Disorders of Skeletal Structure Flashcards
1
Q
Scoliosis
A
- spinal deformity that manifests as lateral curvature of spine
- most common in adolescent girls (due to release of hormones)
- familiar pattern; neuromuscular condition
- idiopathic majority (unknown)
2
Q
Types of Scoliosis
A
- thoracic
- lumbar
- thoraco-lumbar
- combined
3
Q
Scoliosis Assessment
A
- failure of curve to straighten when bending forward with knees straight and arms hanging down feet
- uneven bra strap marks
- uneven hips
- uneven shoulder
- asymmetry of rib cage
- xray reveals curvature
4
Q
Scoliometer
A
- inclinometer that measures trunk asymmetry or axial trunk rotation
- upper thoracic (T3-T4)
- middle thoracic (T5-T12)
- thoraco-lumbar (T12-L1 or L2-L3)
5
Q
Scoliosis Management: Less than 20 Degrees
A
no therapy required
6
Q
Scoliosis Management: More than 20 Degrees
A
treatment can consist of conservative non-surgical approach
7
Q
Scoliosis Management: More than 40 Degrees
A
surgery with spinal fusion
8
Q
Scoliosis Management
A
wear Milwaukee brace for 3 years
9
Q
Scoliosis Nursing Interventions
A
- teach/ encourage exercise
- provide care for child with Milkauwee brace
○ wear brace 23 hours/ day
○ monitor pressure joint
○ promote positive body image - cast care
- assist with modifying clothing for immobilization devices
- adjust diet with decreased activity
- provide client teaching with discharge instructions
○ exercise
○ cast care
○ correct body mechanics
○ alternative education (long term hospitalization)
○ availability of community agencies
10
Q
Lordosis
A
inward curve of lumbar spine (above buttocks)
11
Q
Kyphosis
A
forward rounding of upper back
12
Q
Developmental Dysplasia of Hip
A
- congenital hip dysplasia
- improper formation of hip socket
13
Q
Congenital Hip Dislocation
A
- displacement of head of femur form acetabulum
- present at birth although not always diagnosed
- familiar disorder
- unknown cause: may be fetal position in utero
- acetabulum is shallow and the head of femur is cartilaginous at birth
14
Q
Congenital Hip Dislocation Assessment
A
- unilateral or bilateral
- limitation of abduction (cannot spread legs top change diaper)
- one leg is shorter than the other
- unequal number of skin fold on posterior thigh
15
Q
CHD Barlow’s Test
A
- infant on back, bend knees
- affected knee: lower (head of femur dislocates towards the bed of gravity)
- additional skin folds with knees bent
- lying on abdomen = buttocks of affected side: lower
16
Q
Positive Barlow’s Test
A
- femoral head dislocated posteriorly from acetabulum
- dislocation is palpable as head slips out of acetabulum
- dx confirmed with Ortolani test
17
Q
CHD Ortolani’s Test
A
- supine position, bend knees and place thumb on bent knees, fingers
- bring femur 90 degrees to hip then abduct
- palpable click = dislocation
18
Q
Positive Ortolani’s Test
A
- femoral head reduces into acetabulum
- palpable and audible clunk as hip reduces
19
Q
Trendelenburg Test
A
IF PATIENT CAN WALK:
- have child stand on affected leg only
- pelvis will dip on normal side as child attempts to stay erect
20
Q
CHD Management
A
GOAL: enlarge and deepen socket
EARLY TREATMENT: positioning hip in abduction with head of femur in acetabulum and maintain in position for several months
- traction and casting (hip spica)
- surgery
- Pavlik harness
- hip spica cast
21
Q
CHD Intervention
A
- proper positioning: legs abducted
- trial diapering
- use Frejka pillow splint (jumperlike suit to keep legs abducted)
- place on abdomen with legs in frog position
- immobilization devices
22
Q
Osteogenesis Imperfecta
A
- “brittle bone disease”
- connective tissue (collagen) disorder in which fragile bone formation leads to recurring pathologic fractures
- rare genetic disorder: autosomal dominant (50% chance of passing
- error in collagen synthesis
23
Q
Defect of Type I Collagen Production Might Lead To:
A
- congenital osteopenia (low bone mass) with increased bone fragility
