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NUR 131 > Class 5 Musculoskeletal - child > Flashcards

Class 5 Musculoskeletal - child Flashcards

1
Q

skeletal system review:
provides?
protects?
storage?

A

Provides skeletal framework
Protects vital organs
Provides movement
Storage space for blood cell production, regulating reabsorption and reformation, regulation of minerals and hormones balance.

**bone structural disorders require follow up until child reaches skeletal maturity

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2
Q

Skeletal System Review:

what attaches to what?

A

Bone attaches to joints
Joints connect ligaments
Muscles supported by tendons and cartilage

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3
Q

Pediatric Musculoskeletal Differences:

A

Skull sutures don’t fuse until 12-18 months
Muscle tissue almost completely developed at birth
Soft tissues are resilient
Infants’s bones only 65% ossified at 8 months of age
Fractures in <1 year are uncommon

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4
Q

diagnostic tests: noninvasive

A

Xray
Bone scan
MRI
CT scan

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5
Q

Diagnostic Tests: Xray purpose? NI?

A 
Purpose:
detect abnormalities or determine bone age
NI:
Noninvasive
Not generally NPO
Patient in gown
Assist child w/ proper positioning
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6
Q

Diagnostic Tests: How to view

A

Air: black
Fat: dark grey
Water: light grey
Bone: whitish

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7
Q

Diagnostic Tests: Bone Scan purpose? NI?

A

Purpose:
Investigates trauma, tumors, cysts, infections, early stress fractures, osteomylitis. **Radioactive material given IV and scan 3-4 hours later
NI:
Encourage fluids 2-4 hours prior and after scan
Void before scan so pelvis bones can be seen
May need sedation in child

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8
Q

Diagnostic Tests: MRI purpose? NI?

A 
Purpose:
Organ structures, blood flow, bone marrow, soft tissue, tumors, structure of muscles. **magnetic and radio waves create energy field that's translated to image
NI:
Not NPO
Ensure no metal on pt (complete MRI questionnaire)
Loud noises that might last 1 hour
Assess claustrophobia
Must remain still during scan
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9
Q

Diagnostic Tests: CT scan purpose? NI?

A 
Purpose:
Visualize bone and soft tissue
Has less radiation exposure
With or without contrast dye
NI:
No NPO unless sedation is needed
Place in gown with no snaps
Remove jewelry
Can be scary for children
Check for allergies
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10
Q

Sprains and Strains defined

A

Sprains: joint trauma, ligaments stretched or partially torn. (typically not seen in children- usually end up with fracture instead)
Strains: pulls, tears or ruptures, excessive stretch of muscle
Manifestations:
pain, swelling, localized tenderness, limited ROM, poor weight bearing, pop sound (sprain)
**commonly caused by sports

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11
Q

Dislocation defined

A

Force of stress on the ligament results in displacement of the bone from it’s socket.
Most common sites: phalanges and elbow, hip, shoulder

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12
Q

Sprains and Strains management:

A

Rest, Ice, Compression, Elevation
NSAID’s, no weight bearing, 20 min ice on, 20 min ice off
**compression is best for swelling before edema

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13
Q

Sprains and Strains: nursing considerations

A

Neurovascular checks
Analgesics (NSAID’s, Ibuprofen, acetaminophen)
Distraction play
Healing depends on extent of injury
Weight bearing gradually increased as pain decreases

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14
Q

Fractures: common causes

A 
Accidental and non-accidental trauma
Pathological condition
Increase mobility
Inadequate/immature motor
Cognitive skills
Children heal faster than adults
Weakest point of long bones is epiphyseal plate
**Fractures in infants not common
-bones are less brittle
-higher collagen to bone ratio
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15
Q

Types of fractures:

A

Greenstick: twist and bend of bone
Spiral: effects length (sign of child abuse)
Oblique: horizontal break
Transverse: “clean” break, horizontal
Comminuted: several breaks with bone pieces
Compound/Open: severe break where bone has broken skin

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16
Q

Fractures in Children: diagnostics and manifestations

A

Diagnostics:
Xray, both side view to compare

Manifestations:
pain and tenderness
immobility
decreased ROM
deformity/swelling
ecchymosis
muscle spams
inability to bear weight
crepitus (grating sound or feeling by bone friction)
eyrthema
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17
Q

Fracture Management: Reduction

A

Repositioning of the bone into normal alignment
Closed- manual alignment
Open- surgical using internal/external fixations

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18
Q

Fracture Management: Retention

A

Application of a device to maintain alignment until healing occurs
Repositioning of bone fragments into normal alignment
Splints, casts, traction, external fixation

19
Q

Immobilization of Fractures: Traction types (3)

A

Manual traction: ??

Skin traction: noninvasive, effective for children <15 kg and <2-3 years

Skeletal traction: uses greater force, alignment of bony fragments, wires/pins in bone. Complication osteomylitis.

20
Q

Immobilization of Fractures: what types

A

Splints
Casts
Traction (manual, skin, skeletal)
External fixation (complex fractures to lengthen bones and correct angular deformities.

