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AN305 > F MSK > Flashcards

F MSK Flashcards

1
Q

Ossification complete when
Bones compared to adults
Epiphyseal (growth) plate?

A

Ossification complete by late adolescence into early 20s

Bones are less dense than adults

Epiphyseal plate: injury here is a problem
(effects growth)

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2
Q

Muscle differences (2)

Ligaments and tendons (2)

A

Muscles:
-muscles do not increase in #
-length and circumference increase as child grows

Ligaments and tendons:
-ligaments and tendons are strogner than bones until puberty
-Full ROM but no purposeful movement when born

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3
Q

Genu Varum vs Genu Valgum

(What is it)
When it resolves
Outside of these ranges =?

A

Genu varum: Bow legs
-Infants and toddlers: usually resolves by 2-3y/o

Genu valgum: “knock-knees”
-appears around 2-3 y/o, usually resolves by 7-8 y/o

Outside of these ranges = specialist referral

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4
Q

Neuromuscular & MSK congenital disorders

A

Metatarsus adductus
Club foot (talipes equinovarus)
Hip dysplasia
Osteogenesis imperfecta
Spina bifida
Muscular dystrophy
Cerebral palsy

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5
Q

Metatarsus adductus (most common foot deformity)

What is it
Causes

Degree of flexibility is important for determining what?

A

Forefoot is adducted

Intrauterine positioning

Degree of flexibility = determining tx

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6
Q

Metatarsus adductus

Diagnosis and tx

A

Physical assessment/xray

Tx:
-PT/ observation in mild cases

-passive stretching with serial cast/braces if >15 degree angle or if there is no flexibilty in foot
—casts changed weekly
—braces and orthopedic shoes

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7
Q

Club Foot (talipes equinovarus)

Categories
Can effect what or what
Can be what or what

A

Categories:
-positional: intrauterine crowding
-congenital: (idiopathic)
-syndromic: occurs in associations with other syndromes

Can be unilateral or bilateral

Can be isolated defect or associated with other disorders (CP, Spina Bifida)

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8
Q

Club foot s/s

A

Talipes varus: inversion of the heel

Talipes equinus: plantar flexion

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9
Q

Club foot

Tx (goal is a functional foot)

A

Serial casting (every 1-2 wks)

Weekly manipulations/stretching

Sx with casting (heel cord tenotomy)

Braces/orthotics (for some kids)

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10
Q

Club foot care and assessments

A

Assess: neurovascular, motor development

Cast care

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11
Q

Hip dysplasia

What is it

RF

A

Improper alignment of the femoral head and the acetabulum

RF:
-first born
-females
-family hx
-breech position
-LGA (large for gestational age)

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12
Q

Hip dysplasia

Screen when
S/s

A

Screen infants until 1 y/o

-asymmetrical gluteal and thigh folds
-positive allis sign (1 knee lower than other when flexed)

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13
Q

Hip dysplasia

Diagnosis

Other test

A

US: until 6mo old
Xray: once 6 mo old

Other test:
-ortolani-barlow maneuver:
-Barlow: diuslocation of femoral head by adduction
-Ortolani: reduction back into acetabulum by abduction

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14
Q

Hip dysplasia tx

Newborn-6month

A

Starts as soon as diagnosed
pavlik harness (6-12wks)
-typically corrected after 3 months of use

What pavlik harness does:
-ensures hip flexion and abduction but does not allow hip extension or adduction

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15
Q

Hip dysplasia
Nursing management of pavlik harness

A
  1. Peform neurovascular/skin integrity checks
  2. Change diaper with harness on
  3. Do not adjust straps without consulting provider
  4. If removal of straps is ordered understand how to reapply
  5. Skin care to include use of undershirt, knee socks, avoid lotions and powders
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16
Q

Hip dysplasia tx

Older than 6months or if pavlik harness unsuccessful

Tx and care included

A

Surgical reduction with spica cast:
-Spica cast-stays on about 12 wks

Care includes:
-neurovacular checks
-frequent skin assessment
-cast care
-pain management

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17
Q

Osteogenesis imperfecta

What is it
Aka

A

Inherited connective tissue condition that results in bone fx and deformity along with restrictive growth

Aka: brittle bone disease

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18
Q

Osteogenesis imperfecta s/s

A

Freq fx
Blue sclera
Short stature
Small discolored teeth
Early conductive hearing loss

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19
Q

Osteogenesis imperfecta

Tx

A

Tx is supportive:

Med: pamidronate
-bisphophate (give IV infusion)
—increases bone density and corrects imbalance between bone resorption and bone formation

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20
Q

Osteogenesis imperfecta

Teaching for tx

A

Low impact exercises (swimming)

Assist with braces/splints

Assist with PT/OT

Safety!!!

