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lecture 10 [musculoskeletal + neuromuscular] Flashcards

1
Q

what are the acquired skeletal defects?

(6)

A
  • Legg-Calve-Perthes
  • slipped capital femoral epiphysis(SCFE)
  • kyphosis
  • lordosis
  • scoliosis
  • spinal neuromuscular atrophy
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2
Q

what is Legg-Calve-Perthes disease?

A

asceptic necrosis of the femoral head that can either be unilateral or bilateral

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3
Q

what are the symptoms of LCP?

(6)

A
  • painless limping
  • hip stiffness
  • limited ROM
  • hip, thigh, & knee pain
  • shortened affected leg
  • muscle wasting
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4
Q

what are the treatment goals for LCP?

(4)

A
  • eliminate hip irritability
  • maintain ROM
  • prevent bone collapse
  • ensure well-rounded femoral head
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5
Q

what are the primary therapeutic measures for LCP?

A
  • abduction brace/ cast
  • traction
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6
Q

what is slipped capital femoral epiphysis (SCFE)?

A

spontaneous displacement of the proximal femoral epiphysis that develops shortly before onset of puberty or accelerated growth

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7
Q

SCFE is more commonly seen in boys & obese children

A

true

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8
Q

which conditions are associated with SCFE?

A
  • GH therapy
  • endocrine disorders
  • renal osteodystrophy
  • radiotherapy
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9
Q

what are the primary treatments for SCFE?

A
  • non-weight bearing activity
  • surgery
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10
Q

SCFE must be diagnosed early

A

true

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11
Q

what is kyphosis?

A

convex curvature of the thoracic spine

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12
Q

kyphosis is usually a secondary condition to other diseases like:

A
  • TB
  • chronic arthritis
  • compression fractures
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13
Q

how is kyphosis treated?

A
  • shoulder/ abdomen exercises
  • bracing
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14
Q

what is lordosis?

A

cervical or lumbar curvature of the spine

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15
Q

lordosis is often associated with which other conditions?

A
  • hip contractures
  • scoliosis
  • obesity
  • hip dysplasia
  • SCFE
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16
Q

what is scoliosis?

A

lateral curvature of the spine, possible spinal rotation & thoracic hypokyphosis

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17
Q

what is the “gold standard” treatment for scoliosis?

A

bracing

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18
Q

what are the different types of braces for scoliosis?

(3)

A
  • Boston
  • Milwaukee
  • Charleston
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19
Q

what are the congenital muscular disorders?

A
  • spinal muscular atrophies
  • Duchenne’s muscular dystrophy
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20
Q

Duchenne’s muscular dystrophy is the most severe form of muscular dystrophy

A

true

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21
Q

why are males more affected with Duchenne’s?

A

it is primarily an x-linked genetic disorder

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22
Q

what are the diagnostic procedures for Duchenne’s?

A
  • muscle biopsy
  • blood polymerase chain reaction to detect dystrophin gene mutation
  • blood creatine phosphokinase (elevated)
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23
Q

there is no treatment for Duchenne’s; and families only need to be prepared for impending cardiac & respiratory difficulties along w/ mental retardation

A

true

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24
Q

what are the manifestations of Duchenne’s?

(5)

A
  • Gowers sign
  • waddling
  • difficulty rising to positions
  • progressive muscle atrophy
  • loss of ability to walk by 12yrs
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25
Q

what are the congenital skeletal defects?

(5)

A
  • hip dysplasia
  • club foot
  • genu varum
  • genu valgum
  • osteogenesis imperfecta
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26
Q

what are the expected diagnostic signs of hip dysplasia?

(6)

A
  • Ortolani sign (hip is reduced w/ abduction)
  • Galeazzi/ Allis sign (uneven knee levels)
  • Barlow sign (hip dislocates by adduction)
  • Trendelenberg sign w/ lordosis (tilted hips with standing on one foot)
  • U/S or x-ray
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27
Q

when is an ultrasound appropriate for hip dysplasia?

A

2 weeks old

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28
Q

when is an x-ray appropriate to diagnose hip dysplasia?

A

older than 4mos

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29
Q

what are the treatments for hip dysplasia?

A
  • Pavlik harness
  • Bryant traction
  • Hip spica cast
  • surgical reduction
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30
Q

at what age is the Pavlik harness appropriate?

A

newborn to 6 months

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31
Q

what is a Pavlik harness?

A

a chest harness that abducts legs

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32
Q

what is the treatment for hip dysplasia WITH adduction contracture?

A
  • Bryant traction
  • Hip spica cast
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33
Q

when is surgical reduction appropriate for a child with hip dysplasia?

A

when they are 6 months to 2 years old

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34
Q

what is club foot?

A

a complex deformity of the ankle & foot that is sometimes associated with cerebral palsy & spina bifida

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35
Q

what are the categories of club foot?

A
  • positional
  • syndromic
  • congenital
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36
Q

what causes positional clubfoot?

