FINAL NEW CONTENT Flashcards
How does sedentary lifestyles affect a child’s growth and development
bone demineralization, loss of strength, low exercise tolerance, decreased metabolism, loss of joint mobility, contractures, spinal deformities, impaired healing, increased stress hormone, hypertension, emboli/thrombi risk, constipation,
What is the first intervention for a soft tissue injury
Soft-tissue injuries should be iced immediately.
Then, Elevating the extremity uses gravity to facilitate venous return and reduce edema formation in the damaged area. The point of injury should be kept several inches above the level of the heart for therapy to be effective.
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fractures in children younger than 12 months old have been attributed to…
nonaccidental trauma (child abuse)
Any investigation of fractures in infants, particularly multiple fractures, should include consideration of osteogenesis imperfecta (OI) after nonaccidental trauma has been ruled out.
What is the most common fracture in children
A distal forearm (radius, ulna, or both) fracture is
Describe the 4 types of fractures seen in children
Plastic deformation: Occurs when the bone is bent but not broken. A child’s flexible bone can be bent 45 degrees or more before breaking. However, if bent, the bone will straighten slowly but not completely, producing some deformity but without the angulation seen when the bone breaks. Bends occur most commonly in the ulna and fibula, often in association with fractures of the radius and tibia.
Buckle, or torus, fracture: Produced by compression of the porous bone; appears as a raised or bulging projection at the fracture site. These fractures occur in the most porous portion of the bone near the metaphysis (the portion of the bone shaft adjacent to the epiphysis) and are more common in young children.
Greenstick fracture: Occurs when a bone is angulated beyond the limits of bending. The compressed side bends, and the tension side fails, causing an incomplete fracture similar to the break observed when a green stick is broken.
Complete fracture: Divides the bone fragments.These fragments often remain attached by a periosteal hinge, which can aid or hinder reduction.
Why do you need to use traction on a broken bone
Immediately after a fracture occurs, the muscles contract and physiologically splint the injured area. This phenomenon accounts for the muscle tightness observed over a fracture site and the deformity that is produced as the muscles pull the bone ends out of alignment. This muscle response must be overcome by traction or complete muscle relaxation (e.g., anesthesia) to realign the distal bone fragment to the proximal bone fragment.
Whats the difference between pediatric and adult bone fractures
Fractures heal in less time in children than in adults.
The child may exhibit the same manifestations seen in adults, which may include swelling, bruising, pain or tenderness, deformity, and diminished function (Box 48.2). However, often a fracture is remarkably stable because of intact periosteum. The child may even be able to use an affected arm or walk on a fractured leg. Because bones are highly vascular, a soft, pliable hematoma may be felt around the fracture site.
What are the 6 P’s of a fracture
- Pain: Severe pain that is not relieved by analgesics or elevation of the limb, movement that increases pain
- Pulselessness: Inability to palpate a pulse distal to the fracture or compartment
- Pallor: Pale-appearing skin, poor perfusion, capillary refill greater than 3 s
- Paresthesia: Tingling or burning sensations
- Paralysis: Inability to move extremity or digits
- Pressure: Involved limb or digits may feel tense and warm; skin is tight, shiny pressure within the compartment is elevated
Describe late signs of compartment syndrome
Pallor, paralysis, and pulselessness are late signs
The six primary purposes of traction are:
- To fatigue the involved muscles and reduce muscle spasm so that bones can be realigned
- To position the distal and proximal bone ends in desired realignment to promote satisfactory bone healing
- To immobilize the fracture site until realignment has been achieved and sufficient healing has taken place to permit casting or splinting
- To help prevent or improve contracture deformity
- To provide immobilization of specific areas of the body
- To reduce muscle spasms (rare in children)
The three essential components of traction management are …
traction, countertraction, and friction
traction (forward force) is produced by attaching weight to the distal bone fragment. Body weight provides countertraction (backward force), and the patient’s contact with the bed constitutes the frictional force.
What are the 3 types of traction
Manual traction: Applied to the body part by the hand placed distal to the fracture site. Manual traction may be provided during application of a cast but more commonly when a closed reduction is performed.
Skin traction: Applied directly to the skin surface and indirectly to the skeletal structures. The pulling mechanism is attached to the skin with adhesive material or an elastic bandage. Both types are applied over soft, foam-backed traction straps to distribute the traction pull.
Skeletal traction: Applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture.
What is Bryant traction
Bryant traction is a type of running traction in which the pull is in only one direction. Skin traction is applied to the legs, which are flexed at a 90-degree angle at the hips. The child’s trunk (with the buttocks raised slightly off the bed) provides countertraction.
