Class 5 Musculoskeletal - child Flashcards by jodi Trethewey

skeletal system review:
provides?
protects?
storage?

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

How well did you know this?

Not at all

Perfectly

Skeletal System Review:

what attaches to what?

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

How well did you know this?

Not at all

Perfectly

Pediatric Musculoskeletal Differences:

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

How well did you know this?

Not at all

Perfectly

diagnostic tests: noninvasive

Xray
Bone scan
MRI
CT scan

How well did you know this?

Not at all

Perfectly

Diagnostic Tests: Xray purpose? NI?

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

How well did you know this?

Not at all

Perfectly

Diagnostic Tests: How to view

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

How well did you know this?

Not at all

Perfectly

Diagnostic Tests: Bone Scan purpose? NI?

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

How well did you know this?

Not at all

Perfectly

Diagnostic Tests: MRI purpose? NI?

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

How well did you know this?

Not at all

Perfectly

Diagnostic Tests: CT scan purpose? NI?

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

How well did you know this?

Not at all

Perfectly

Sprains and Strains defined

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

How well did you know this?

Not at all

Perfectly

Dislocation defined

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

How well did you know this?

Not at all

Perfectly

Sprains and Strains management:

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

How well did you know this?

Not at all

Perfectly

Sprains and Strains: nursing considerations

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

How well did you know this?

Not at all

Perfectly

Fractures: common causes

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

How well did you know this?

Not at all

Perfectly

Types of fractures:

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

How well did you know this?

Not at all

Perfectly

Fractures in Children: diagnostics and manifestations

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

How well did you know this?

Not at all

Perfectly

Fracture Management: Reduction

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

How well did you know this?

Not at all

Perfectly

Fracture Management: Retention

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

Immobilization of Fractures: Traction types (3)

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.

Immobilization of Fractures: what types

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

Casts:

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

What are the 5 “P’s”

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

Casts: care and assessment

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

Traction:

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

Traction: purpose?

``` Lessen/eliminate muscle spasms Stabilize/alignment Prevent deformities Position Immobilize fracture site ```

Skin Traction:

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

Skeletal Traction:

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!

External Fixation Devices: used to?

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!

Neurovascular assessment using CMTS

Color Motion Temperature Sensation **top to bottom, side to side assessment

Signs of neurovascular status impairment: assessment and NI

``` 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 ```

Assessment and care of immobilizing devices: | Traction apparatus

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

Assessment and care of immobilizing devices: | Assessment of patient

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

Osteomyelitis: what is it? Risk?

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

Osteomyelitis manifestations:

``` 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 ```

Osteomyelitis: diagnosis, imaging, labs

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

Osteomyelitis: NI

``` Pain management Monitor and document neurovascular IV antibiotics Wound care Maintain nutritional status ```

Scoliosis: define

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

Scoliosis: management

Curves <25 degree require long term monitoring | Brace treatment for curves >25 degree on skeletally immature patients

Scoliosis: surgical intervention and complications

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

Hip Dysplasia: risk factors

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

Hip Dysplasia: Ortolani and Barlow test

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

Clubfoot: diagnostics and management

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

Muscular Dystrophy: info and pathophysiology

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