A

intrauterine crowding

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37
Q

what is syndromic clubfoot?

A

a category of the disorder that occurs with other syndromes

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38
Q

what are the therapeutic procedures for club foot?

A

casting

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39
Q

how are the series of casts implemented for clubfoot?

A

applied every 2-3 days for up to 3 weeks, then 1-2 week intervals

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40
Q

genu varum

A
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41
Q

genu valgum

A
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42
Q

what is osteogenesis imperfecta?

A

an inherited connective tissue disorder that results in bone fractures along w/ restricted growth

“brittle bone disease”

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43
Q

what are the clinical manifestations of osteogenesis imperfecta?

A
  • multiple bone fractures
  • blue sclera
  • early hearing loss
  • hypoplastic discolored teeth
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44
Q

what is the treatment for osteogenesis imperfecta?

A

pamidronate IV with biphosphate

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45
Q

what is the expected MOA of pamidronate?

A

increases bone density

46
Q

what are the types of fracture in children?

A
  • bend
  • buckle
  • greenstick
  • complete
47
Q

bend fratcures only occur in the ulna & fibula when there is a fracture in the radius & tibia

48
Q

the most common site for a fracture in a child is the growth plates, where is it?

A

located on the ends of the hard bone (epiphysis)

49
Q

what are the types of fracture lines?

A
  • transverse
  • oblique
  • spiral (circular)
50
Q

what are the signs of compartment syndrome that occurs with casts?

5 P’s

A
  • paresthesia
  • pallor
  • paralysis
  • pain
  • pulselessness
51
Q

what are the nursing priorities for a child with a cast?

A

regular skin checks & neurovascular checks

52
Q

what are the components of neurovascular assessments?

A
  • sensation
  • skin temperature
  • skin color
  • cap refill
  • pulses
  • movement
53
Q

what are tractions used for?

(4)

A
  • provide muscle rest
  • immobilization
  • alignment
  • prevent contractures
54
Q

what are the types of tractions?

(3)

A
  • skin
  • manual
  • skeletal
55
Q

how do skin tractions correct musculoskeletal dislocations?

A

applies pulling force using tape & straps on the skin (w/ weights)

56
Q

what are the types of skin tractions?

A
  • Bryant
  • Buck
  • Russell
57
Q

what is a skeletal traction?

A

a continuous pulling force through the use of weights that uses pins or rods inserted through a bone

58
Q

what are the types of skeletal traction?

A
  • cervical/ halo
  • 90-90
  • external fixators
59
Q

what is a manual traction?

A

application of casts along with having a closed reduction

60
Q

what are the infectious musculoskeletal problems?

(4)

A
  • osteomyelitis
  • septic arthritis
  • lupus
  • juvenile arthritis
61
Q

what is osteomyelitis?

A

an infection within the bone secondary to a bacterial infection (open fracture or bloodborne)

62
Q

what are the treatments & measures for osteomyelitis?

(3)

A
  • IV/ oral ABX
  • immobilize w/ cast
  • monitor for adverse rxns (such as superinfection & hepatic, renal, and hematologic complications)
63
Q

what is septic arthritis?

A

bacterial infection of the joint

64
Q

what is the most common bacterial agent for septic arthritis?

65
Q

what are the manifestations of septic arthritis?

(3)

A
  • severe joint pain
  • swelling
  • warmth at site
66
Q

what is juvenile arthritis?

A

a chronic inflammation of synovium & eventual erosion of articular cartilage

67
Q

what are the medications for juvenile arthritis?

(4)

A
  • NSAIDs
  • Methotrexate
  • Etanercept (tumor-necrosis factor alpha receptor)
  • Prednisone
68
Q

nurses must apply heat packs to the affected joints for pain & stiffness reduction

69
Q

what is lupus?

A

a chronic multisystem autoimmune disease of connective tissue & blood vessels

70
Q

what are the congenital neuromuscular problems?

(4)

A
  • cerebral palsy
  • neural tube defects
  • hypotonia
71
Q

what are the types of neural tube defects?

A
  • anencephaly
  • spina bifida
72
Q

what is cerebral palsy?

A

a nonprogressive impairment of motor function that causes spasticity or dyskinesia (involuntary movements)

73
Q

what is the most prominent etiology of cerebral palsy?

A

kernicterus

elevated bilirubin in newborns

74
Q

what are some risk factors for cerebral palsy?

A
  • LBW
  • maternal chorionaminionitis
  • anoxia in-utero
75
Q

what are the s/s of cerebral palsy?

(8)

A
  • persistent Moro reflex or tonic neck reflex
  • failure to smile by 3 months
  • persistent tongue thrust by 6 months
  • spasticity
  • scissoring of legs
  • nystagmus
  • hearing loss
  • feeding difficulties
76
Q

what kinds of care management do patients with cerebral palsy need?

(5)

A
  • physical therapy
  • speech therapy
  • occupation therapy
  • rhizotomy (surgery)
  • medication
77
Q

children with cerebral palsy are more likely to aspirate while feeding

78
Q

what are the medications that are usually given to patients with cerebral palsy?