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21
Q

Spina bifida 3 forms

A

Occulta

Meningocele

Myelomeningocele

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22
Q

Spina bifida (occulta)

What is it/location
Usually what

A

Mildest form: lumbosacral area

-defect of vertebral bodies
-no protrusion of spinal cord/meninges

-often asymtpomagtic and goes undetected

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23
Q

Spinal bifida (occulta)

S/s

A

Sacral dimple
Tuft of hair
Discoloration of skin at site
(tethered cord/walk on tiptoes)

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24
Q

Spina bifida (occulta)

Tx

A

Usually not require interventions if asymptomatic

BUT may require sx for tethered cord/symptomatic

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25
Q

Spina bifida cystica (meningocele)

What is it

A

Sac like protrusion containing meninges and CSF

Spinal cord in normal position

26
Q

Spina bifida cystica (meningocele)

Tx

A

Assess neuro status
Monitor for leaking CSF/ increased ICP

Surgical correction REQUIRED

27
Q

Spina bifida cystica (myelomeningocele)

What is it/ s/s

A

Sac like protrusion contains meninges/CSF/nerves

Spinal cord often ends at the point of defect (higher defect has more affects):
-absent motor/sensory function
-bowel/bladder incontinence

28
Q

Spina bifida cystica:
Infection prevention & injury prevention (4)

A

Sterile saline-soaked gauze to keep sac moist:
-monitor for leakage of CSF/increased ICP

Place in prone position/supported side position

Use infant wamrer/isolette (monitor for drying of sac) (no clothes allowed on sac)

Proper diapering (keep free of feces/urine

29
Q

Increased ICP signs

A

Increased HC
Bulging fontannel
LOC change
High pitched cry
Cushing triad (brady cardia/ widening pulse pressures/ chyne stokes respirations)

30
Q

Spina bifida cystica: complications and needs

A

Paralysis (wheelchair, walker needed)

Bowel/bladder incontinence:
-straight cath
-vesicostomy (Monit)
-appendicostomy (MACE)

Hydrocephalus

Chiari malformation (brain tissue protrudes into spinal cord)

31
Q

Spina bifida: multidisciplinary approach

A

NICU/PICU stays
Neurology
Neurosurgery
Urology
GI
Orthopedics
PT/OT/ST

32
Q

(Vesicostomy) MONTI

vs

(Appendicostomy) MACE

DONT HAVE TO KNOW JUST IDEA

A

MONTI:
stoma sutured to body wall
Urethra sutured

MACE:
In colon use appendix so we can do an enema to clean out colon and empty it

33
Q

Muscular dystrophy

What is it
Type

A

Inherited disorder w/ progressive degeneration of skeletal muscles (causing muscle weakening/wasting

Type:
Duchenne muscular dystrophy (most common)
Limb-girdle muscular dystrophy
Facioscapulohumeral dystrophy

34
Q

Duchenne’s muscular dystrophy

What is it/mostly affects who
Onset?
Life expectancy

A

X-linked recessive (affects mostly males)

Early childhood onset (3-6y/o)

Progressive

Life expectancy (early adulthood)

35
Q

Duchenne muscular dystrophy

S/s
3
3 toddler/preschool
5 school age

A

Fatigue
Muscle weakness (beginning in lower extremity)
Late walkers (12mo usually)

Toddler/preschool (unsteady gait/fall often)
Large calf muscles (fat deposits)
Gowers sign

School age (walk on toes/balls of feet, waddling gait)
12y/o will lose ability to walk
Muscle atrophy of face/chest/neck
Respiratory/cardiac difficulties
Mild congitive delays

36
Q

Gowers sign

A

Muscular dystrophy sign:

Have to use entire upper body to get off floor

37
Q

Duchenne muscular dystrophy

Diagnosis

A

Genetic analysis (inherited)

Muscle biopsy

Elevated CK levels (creatinine kinase = muscle damage)

38
Q

Duchenne muscular dystrophy

Tx

A

No cure

-Corticosteroids (slow pregression)
-Mobility/ROM/ADLs
-Respiratory assistance (IS/positioning/cough assist/nebulizers/CPT/CPAP/BiPAP)
-Gtube/tube feedings

-end of life discussion/comfort care

39
Q

Cerebral palsy

What is it

A

Nonprogressive impairment of motor function

Lack muscle control/coordination

Can cause visual/hearing/speech impairment

40
Q

Cerebral palsy risk factors (baby)

A

Head trauma (shaken baby)
Maternal infction
Maternal chorioamionitis
Premature birth
Very low birth wt
Interruption of oxygen delivery to fetus during birth
Direct injury to neonate during birth
Maternal drug use

41
Q

Cerebral palsy s/s

A

Failure to meet developmental milestones/Persistent primitive reflexes (dont go away)
Gagging/choking w/ feeding/poor suck reflex
Poor head control
Sz
Vision/speech/hearing impairment
Arching back/Rigid posture
Toe walking