What is Buck extension traction
Buck extension traction is a type of traction with the legs in an extended position. Except for fracture cases, turning from side to side with care is permitted to maintain the involved leg in alignment. Buck extension traction is used primarily for short-term immobilization, such as preoperative management of a child with a dislocated hip, or for correction of contractures or bone deformities, such as in Legg-Calvé-Perthes disease. Buck extension traction may be accomplished with either skin straps or a special foam boot designed for traction.
What is Russell traction
Russell traction uses skin traction on the lower leg and a padded sling under the knee. Two lines of pull, one along the longitudinal line of the lower leg and one perpendicular to the leg, are produced. This combination of pulls allows realignment of the lower extremity and immobilizes the hip and knee in a flexed position.
What is the most common skeletal traction
A common skeletal traction is 90-degree-90-degree traction (90-90 traction). The lower leg is supported by a boot cast or a calf sling, and a skeletal Steinmann pin or Kirschner wire is placed in the distal fragment of the femur, resulting in a 90-degree angle at both the hip and the knee. From a nursing standpoint, this traction facilitates position changes, toileting, and prevention of complications related to traction.
Most cervical traction is accomplished with the use of…
halo brace or halo vest. This device consists of a steel halo attached to the head by four screws inserted into the outer skull; several rigid bars connect the halo to a vest that is worn around the chest, thus providing greater mobility of the rest of the body while avoiding cervical spinal motion altogether. If the injury has been limited to a vertebral fracture without neurologic deficit, a halo brace can be applied to permit earlier ambulation.
Whats the difference between a sprain and a strain
A sprain occurs when trauma to a joint is so severe that a ligament is partially or completely torn or stretched by the force created as a joint is twisted or wrenched, often accompanied by damage to associated blood vessels, muscles, tendons, and nerves. Common sprain sites include ankles and knees.
A strain is a microscopic tear to the musculotendinous unit and has features in common with sprains. The area is painful to touch and swollen. Most strains are incurred over time rather than suddenly,
What does RICE stand for
REST ICE COMPRESSION ELEVATION
Define contusion
A contusion (bruise) is damage to the soft tissue, subcutaneous structures, and muscle. The tearing of these tissues and small blood vessels and the inflammatory response lead to hemorrhage, edema, and associated pain when the child attempts to move the injured part. The escape of blood into the tissues is observed as ecchymosis, a black-and-blue discoloration.
What is developmental dysplasia of the hip (DDH)
The broad term developmental dysplasia of the hip (DDH) describes a spectrum of disorders related to abnormal development of the hip that may occur at any time during fetal life, infancy, or childhood.
What are the 3 predisposing factors associated with DDH:
(1) physiologic factors, which include maternal hormone secretion and intrauterine positioning;
(2) mechanical factors, which involve breech presentation, multiple fetus, oligohydramnios, and large infant size as well as swaddling where the hips are maintained in adduction and extension, which in time may cause a dislocation; and
(3) genetic factors, which entail a higher incidence of DDH in siblings of affected infants and an even greater incidence of recurrence if a sibling and one parent were affected.
What are the 2 groups associated with DDH
(1) idiopathic, in which the infant is neurologically intact
(2) teratologic, which involves a neuromuscular defect, such as arthrogryposis or myelodysplasia. The teratologic forms usually occur in utero and are much less common.
What are the Three degrees of DDH
- Acetabular dysplasia: This is the mildest form of DDH, in which there is a delay in acetabular development evidenced by osseous hypoplasia of the acetabular roof that is oblique and shallow, although the cartilaginous roof is comparatively intact. The femoral head remains in the acetabulum.
- Subluxation: The largest percentage of DDH, subluxation, implies incomplete dislocation of the hip. The femoral head remains in contact with the acetabulum, but a stretched capsule and ligamentum teres cause the head of the femur to be partially displaced. Pressure on the cartilaginous roof inhibits ossification and produces a flattening of the socket.
- Dislocation: The femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over the fibrocartilaginous rim. The ligamentum teres is elongated and taut.
A striking relationship exists between the development of hip dislocation and methods of…
swaddling the hips.
Names some Clinical Manifestations of Developmental Dysplasia of the Hip
Shortening of limb on affected side (Galeazzi sign) Restricted abduction of hip on affected side Unequal gluteal folds (best visualized with infant prone) Positive Ortolani test (hip is reduced by abduction) Positive Barlow test (hip is dislocated by adduction)
How do you manage an infant’s DDH
the Pavlik harness is the most widely used, and with time, motion, and gravity, the hip works into a more abducted, reduced position (Fig. 48.14). The harness is worn continuously, 22 to 24 hours per day depending on the severity of dysplasia, until the hip is proved stable on both clinical and ultrasound examination, usually within 6 to 12 weeks.