21
Q

Casts:

A

Provide support and maintain anatomic position for healing
Age, type of fracture/surgery determine type of cast
Teach: use backpack to carry items

22
Q

What are the 5 “P’s”

A 
Pain
Pallor
Pulselessness
Paresthesia ("pins/needles" feeling)
Paralysis
23
Q

Casts: care and assessment

A 
Keep dry
Keep distal end higher than proximal end (elevate)
Don't poke inside cast or apply liquid/powder inside
Assess 5P's q 1hr for 24 hours
Cap refill <2 seconds
Observe for s/s of complications
Odor
Cyanosis
Cool skin
Absent pulse
Edema
N/V
Pain
24
Q

Traction:

A

Pull or force exerted on one part of body
Applied to spine, pelvis or long bones
Angle of the pulley exerts pull, child’s weight provide counter-traction in order to be effective
Can be continuous or intermittent
Always assume continuous unless doc order different

25
Q

Traction: purpose?

A 
Lessen/eliminate muscle spasms
Stabilize/alignment
Prevent deformities
Position
Immobilize fracture site
26
Q

Skin Traction:

A

Non-invasive and well tolerated
Best for kids under 15 kg and under 3 years
Applied to pelvis, spine, long bones
Use of external devices such as foam, straps, bandages applied to skin attached to pulleys and weights
Not appropriate if: open wounds, skin breakdown, skin infection

27
Q

Skeletal Traction:

A

Exerts greater force
Tolerated for longer periods
Maintains alignment of bony fragments and assists in proper healing
Traction maintained by metal device inserted into bone
Osteomylitis is most complication
Pin site care!

28
Q

External Fixation Devices: used to?

A

Complex fractures
Lengthen bones
Correct angular deformities involving bone and soft tissue
Allows for periodic changes in alignment with external device with pine inserted into bone
Infection is risk r/t pin sites
50% infection of pin site
Pin site care!

29
Q

Neurovascular assessment using CMTS

A

Color
Motion
Temperature
Sensation

**top to bottom, side to side assessment

30
Q

Signs of neurovascular status impairment: assessment and NI

A 
Assessment:
Coldness
Cyanosis
Swelling
Sluggish cap refill
Pallor
Loss of motion
N/V
NI:
Touch skin distal to device
Ask child to move fingers/toes
Touch extremities
31
Q

Assessment and care of immobilizing devices:

Traction apparatus

A 
Weights hang freely
Ropes on pulleys appropriately
Proper positioning with trapeze
Monitor slippage of tape, boot etc
Keep continuous unless ordered
Pin care
32
Q

Assessment and care of immobilizing devices:

Assessment of patient

A 
Proper positioning
Nutrition, high in protein, vit c, fluids
Pain management
Skin breakdown/infection
Psych well being
Complications of immobility
33
Q

Osteomyelitis: what is it? Risk?

A

Bacterial infection of the bone (cortex or bone marrow cavity)
Open fractures/trauma
Soft tissue injury
External fixation or skeletal traction devices

34
Q

Osteomyelitis manifestations:

A 
Fever, irritability, lethargy, feeding difficulties
Pain, warmth, erythema
Tenderness over site of infection
Favoring affected extremity
Limited ROM
Painful joint w/ movement
Odor possible
**Call HCP
35
Q

Osteomyelitis: diagnosis, imaging, labs

A

Imaging: MRI, CT, bone scan, US
Labs: elevated ESR (Erythrocyte sedimentation rate), CRP (C-Reactive Protein), WBC, blood cultures

36
Q

Osteomyelitis: NI

A 
Pain management
Monitor and document neurovascular
IV antibiotics
Wound care
Maintain nutritional status
37
Q

Scoliosis: define

A

Lateral deviation/curvature of spine >10 degree
Curvature causes rotation of vertebral bodies of spine
Worsening curvature leads to rib cage deformities compromising resp function and distortion of intrathoracic and ab organs that does not affect organ function generally

38
Q

Scoliosis: management

A

Curves <25 degree require long term monitoring

Brace treatment for curves >25 degree on skeletally immature patients

39
Q

Scoliosis: surgical intervention and complications

A

Recommended on reaching 40-50 degrees to prevent further progression
Significant blood loss
Injury to spinal cord

40
Q

Hip Dysplasia: risk factors

A 
First born
Female
Breech position
Low level of amniotic fluid
African and Chinese decent have low incidences
Native American high incidence
41
Q

Hip Dysplasia: Ortolani and Barlow test

A

Ortolani:
Examiner abducts the hip while applying anterior force on the femur to reduce the hip joint
Barlow:
Examiner adducts the hip while applying posterior force on the knee to promote dislocation

42
Q

Clubfoot: diagnostics and management

A 
Ultrasound prenatally
Therapeutic:
started ASAP
Serial stretching, manipulation and casting (Ponseti casting method)
Surgery
Recurrence is common
Follow up until skeletal maturity
43
Q

Muscular Dystrophy: info and pathophysiology

A

Progressive, degenerative diseases that affect muscle cells of specific muscle groups causing weakness and atrophy.

Pathophysiology
Muscle fibers leak creative kinase and take on excess Ca+ causing more damage
Muscles degenerate and replaced with fat and connective tissues
Muscle death causes weakness and wasting
Usually identified early childhood
Includes >30 types but Duchenne MD is most common

NUR 131 (38 decks)

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