- other connective tissue manifestations (dental abnormalities, las joints, thin skin)
24
Q
OI Pathophysiology
A
- caused by dominant mutation in COL1A1 or COL1A1 genes that encode type I collagen
- fewer 10% believed to be caused by recessive mutations
- results from mutations in the loci coding for pro-α 1 and pro-α 2 chains which form the helical
structure of collagen 1
25
OI Radiographic Features
- bones are thin and undertabulated (gracile)
- normal in length or shortened, thickened, and deformed by multiple fractures
- intra-sutural (wormian) bones on skull radiograph
- cranial enlargement
- shortening of limbs due to intrauterine fractures
26
Osteogenesis Imperfecta and Eyes
- thinning of sclera
- consequent showing of underlying veins through whites of eyes
- blue sclera (major symptoms, helps in dx)
27
Congenital OI
life expectancy is short
28
Tarda OI
life expectancy is normal
29
Types According to Silence Classification System
based on inheritance as autosomal recessive or dominant
30
Type I and IV OI
- more mold manifestation
- can persist to adulthood
31
Type II and III
- more severe
- can result in fracture (birthing or childhood)
- associated with high mortality rate
32
Type I OI
- most common
- reach normal height
- few obvious skeletal deformities
- causes more fractures during childhood > adulthood
- hearing loss pronounced and begins early in childhood
33
Type II OI
- most rare
- most severe
- produce numerous deformities
- often fatal in infancy
- profoundly affects lungs (causes significant breathing problem
- CO2 high compared to O2
- fractures in all long bones
- multiple fractures in ribs (shortened, "beaded")
- poor ossification of skull
34
Type III OI
- obvious deformities
- fractures before birth
- UTZ can detent in fetus
- also affects lungs and muscles
- hearing loss in early childhood = complete in adolescence
35
Type IV OI
- more severe than type I
- less severe than type III
- hearing loss begins in early childhood (often profound)
36
OI Signs and Symptoms
- weak bones
- below average ht
- hx multiple fracture
- bone deformity
- increased serum alkaline phosphatase
- poor skeletal development
- soft brownigh teeth
- hearing loss
- blue sclera
- loose joints (hypermobility) and flat feet
37
OI Management
- genetic counseling
- rehabilitation: lightweight leg brace, alignment, casting of fracture
- orthopedic surgery: intramedullary rod insertion
- biphosphonates = increase bone mineral density
- lightweight leg braces = aid in mobility and ambulation
38
OI NDx: Potential for Alteration in Tissue Perfusion r/t to Construction of Cast
- check color, sensation, and motion distal to cast q15
- check pedal or radial pulse
- check for tightness by slipping finger under edge (impossible = too tight)
- ask child to move toes or fingers
- elevate casted extremity
39
OI NDx: Potential for Alteration in Skin Integrity
- remove plaster flakes
- handle wet cast carefully (not cause indentation)
- expose wet cast to air (hasten drying)
- support heavy cast with sling/ pillow (decrease pressure of cast edges)
- check cast for foul/ musty odor
40
OI NDx: Potential for Fear and Loneliness
- encourage expression of feelings
- diversional play
- encourage fam and friends to visit often
- provide educational opportunities (long term hospitalization)
41
OI NDx: Potential for Knowledge Deficit of Family
- encourage discussion of feelings and fears
- provide info and reassurance
- involve family in child's care in hospital
- prepare family for some emotional regression
42
Care of Child with Cast
- plaster: will remain wet for atleast 24 hours
- cast must remain open to air until dry
- casted extremities: elevated = help blood return and reduce swelling
- initial chemical hardening reaction = change in infant's body
- choose toys too big to fit in cast
- do not use baby powder near cast = medium for bacteria
- prepare for anticipated casting = having child help apply cast in doll
