Exam 2 Flashcards
Osteogenesis Imperfecta
A group of inherited disorders characterized by fragile bones that break easily (aka brittle bone disease)
Scoliosis is a varying degree of OI
Scoliosis
a term referring to any abnormal curve in the body. Scoliosis can be defined as congenital, neuromuscular, or idiopathic.
Management of scoliosis
Curves are measured using the Cobb angle, the larger the degree of curvature, the more severe the deformity
The goals of treatment are to prevent progression of the spinal deformity, allow the child to reach the end of growth with a reasonably straight, well-balanced spine, and to allow the spine to grow as much as possible.
Children with cerebral palsy are at risk
Observe (45o)
Developmental Dysplasia of the Hip
Abnormal growth of the hip- Abnormal relationship between the acetablulum and femoral head
#1 cause of pediatric lawsuits
Will lead to poorly formed hips, abnormal gait, pain, hip damage and osteoarthritis
Uneven gluteal folds
Asymmetric hip abduction
Uneven knee heights
Waddling gait
Developmental Dysplasia of the Hip: Treatment
Early diagnosis is the most crucial aspect of the treatment
18 months or failed closed reduction = Open reduction with adductor tenotomy and arthrogram, Spica cast for 6 weeks then cast change in OR with repeat arthrogram –> Total time in spica ~ 12 week
Developmental Dysplasia of the Hip: Diagnosis
Positive physical exam = referral to pediatric orthopaedics
4 months of age: AP and Frog xray
Cerebral Palsy
Non-progressive, non-contagious CNS disorder caused by hypoxic brain injury
Symptoms range from minor to severe and include abnormal muscle movement, tone, balance, gait disturbances
Complications: mental impairments, seizures, growth problems, impaired vision or hearing, and hydrocephalus
Cerebral Palsy: Medications
Oral meds to treat spasticity = Baclofen, dantrolene sodium and diazepam
Parenteral meds to treat spasticity = Baclofen, botulin toxins
Cerebral Palsy: Treatment
Promote mobility (ex. horseback riding)
Promote nutrition
Provide support and education
Skin care
Amputation
Amputation of the upper extremities is never indicated as almost any portion of a limb is better than no limb.
Lower limb amputations are common and often indicated if the joints of the extremity are non-functional and unstable.
It is important to help parents consider the child’s function long term and remind them that their child and their friends will know this as “normal.”
Club feet: Treatment
Ponseti casting technique–> Serial casting supinates and abducts the foot until the forefoot is in normal alignment with the hindfoot.
After the serial casting, p/t wears the Denis-Browne bar. Wear the shoes 23 hours, time given for skin checks and baths. Wear until 8-9 months when they begin to express an interest in standing/walking.
Infants will hit milestones despite shoe and bar wear. They will sit, crawl, and stand in bar.
Cast care
Don’t put anything in cast
Can’t get wet (Unless waterproof, short arm casts only)
Benadryl or hairdryer on cool setting for itching
4-6 weeks typically
longer than 6 wks will cause joint contracture
Patient should be able to wiggle digits and always have normal color
Compartment Syndrome
Medical Emergency
Muscle groups are compartmentalized in the body by fascia
Fascia does not expand
Excessive swelling will lead to increased pressure in the compartment
Most common in lower leg and forearm, can occur anywhere
Compartment Syndrome: Causes
surgery, complex fractures, soft tissue injuries, crushing trauma, tight cast, IV infiltration, hyponatremia, snake bites, burns
Compartment Syndrome: S/S
Severe pain that gets worse (not relieved with medication), decreased function, loss of sensation, weakness, pale of skin
Pain when the compartment is squeezed, severe pain when you move the affected area, swollen/shiny skin
Often missed in unconscious p/t’s
Mumps: S/S
History of exposure or lack of immunization; malaise; low grade fever; anorexia; ear pain; pain with chewing; unilateral or bilateral parotid swelling, fever; orchitis in boys
Mumps: Management
Acetaminophen for fever
Oral fluids
Ice packs to testicles with support if orchitis present
Droplet precautions for 9 days after swelling starts
Pinworms: S/S
itching at night, teeth grinding at night, wt. loss, enuresis
Pinworms: Management
mebendazole x1, then repeated in 2 weeks; treat all in household
Rubeola (Measles): S/S
Koplik’s spots (grayish bumps on buccal mucosa), fever, acute rhinitis, cough, conjunctivitis, erythematous macropapular rash