What is club foot
The foot is pointed downward (plantarflexed) and inward in varying degrees of severity (Fig. 48.15). Clubfoot may occur as an isolated deformity or in association with other disorders or syndromes, such as chromosomal abnormalities, arthrogryposis, or spina bifida.
What are the 3 types of club foot
(1) positional clubfoot (also called transitional, mild, or postural clubfoot), which is believed to occur primarily from intrauterine crowding and responds to simple stretching and casting;
(2) congenital clubfoot, also referred to as idiopathic, which may occur in an otherwise normal child and has a wide range of rigidity and prognosis; and
(3) syndromic (or teratologic) clubfoot, which is associated with other congenital anomalies (such as myelomeningocele or arthrogryposis) and is a more severe form of clubfoot that is often resistant to typical treatment.
How do you treat club foot
Treatment of clubfoot involves three stages:
(1) correction of the deformity,
(2) maintenance of the correction until normal muscle balance is regained, and
(3) follow-up observation to avert possible recurrence of the deformity. Some feet respond to treatment readily; some respond only to prolonged, vigorous, and sustained efforts; and the improvement in others remains disappointing even with maximal effort.
Nursing care of the child with clubfoot is the same as for any child who has a cast (see earlier in the chapter). Because the child will spend considerable time in a corrective device, nursing care plans include both long- and short-term goals. Careful observation of the skin and circulation is particularly important in young infants because of their rapid growth rate.
Describe Skeletal limb deficiency
characterized by underdevelopment of skeletal elements of the extremities. The range of malformation can extend from minor defects of the digits to serious abnormalities, such as
amelia, absence of an entire extremity, or
meromelia, partial absence of an extremity
Most reduction defects are primary defects of development of the limb, but prenatal destruction of the limb can occur, such as full or partial amputation of a limb in utero from constriction of an amniotic band (amniotic band syndrome).
Heredity appears to play a prominent role, and prenatal environmental insults have been implicated in a number of cases,
The child with a limb deficiency should be fitted with prosthetic devices, and the devices should be applied at the earliest possible stage of development in an attempt to match the infant’s motor readiness.
a temporary disturbance of circulation or vascular supply to the femoral capital epiphysis produces an ischemic avascular necrosis of the femoral head. During middle childhood, circulation to the femoral epiphysis is more tenuous than at other ages and can become obstructed by trauma, inflammation, coagulation defects, and a variety of other causes. The pathologic events seem to take place in four stages:
Stage I: Initial, or avascular, stage: Avascular necrosis or infarction of the proximal femoral epiphysis with degenerative changes producing flattening of the upper surface of the femoral head or a decrease in femoral head height
Stage II: Fragmentation, or resorptive, stage: Femoral head resorption and revascularization produces collapse of the femoral head and fragmentation that gives a mottled appearance on radiographs
Stage III: Reossification stage: New bone formation, which is represented on radiographs as calcification and ossification or increased density in the areas of radiolucency; this filling-in process appears to begin in the periphery of the femoral head and progress centrally
Stage IV: Healing, or remodeling, stage: Gradual reformation of the head of the femur without radiolucency; this occurs until skeletal maturity
Describe Slipped capital femoral epiphysis (SCFE)
Slipped capital femoral epiphysis (SCFE) refers to the spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction. It develops most frequently shortly before or during accelerated growth and the onset of puberty (children between 8 and 15 years old
Clinical Manifestations of Slipped Capital Femoral Epiphysis
Very often obese (body mass index > 95%)
Limp on affected side
Possible inability to bear weight because of severe pain
Pain in groin, thigh, or knee
May be acute, chronic, or acute-on-chronic
Continuous or intermittent
Affected leg is externally rotated
Loss of hip flexion, abduction, and internal rotation as severity increases
Affected leg may appear shorter
When would a child with scoliosis need surgery
Surgical intervention may be required for treatment of severe curves, which are typically greater than 45 to 50 degrees, as these curves generally continue to progress over time even after skeletal maturity is reached
When is the best time to assess a child for scoliosis
during the preadolescent growth spurt. screen girls at 10 and 12 years old and boys once at either 13 or 14 years old
When would you use bracing and exercise for scoliosis
For moderate curves (25 to 45 degrees) in the growing child and adolescent, bracing may be the treatment of choice. Historically, bracing has not been shown to be curative; the goal is to slow the progression of the curvature to allow skeletal growth and maturity. The two most common types of bracing are the Boston and Wilmington braces