(7)

A
  • Baclofen
  • Diazepam
  • Botulinin toxin A
  • Dilantin
  • Valium
  • Botox
  • ADHD meds
79
Q

what are the measures that parents can take to prevent aspiration in children with cerebral palsy?

A
  • jaw support
  • upright position
80
Q

what is the etiology of anencephaly?

A

the neurall tube in-utero fails to close, leading to an underdeveloped brain in which the infant does not have a forebrain nor a cerebrum

81
Q

what is spina bifida?

A

an NTD characterized by failure of the osseus spine to close

82
Q

what are the categories of spina bifida?

(2)

A
  • occulta
  • cystica
83
Q

what are the characteristics of spina bifida occulta?

(4)

A
  • affects the lumbosacral area
  • not visible externally
  • missing vertebral bone surface(dimpling)
  • no spinal cord involvement
84
Q

what are the characteristics of spina bifida cystica?

A

visible defect w/ sac-like protrusion

85
Q

what are the subtypes of spina bifida occulta?

A
  • meningocele
  • myelomeningocele
86
Q

what are the characteristics of spina bifida cystica w/ a meningocele?

A
  • sac contains spinal fluid & meninges
  • no neurologic deficits
87
Q

what are the characteristics of spina bifida cystica w/ a myelomeningocele?

A
  • sac contains spinal fluid, meninges, and nerves
  • caused by failure to close of neural tube
  • decreased motor & sensory function
88
Q

what are the expected findings of spina bifida occulta?

(4)

A
  • dimpling in the lumbosacral area
  • port wine angioma
  • dark hair tufts
  • subcutaneous lipoma
89
Q

what are the expected findings of spina bifida cystica?

(5)

A
  • flaccid muscles
  • lack of bowel control
  • rectal prolapse
  • spinal curvature abnormalities (kyphosis/ scoliosis)
  • protruding sac
90
Q

most patients with spina bifida have a latex allergy

91
Q

what are the s/s of hydrocephalus?

A
  • sunset eyes
  • increased head circumference
  • Cri du chat
  • poor feeding (w/ increased ICP)
92
Q

what is the primary cause for hydrocephalus?

A

Arnold Chiari syndrome

93
Q

what is another term for hypotonia?

A

floppy infant syndrome

94
Q

what is the most common diagnostic test for hypotonia?

A

EMG

measures muscle response to a nerve’s stimulation of the muscle

95
Q

what are the causes of spinal cord injuries?

(4)

A
  • MVA
  • long-acting PCN in the artery
  • hyperextension of the neck
  • spinal compression
96
Q

cervical spines 1-8 innervate which part of the body?

A
  • diaphragm
  • neck
  • upper arms
  • upper trunk
97
Q

thoracic spines 1-12 innervate which part of the body?

A
  • anterior trunk
  • posterior trunk
  • intercostal muscles
98
Q

lumbar spine 1 through lumbar spine 5 innervate which part of the body?

(5)

A
  • lower trunk
  • bladder
  • rectum
  • sexual organs
  • legs
99
Q

what is stage 1 of spinal cord injuries?

(5)

A
  • flaccid paralysis
  • loss of sensation
  • spinal shock syndrome
  • edema
  • autonomic dysreflexia
100
Q

what happens duing stage 2 of a spinal cord injury?

A
  • autonomic dysreflexia
  • spinal reflex activity returns
101
Q

what are the diagnostic tests for spinal cord injuries?

A
  • check sensation along dermatomes
  • CT
  • MRI
102
Q

what is the nursing management for spinal cord injuries?

(6)

A
  • cervical traction
  • reduce spinal swelling with steroids
  • immobilize the spine
  • assess neuro status q1h
  • rehab
103
Q

what are the infectious neuromuscular dysfunctions?

A
  • Guillain Barre syndrome
  • Tetanus
  • Botulism
104
Q

Guillain Barre syndrome usually arises from viral infections & vaccinations as an immune response

105
Q

what is the hallmark sign for Guillian Barre syndrome?

A

ascending paralysis

106
Q

which neurotoxin causes tetanus?

“lock jaw”

A

clostridium tetani

107
Q

how long is the incubation period for C. tetani?

A

3 days - 3 weeks

108
Q

what are the s/s of tetanus?

A
  • risus sardonicus
  • opisthotonus
  • muscular rigidity of neck muscles
  • trismus (lock jaw)
109
Q

what is the treatment for children w/ tetanus who are unimmunized?

A
  • tetanus immune globulin
  • tetanus toxoid
  • ABX
110
Q

what is botulism?

A

serious food poisoning caused by the bacteria clostridium botulinum from improperly sterilized food

111
Q

what are the s/s of botulism?

(5)

A
  • blurred vision
  • dizziness
  • vomiting
  • dysphagia
  • descending paralysis
112
Q

honey is the most common cause for botulism

PEDS (11 decks)

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