Normal Findings - ____ ROM of (3) bilaterally - stable _____ - No _____ - No _____ to right ankle

- ROM of hips, knees, ankles - Gait - Ataxia - Tenderness

Abnormal Findings - _____ to _____ aspect of right ankle - Pain with ______ - Moderate ______

- Tenderness, Lateral - Extension - Swelling

Casting - Help keep ____/d____ - Explain that it gets ___ when ____ - May take time to ____

- calm/distracting - warm when forming - dry

Exam 2 Musculoskeletal Disorders Flashcards by Felita Salim

Physical Assessment: Look at

1) I____
2) In____ (S/S)
3) F_____ (2)
4) L___ (1)
5) G____ (looking for _____)

1) Injury (common injuries of small children)
2) Inflammation
3) Feet (Flat footed, Club feet)
4) Legs (Bowed Legs)
5) Gait (symmetry)

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Flat feet are normal till age ____

Bowed legs normal till age ____

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Palpate for

1) Full _____
2) ____ Tenderness - is indicative of _____

ALWAYS LOOK TO RULE OUT ______*

1) ROM
2) Point (fractures)

ABUSE!

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Normal Findings

____ ROM of (3) bilaterally
stable _____
No _____
No _____ to right ankle

ROM of hips, knees, ankles
Gait
Ataxia
Tenderness

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Abnormal Findings

_____ to _____ aspect of right ankle
Pain with ______
Moderate ______

Tenderness, Lateral
Extension
Swelling

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Soft Tissue Injury = (3)

Sprains, Strains, Contusions

no bony involvement

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Sprains =

= Twisting of a joint, damage to ligaments

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Strains =

= Tearing or pulling of muscle, may also effect tendons

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Contusions =

= Bruises to the muscle (educate pt that they will change color)

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Causes of Soft Tissue Injuries (3)

Falls, Athletics, Accidents

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S/S of Soft Tissue Injury 5 __’s

5 P's 
Pain
Pulses 
Pallor 
Paresthesia 
Paralysis

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S/S of Soft Tissue Injuries by types

1) Sprain = REEHP
2) Strain = IE
3) Contusion = ID

1) Redness, Edema, Ecchymosis, Heat, Pain
2) Inflammation, Ecchymosis
3) Inflammation, Discoloration

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Nursing Interventions for Soft Tissue Injuries

1) ______ to rule out fracture
2) _____*
3) What medication?
4) _____ therapy

1) X-Ray
2) RICE*
3) NSAIDS (motrin, advil)
4) Physical Therapy

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Rest = S\_\_\_\_, C\_\_\_\_, B\_\_\_\_
Ice = \_\_\_x/day, \_\_ min 
Compression = \_\_\_-bandage/s\_\_\_
Elevation = above the \_\_\_\_\_\_

Slings, Crutches, Bedrest
3 x/day, 20 min
Ace-bandage/Splint
Heart

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Fractures =

Any break to the bone

accidental or non-accidental

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S/S of Fracture

1) I_____
2) B_____
3) P______
4) ______ ROM
5) Non- ____ bearing

1) Inflammation
2) Bruising
3) Pallor
4) Limited ROM
5) Non-weight bearing (not willing to walk on it)

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Assessment for Fractures

1) __-____
2) _____ (EBP transitioning to use this to check for fractures bc X-Ray has radiation)

1) X-Ray

2) US

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Treatment for Fractures

1) C_____
2) C____ measures
3) Tr_____
4) ______ fixation devices
5) Te____

1) Casting
2) Comfort
3) Traction
4) External fixation devices
5) Teaching

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Casting

Help keep ____/d____
Explain that it gets ___ when ____
May take time to ____

calm/distracting
warm when forming
dry

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Comfort Measure (1) 
Traction (1)

Sedation

Pulling

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External fixation devices =

What is a complication of these devices?

= Bone screwed into external

Osteomyelitis (bone infection-higher risk for open fractures)

Teaching

Do not ___ anything in the cast
____ formation (on skin directly above fracture)
Check for ___ refill

Stick
Callus
Cap refill

Club Foot =

Malalignment of feet, which resists being moved into proper alignment

Causes of Club Foot (3)

Fetal Positioning
Intrauterine restriction (ex. multiple gestations)
Boys > Girls

S/S of Club Foot - Appears _____ - Unable to:

- Abnormal | - Unable to return to proper alignment

Assessment of Club Foot (2) | Treatment (3)

- X-ray/Ultrasound | - Serial Casting (constant reapplication due to rapid growth), Surgery, Physical Therapy

Developmental Dysplasia of the Hip =

Subluxation (slight misalignment) or complete dislocation of hip

Causes of DDH (2)

Fetal Positioning | Girls > Boy

Physical Appearance of DDH | Asymmetry of what 2 things

- Asymmetry of thigh folds | - Asymmetry of femur lengths (knees up and see if one is higher)

Tests for DDH (2) A normal hip would test negative for these maneuvers

Barlow's = push knees in and back to feel hip come out (a clunk) Ortalani's = after hips go out, push knees out and hips should go back in

Assessment of DDH 1) Based on ____ exam 2) Radiology tests (2)

1) Screening | 2) X-Ray/Ultrasound

Treatment for DDH (2*)

Pavlik harness* | Spica Casting*

Pavlik Harness = - should only be used if baby is how old? - No l___/p___ - Frequent visits for ____ - They should be in the harness how long each day?

