Exam 2: Musculoskeletal Alteration Flashcards
1
Q
Fractures in Children
A
Children are susceptible to fractures d/t their natural tendency toward active mobility and limited gross motor coordination.
2
Q
Fractures in Infants
A
- True accidents causing fractures are rare
- Investigate further
3
Q
Common Childhood Fractures include
A
- Forearm fractures
- Clavicle
- Epiphyseal Injuries: weakest point; may cause problems if fracture line is not transverse
4
Q
What are the most common cause of fractures in children?
A
Sports
5
Q
Fractures
A
Muscle contracts to splint injury after fracture occurs; may pull bone ends out of alignment.
6
Q
Emergency Treatment of a Fracture
A
- Assess the 5 P’s
- Determine mechanism of injury
- Move injury as little as possible
- Cover open wounds-clean/sterile dressing
- Immobilize limb
- Reassess neuromuscular status
- Apply traction if circulatory compromise
- Elevate
- Apply ice
- Call EMS
7
Q
What are the 5 P’s?
A
- Pain
- Pulselessness
- Pallor
- Paresthesia
- Paralysis
8
Q
What are clinical manifestations of fractures?
A
- Generalized swelling
- Pain/Tenderness
- Diminished function
- Bruising
- Muscular rigidity
- Crepitus
9
Q
Assessment of Fractures
A
If child will not allow you to touch them, have them point to where it hurts and wiggle fingers
10
Q
How are fractures diagnosed?
A
X-Ray
11
Q
Fracture management goals
A
- Reestablish alignment
- Retain alignment and length
- Restore function
- Prevent further injury
12
Q
Management of Fractures
A
- Pain Management
- Casts may be delayed due to swelling
13
Q
Fractures in children heal quickly due to
A
- Thickened periosteum
- Generous blood supply
14
Q
What are complications of fractures?
A
- Circulatory Impairment
- Nerve Compression Syndrome
- Compartment Syndrome
- Epiphyseal Damage
- Nonunion
- Malunion
- Infection
- Kidney stones
- Pulmonary emboli
15
Q
Compartment Syndrome
A
- Occurs when pressure within a closed space increases and compromises circulation to the muscles and nerves. (Have a cast, swelling occurs and no where for the swelling to go which causes pressures on the nerves, vessels and causes cell death)
- May occur in as little as 30 minutes
- Early detection is important
16
Q
Compartment Syndrome: Assessment
A
Monitor the 6 P’s (Box 29-3)
17
Q
What are signs and symptoms of compartment syndrome?
A
Deterioration in neuromuscular status:
- Sensory deficit
- Motor weakness (will not be able to move and extend fingers - very painful; will be pale)
- Pain
- A palpable pulse and brisk capillary refill may be present.
18
Q
Compartment Syndrome Treatment
A
- Immediate relief of pressure: may require fasciotomy
- Do not elevate above the level of the heart! (If you elevate, the blood goes out and won’t be able to get blood back into that area d/t the pressure and cells will die off)
19
Q
What are late findings of compartment syndrome?
A
- Paresis and Paresthesia
- Signs of permanent damage
20
Q
Compartment Syndrome: Notify HCP for
A
- If patient is extending fingers or wiggling toes = pain
- Poor/absent radial and pedal pulses
21
Q
If compartment syndrome is suspected , the nurse should
A
- Elevate extremity only to the level of the child’s heart
- Loosen any restrictive bandages or dressings
- Splint the cast (if able)
- Notify Physician
- Administer pain medication as ordered
- NPO status for possible emergent surgical management
22
Q
Casts: Assessment
A
The 5 P’s
23
Q
Children in a cast
A
- Immobilizes the joint above and below the fracture.
- Cast purpose: to maintain alignment
24
Q
Cast Management
A
- Keep cast clean and dry
- Do no put anything in the cast (provides environment for infection if there is a break in the skin)
- Do not dry with fans (it will only dry outside of the cast but inside will still be wet)
- Immediately report the 5 P’s of Ischemia
- Evaluate “hot spots” on surface or foul smelling areas of the cast (indicates infection)
25
Sprain
-When trauma to a joint causes a ligament to either stretch or partially or completely tear.
26
What are characteristics of a sprain?
- Often accompanied by damaged blood vessels, muscles, tendons and nerves.
- Joint “feels loose”, “snap” or “pop”
- Rapid onset of swelling
- Immediate disability and reluctance to use joint
27
Strain
- A microscopic tear to the mmusclotendinous unit
| - The more rapid the strain occurs the more severe
28
Strain Characteristics
- Area is painful to touch and swollen
| - Usually happens over time
29
Sprains/Strains Management
- 6-12 hours the most critical period
- Ice injury immediately: should be intermittent and no longer than 30 minutes at a time to prevent tissue injury
- Elevate the Extremity
30
What acronyms can be used to manage sprains/strains?
- RICE: Rest, Ice, Compression, Elevation
| - ICES: Ice, Compression, Elevation, Support
31
Legg-Calve’-Perthes Disease
- Aseptic necrosis of the femoral head; A disturbance of circulation to the femoral capital epiphysis.
- Self-limiting disorder
- May take 18 months to several years
- Reformed femoral head may appear severely altered or completely normal
- Unknown cause
32
Clinical Manifestations of Legg-Calve’-Perthes Disease
- Insidious onset
- Intermittent limp on affected side (most apparent in the morning or after a long day of activities)
- Hip soreness
- Pain
- Joint dysfunction
- Limited ROM
33
How is Legg-Calve’-Perthes Disease diagnosed?
