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NURS 406 > Exam 2: Musculoskeletal Alteration > Flashcards

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.

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2
Q

Fractures in Infants

A
  • True accidents causing fractures are rare

- Investigate further

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3
Q

Common Childhood Fractures include

A
  • Forearm fractures
  • Clavicle
  • Epiphyseal Injuries: weakest point; may cause problems if fracture line is not transverse
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4
Q

What are the most common cause of fractures in children?

A

Sports

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5
Q

Fractures

A

Muscle contracts to splint injury after fracture occurs; may pull bone ends out of alignment.

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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
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7
Q

What are the 5 P’s?

A
  1. Pain
  2. Pulselessness
  3. Pallor
  4. Paresthesia
  5. Paralysis
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8
Q

What are clinical manifestations of fractures?

A
  • Generalized swelling
  • Pain/Tenderness
  • Diminished function
  • Bruising
  • Muscular rigidity
  • Crepitus
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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

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10
Q

How are fractures diagnosed?

A

X-Ray

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11
Q

Fracture management goals

A
  • Reestablish alignment
  • Retain alignment and length
  • Restore function
  • Prevent further injury
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12
Q

Management of Fractures

A
  • Pain Management

- Casts may be delayed due to swelling

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13
Q

Fractures in children heal quickly due to

A
  • Thickened periosteum

- Generous blood supply

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14
Q

What are complications of fractures?

A
  • Circulatory Impairment
  • Nerve Compression Syndrome
  • Compartment Syndrome
  • Epiphyseal Damage
  • Nonunion
  • Malunion
  • Infection
  • Kidney stones
  • Pulmonary emboli
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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
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16
Q

Compartment Syndrome: Assessment

A

Monitor the 6 P’s (Box 29-3)

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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.
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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)
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19
Q

What are late findings of compartment syndrome?

A
  • Paresis and Paresthesia

- Signs of permanent damage

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20
Q

Compartment Syndrome: Notify HCP for

A
  • If patient is extending fingers or wiggling toes = pain

- Poor/absent radial and pedal pulses

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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
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22
Q

Casts: Assessment

A

The 5 P’s

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23
Q

Children in a cast

A
  • Immobilizes the joint above and below the fracture.

- Cast purpose: to maintain alignment

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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)
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25
Q

Sprain

A

-When trauma to a joint causes a ligament to either stretch or partially or completely tear.

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26
Q

What are characteristics of a sprain?

A
  • 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
Q

Strain

A
  • A microscopic tear to the mmusclotendinous unit

- The more rapid the strain occurs the more severe

28
Q

Strain Characteristics

A
  • Area is painful to touch and swollen

- Usually happens over time

29
Q

Sprains/Strains Management

A
  • 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
Q

What acronyms can be used to manage sprains/strains?

A
  • RICE: Rest, Ice, Compression, Elevation

- ICES: Ice, Compression, Elevation, Support

31
Q

Legg-Calve’-Perthes Disease

A
  • 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
Q

Clinical Manifestations of Legg-Calve’-Perthes Disease

A
  • 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
Q

How is Legg-Calve’-Perthes Disease diagnosed?

A

XR or MRI

34
Q

The ultimate outcome of Legg-Calve’-Perthes Disease depends on

A
  • Early identification
  • Efficient treatment
  • Child’s age at onset
  • Younger the age better prognosis: 5yrs and younger have best outcome
35
Q

Legg-Calve’-Perthes Disease: Prognosis

A

-Good compliance = excellent prognosis

36
Q

Treatment for Legg-Calve’-Perthes Disease

A
  • 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
Q

Scoliosis

A

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
Q

What are the types of scoliosis?

A
  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
Q

Kyphosis

A

Front-to-back rounding, usually of thoracic spine

40
Q

Lordosis

A

Exaggerated concave curvature of the spine, usually at lumbar

41
Q

Scoliosis: Treatment is based on

A
  • Magnitude
  • Location
  • Type of curve
  • Age and skeletal maturity of child/adolescent
  • Underlying and contributing disease process
42
Q

Scoliosis Treatment: Bracing

A
  • Treats mild to moderate curvatures
  • Not curative
  • Exercise is used in conjunction
  • Maintain and increases the strength of the spine and abdominal muscles
43
Q

Scoliosis Treatment: Surgery

A
  • Correction of severe curves

- Includes spinal fusion or metallic staples placed into vertebral bodies

44
Q

Scoliosis: Surgical Management

A
  • 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
Q

Developmental Dysplasia of the Hip

A
  • Broad term for describing disorders related to abnormal development of the hip.
  • Cause unknown
46
Q

Developmental Dysplasia of the Hip: Clinical Manifestations

A
  • 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
Q

Diagnosis of Developmental Dysplasia of the Hip

A
  • Diagnosed in newborn period

- Ortolani or Barlow test: most reliable from birth to 4 weeks

48
Q

Management of Developmental Dysplasia of the Hip

A
  • Begin treatment as soon as recognized

- Hip joint is maintained in a safe position at all times: Pavlik Harness or Serbia Spica Casts

49
Q

Developmental Dysplasia of the Hip Treatment: The longer treatment is delayed:

A
  • More severe the deformity
  • More difficult to treat
  • Less favorable prognosis
50
Q

Plavik Harness Teaching

A
  • 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
Q

Spica Cast Teaching

A
  • 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
Q

Club foot

A
  • Deformity of the ankle and foot (forefoot abduction, midfoot supination, hindfoot varus, ankle equinus)
  • Readily apparent at birth
53
Q

Characteristics of Clubfoot

A
  • Affected foot is usually smaller and shorter; empty heel pad; transverse plantar crease
  • Increased risk of hip dysplasia
54
Q

Goal of Clubfoot Management

A

Painless, plantigrade and functional foot

55
Q

Clubfoot Management

A
  • Casted until maximum correction is achieved (usually within 6-10 weeks)
  • Outcomes are not always predictable
56
Q

Juvenile Idiopathic Arthritis

A
  • Chronic childhood arthritis
  • An autoimmune inflammatory disease
  • No known cause: multifactorial
57
Q

Juvenile Idiopathic Arthritis: To diagnose

A
  • 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
Q

What are clinical manifestations of juvenile idiopathic arthritis?

A
  • Persistent joint swelling lasting longer than 6 weeks.

- Joints are: Stiff “hell phenomenon”; swollen; warm to the touch; erythematous; limited ROM

59
Q

Management of Juvenile Idiopathic

A
  • Preserving function
  • Controlling inflammation: NSAIDs
  • Minimizing deformity
  • Reducing the impact on the child’s development
60
Q

Osteogenesis Imperfecta

A
  • Rare genetic disorder
  • Excessive fractures and bone deformity
  • Autosomal dominant inheritance (most severe form)
61
Q

Osteogenesis Imperfecta: Gene defect results in

A
  • Faulty bone mineralization
  • Abnormal bone architecture
  • Increased susceptibility to fracture
62
Q

What are clinical features of Osteogenesis Imperfecta?

A
  • 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
Q

Osteogenesis Imperfecta: Management

A
  • 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
Q

Osteogenesis Imperfecta: Education

A
  • 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)

NURS 406 (18 decks)

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