgery and position/transfers

Answer

A

Epidural sometimes but mostly single shot epimorph (usually cast will help pain after 48 hours)
IV narcotics
PO narcotics
Antispasmodics for first 48 hours
Movement is difficult with a spica cast – on both patient and parents. (bean bag chair lol)
Reposition frequently and support legs with pillows
Watch feet for pressure sores

Transfers depend on size of child
- independent (parents) vs mechanical lift in older child.
- Standard wheelchair not appropriate (use spika wheelchair)
- Spica table

Question 63

Q

skin care for DDH

Answer

A

Make sure cast is not too tight
Check skin for breakdown from cast.
Keep cast as clean and dry as possible
reverse Trendelenberg position is key → must be used so that the urine and BM go down and not towards the cast
Sponge bath only while in cast
Combat smells with eucalyptus oil

Teaching
- Clothing to the upper body only - has to be loose and larger than typical size.
- Check skin daily for sores.
- Casts are NOT waterproof – no bathing/swimming.
- Watch food that may spill into the front of the cast or get trapped inside.

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