XR or MRI
34
The ultimate outcome of Legg-Calve’-Perthes Disease depends on
- Early identification
- Efficient treatment
- Child’s age at onset
- Younger the age better prognosis: 5yrs and younger have best outcome
35
Legg-Calve’-Perthes Disease: Prognosis
-Good compliance = excellent prognosis
36
Treatment for Legg-Calve’-Perthes Disease
- Conservative therapy: Bracing/casts (continued for 2-4 years)
- Surgical correction: (i.e osteotomy) return to normal activity in 3-4 months
- Education
- Growth and development activities
37
Scoliosis
Complex spinal deformity in 3 planes:
1. Lateral curvature
2. Spinal rotation (rib asymmetry)
3. Hypokyphosis of thorax: Usually lateral deviation or curvature of the spine (usually >10 degrees)
38
What are the types of scoliosis?
1. Congenital: occurs in fetal development
2. Infantile: birth to age 3
3. Juvenile: ages 3-10
4. Adolescent: >10 years; most common type; occurs during the growth spurt of early adolescents; most noticeable during this time
39
Kyphosis
Front-to-back rounding, usually of thoracic spine
40
Lordosis
Exaggerated concave curvature of the spine, usually at lumbar
41
Scoliosis: Treatment is based on
- Magnitude
- Location
- Type of curve
- Age and skeletal maturity of child/adolescent
- Underlying and contributing disease process
42
Scoliosis Treatment: Bracing
- Treats mild to moderate curvatures
- Not curative
- Exercise is used in conjunction
- Maintain and increases the strength of the spine and abdominal muscles
43
Scoliosis Treatment: Surgery
- Correction of severe curves
| - Includes spinal fusion or metallic staples placed into vertebral bodies
44
Scoliosis: Surgical Management
- Long roll in bed to change positions (can’t do anything that includes bending)
- Skin care management is important
- Pain management (ambulation will make the pain go away)
- Neurological status of extremities is important (make sure than can move legs, feel, wiggle; any type of numbness should be reported immediately)
- Bracing used when mobile until fusion is solid (usually mobile within a few days)
45
Developmental Dysplasia of the Hip
- Broad term for describing disorders related to abnormal development of the hip.
- Cause unknown
46
Developmental Dysplasia of the Hip: Clinical Manifestations
- Asymmetric thigh and gluteal folds
- Affected leg shorter than the other
- Instability of the hip: delays walking, produces characteristics limp, waddling gait, and toe walking
47
Diagnosis of Developmental Dysplasia of the Hip
- Diagnosed in newborn period
| - Ortolani or Barlow test: most reliable from birth to 4 weeks
48
Management of Developmental Dysplasia of the Hip
- Begin treatment as soon as recognized
| - Hip joint is maintained in a safe position at all times: Pavlik Harness or Serbia Spica Casts
49
Developmental Dysplasia of the Hip Treatment: The longer treatment is delayed:
- More severe the deformity
- More difficult to treat
- Less favorable prognosis
50
Plavik Harness Teaching
- Worn 23 hr/day and removed only according to physician’s recommendation
- Can be fed in usual positions
- Protect child’s skin and legs under harness
- Diaper goes under harness
51
Spica Cast Teaching
- Tuck a disposable diaper beneath the cast edges at the circular perineal opening
- Place sanitary napkin within the diaper that is tucked under the cast edges
- Elevate HOB to help urine and feces drain downward and away from cast.
- Support extremities.
- Position change q2h
- Move child to different areas during the day
- Assess for signs of neurovascular damage, infection
52
Club foot
- Deformity of the ankle and foot (forefoot abduction, midfoot supination, hindfoot varus, ankle equinus)
- Readily apparent at birth
53
Characteristics of Clubfoot
- Affected foot is usually smaller and shorter; empty heel pad; transverse plantar crease
- Increased risk of hip dysplasia
54
Goal of Clubfoot Management
Painless, plantigrade and functional foot
55
Clubfoot Management
- Casted until maximum correction is achieved (usually within 6-10 weeks)
- Outcomes are not always predictable
56
Juvenile Idiopathic Arthritis
- Chronic childhood arthritis
- An autoimmune inflammatory disease
- No known cause: multifactorial
57
Juvenile Idiopathic Arthritis: To diagnose
- Must be younger than 16 years
- Have joint swelling in 1 or more joints for at least 6 weeks
- Swelling cannot be a result of trauma, infection or malignancy
58
What are clinical manifestations of juvenile idiopathic arthritis?
- Persistent joint swelling lasting longer than 6 weeks.
| - Joints are: Stiff “hell phenomenon”; swollen; warm to the touch; erythematous; limited ROM
59
Management of Juvenile Idiopathic
- Preserving function
- Controlling inflammation: NSAIDs
- Minimizing deformity
- Reducing the impact on the child’s development
60
Osteogenesis Imperfecta
- Rare genetic disorder
- Excessive fractures and bone deformity
- Autosomal dominant inheritance (most severe form)
61
Osteogenesis Imperfecta: Gene defect results in
- Faulty bone mineralization
- Abnormal bone architecture
- Increased susceptibility to fracture
62
What are clinical features of Osteogenesis Imperfecta?
- Varying degrees of bone fragility, deformity and fracture
- Blue sclerae
- Short stature (increased broken bones)
- Osteoporosis
- Hearing loss (little bones in the ears can be affected)
- Hypoplastic discolored teeth
63
Osteogenesis Imperfecta: Management
- Primarily supportive
- Careful handling
- IV Biphosphonate therapy (may promote increased bone density)
- Physical therapy (strengthens muscles, supports bones and prevents breaks)
- Splints/braces
- Genetic counseling (50% risk to pass on to offspring)
- Education
64
Osteogenesis Imperfecta: Education
- Do not pick up child from underarms (can cause rib fractures)
- Do not grab ankles, lift up legs during diaper changes (can all lead to broken bones)