42
Q

Cerebral palsy
Tx

A

Individualized to meet client

-promote independence (self care is goal)
-monitor airway (position/suciton/aspiration/reflux precautions)
-skin care (assess under braces/aplints/turning)
-nutrition (PO, Gtube, high calorie/protein, fiber)

43
Q

Cerebral palsy

Tx (MEDS)

A

-Baclofen: PO or intrathecal (pump)

-Diazepam (valium)

Antiepileptics:
-levetiracetam (Keppra)
-valporic acid

44
Q

Acquired MSK deformities/disorders

A

Legg-Calve Perthes disease
Scoliosis
Injuries (FX)

45
Q

Legg-calve-perthes disease

What is it
RF

A

Aseptic necrosis of the femoral head
(unilateral or bilateral)

RF:
Age 2-12y/o (but mostly 4-8y/o)
Males
Trauma/decreased circulation

46
Q

Legg-calve-perthes disease

Healing

A

New blood vessels are formed w/ bone resorptions and deposition for up to 18-24 months

During this time bone very soft and more likely to fx

47
Q

Legg-calve-perthes disease

Diagnostics

A

Xray/MRI

48
Q

Legg-calve-perthes disease

Onset
S/s

A

Insidious onset

Intermittent limp
Limited ROM
Stiffness of hip
Mild pain: Groin/thigh/knee
Shortening of affected leg

49
Q

Legg-calve-perthes disease

Prognosis

Tx

A

Self-limiting disease (depends on stage/severity)

Tx:
Nsaids

-Rest/limited wt baring
-Possible brace
-PT/advance to active motion as perscribed
-Avoid contact/high impact sports
(Swimming/bicycling help ROM and are low impact)

50
Q

Scoliosis

What is it
Cause

A

Lateral curvature of spine (exceeds 10degrees)
-spinal rotation also causes rib asymmetry

Cause:
Acquired (neuromuscular disorders)

51
Q

Scoliosis

RF

A

Genetic tendency

Females

Highest incidence between 8-15y/o

52
Q

Scoliosis

Screened when (how to do it)
assessment findings
Diagnostics

A

Screen preadolescence

Have child bend forward at waist w/ arms hanging
-asymmetry of scapula/ribs/shoulders/hips
-improperly fitting clothes (one leg shorter)

Diagnostics: tells us degree of curvature
-xray/CT/MRI

53
Q

Scoliosis tx

A

Under 10 degrees we do nothing

Needs to be corrected before 40degrees
-brace

Surgery: spinal fusion
-for severe cases (>45degrees)

54
Q

Scoliosis nursing management

Brace education

A

Bracing prevents further curvature
(doesnt correct current curve)

Worn up to 23 hours per day

Lengthy treatment (months to years)

55
Q

Scoliosis (post surgical education)

What to do
Restrictions

A

Pain control (PCA pump)
Monitor incision & drainage (JP drain)
Log roll to prevent flexion of spine
Early mobility w/ PT

Activity restriction for 6-8 months:
-cannot lift more than 10lbs
-sports (except swimming/walking)

56
Q

Injuries: fractures

More frequent in who

Risk factores

A

More frewuent in children than adults (but heals fast

RF:
-Obesity, nutrition, ordinary play activities
-recreations place children at risk
(running/climbing/skateboarding/skiing/bicycle accidents/sports)

57
Q

Salter-harris classification system for fractures

A

Type 1 & 2:
-do not have growth plate disturbances
(Wont affect growth)

Types 3, 4 & 5:
-can cause distubances in growth plates
(Issues with growth)

58
Q

Fracture

Diagnostics
Tx

Open fx?

A

Xray/CT

Monitor VS/Pain/neurovascular
Stabilize area/limit movement
RICE
Pain meds

Tetanus vaccine/ABX if open fracture

59
Q

Fracture

Ways to immobilization

A

Splinting
Bracing
Casting
Traction

Closed reduction (no sx)

Open reduction (rods/screws in) (external fixation)
(Sx) (pin care)

60
Q

Fracture cast care

Tx
Avoids
Notify if

A

-elevate limb after cast applied
(Some swelling is normal)
-circle/monitor drainage
-assess pulse/neurovascular
-keep clean/dry
-report severe pain or pain not relieved by meds

Avoids:
Nothing put in cast
No lotion or powders
If wet inside do not use hot blow dryer (burns)

If itching (use blow dryer on cold setting)

61
Q

Fracture complications

A

Compartment syndrome:
-compression of nerve/blood vessels/muscle inside confinded space results in neuromuscular ischemia
(Usually forearm/tibial fractures)

Osteomyelitis

Embolism
-fat embolism/PE

62
Q

Assessment of fracture (5 P’s)

A

Pain (unrelieved w/ elevation and analgesics)

Pulselessness (distal to fx site)

Pallor

Paresthesia (distal to fx site)

Paralysis (movement distal to fx site)

AN305 (17 decks)

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