Exam 2 Musculoskeletal Disorders Flashcards
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)
Flat feet are normal till age ____
Bowed legs normal till age ____
2
3
Palpate for
1) Full _____
2) ____ Tenderness - is indicative of _____
ALWAYS LOOK TO RULE OUT ______*
1) ROM
2) Point (fractures)
ABUSE!
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
Soft Tissue Injury = (3)
Sprains, Strains, Contusions
no bony involvement
Sprains =
= Twisting of a joint, damage to ligaments
Strains =
= Tearing or pulling of muscle, may also effect tendons
Contusions =
= Bruises to the muscle (educate pt that they will change color)
Causes of Soft Tissue Injuries (3)
Falls, Athletics, Accidents
S/S of Soft Tissue Injury 5 __’s
5 P's Pain Pulses Pallor Paresthesia Paralysis
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
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
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
Fractures =
Any break to the bone
accidental or non-accidental
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)
Assessment for Fractures
1) __-____
2) _____ (EBP transitioning to use this to check for fractures bc X-Ray has radiation)
1) X-Ray
2) US
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
Casting
- Help keep ____/d____
- Explain that it gets ___ when ____
- May take time to ____
- calm/distracting
- warm when forming
- dry
Comfort Measure (1) Traction (1)
Sedation
Pulling
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