= keeps legs abducted to keep trochanter in the acetabulum - less than 6 months old - no lotion/powder - adjustments (do not let parents adjust!) - 24/7, with 1 hour off to shower

Spica Casting = - should be used if baby is how old? or if what fails?

= covers from armpits around chest to ankles - older than 6 months, or if harness fails

Legg Calve Perthes = Cause =

= necrosis of femur and at times, acetabulum; blood supply returns but damage to bone is done = Blood does not go to the head of the femur (and sometimes the acetabulum)

S/S of Legg-Calve-Perthes 1) P____ 2) L_____ (that worsens with ___)

1) Pain | 2) Limp (worsens with activity)

Assessment of Legg-Calve-Perthes 1) __-___/___ scan/M___ 2) ____ diagnosis is key

1) X-Ray/Bone scane/MRI (MRI to see how far its progressed, one appears necrotic/broken down) 2) Early diagnosis is key

Treatment fo Legg-Calve-Perthes - What medication? - _____ bearing - _____ extension to _____ (assess 5 P's)

- NSAID's - NON-weight bearing (crutches) - Buck extension to immobilize

Slipped Capital Femoral Epiphysis =

= Head of femur separated from the rest of the femur at the growth plate

Causes of Slipped Capital Femoral Epiphysis 1) ____weight 2) T_____ (at ___ ___)

1) Overweight | 2) Teenagers (at growth spurt)

S/S of SCFE 1) Hip ______ 2) Painful ____ 3) L____ 4) _____ hip flexion 5) Pain increases when toes turned _____ 6) Position of comfort =

1) tenderness 2) ROM 3) Limp 4) decreased 5) inward 6) external rotation of affected leg

Assessment of SCFE 1) History suggests - ____ pre-teen 2) _____ definitive

1) Obese preteen | 2) X-ray

Treatment for SCFE 1) _____ immediately 2) _______ of the joint

1) Surgery (don't want to delay growth) | 2) Immobilization

Scoliosis = More common in girls or boys? Happens during when?

= Lateral curvature and rotation of the spine Girls > Boys During pubertal growth

S/S of Scoliosis - uneven ____ - one scapula/clavicle ____ than the other - Hip/rib ______ - Severe = ____/____ compromise - Back ____

- posture - higher - asymmetry - cardiac/respiratory - pain

Assessment of Scoliosis 1) How to screen? 2) Monitor ___ ____ during exam Treatment 1) is based on ___ and c_____ 2) Bracing = is it a cure? 3) S_____

1) Tell pt to bend over at hips and touch toes 2) physical appearance 1) age, curvature 2) NOT curative, help prevent worsening 3) surgery

Duchenne Muscular Dystrophy = Cause = ______* Greater in boys or girls?

= Progressive loss of function due to muscular loss (but not cognition) Hereditary* Boys > Girls bc X linked

S/S of Duchenne Muscular Dystrophy 1) Initially growth/development is? 2) What age do they start to lose function that was previously attained? 3) What type of functions do they start to lose first? 4) ____ sign* develops (what is it?) 5) What will they need by teenage years?

1) normal 2) 3 yo 3) small functions -> gross motor 4) Gower's* (get up like an old man) 5) wheelchair

Assessment of Duchenne Muscular Dystrophy - Monitor using ____ tools - ____* tests bc its ______ Treatment of Duchenne Muscular Dystrophy - Is there a cure? - Preserve _____, vital ____ function, and _____ as long as possible

- screening - DNA* bc its hereditary - NO cure - ambulation, organ function, independence

Osteomyelitis = Caused by =

= Bacterial infection in the bone = introduced via a skin break or the vascular system

S/S of Osteomyelitis 1) F_____ 2) C_____ a lot 3) R_____, W____, S_____, P_____ 4) L______ Looks _____

1) Fever 2) Crying 3) Redness, warmth, swelling, pain 4) Limping Cellulitic

Nursing Interventions for Osteomyelitis 1) Draw ____ 2) Hang _____* as ordered 3) Prep for _____ PRN 4) Prep for scans (4)

1) Labs 2) Antibiotics* 3) Surgery 4) X-ray, MRI, CT, bone scans